Case study: Two air ambulance flights for one family

A TAA plane

Dr Eva Wurz of Tyrol Air Ambulance reports on what initially seemed to be a normal inquiry for an air ambulance mission, but turned out to be a complex case with many questions

Background
A Turkish family living in Austria had gone to visit their relatives for a holiday. The parents and their four children, like many others, wanted to travel the long way from Austria to Turkey by car. However, around halfway through the journey, a serious accident occurred when the father, who was driving the car, fell asleep at the wheel. The whole family had to be taken to the nearest hospital in Nis, Serbia. All were seriously injured, except for one of the children.

Mission clarification
At this stage, Tyrol Air Ambulance was involved, and were asked by the family’s insurance company to co-ordinate a double transport for the two family members that had been seriously injured in the accident. 
Usually a medical assessment is carried out for any ambulance flight, but for this mission, no detailed medical reports were available from the hospital – the customer was only able to provide a list of injuries, and even within this information, some conflicting statements regarding the treatment were documented. It was thus decided that a team was needed to verify the available medical information on site. Tyrol Air Ambulance and the insurance company decided to carry out a medical assessment for the entire family at the treating hospital, especially as the father’s medical status (comatose) was particularly unclear.
For this mission, when it became clear that both adults and three children were affected, and there was also uncertainty about the severity of the injuries and the age of the children, the decision was taken to appoint a paediatric medical team, so we engaged the services of our partner Pediatric Air Ambulance.
Tyrol Air Ambulance started this mission with the clear aim of repatriating the mother and the most seriously injured son the same day. At the hospital, however, the medical assessment was carried out and it quickly became clear that the father’s injuries were life threatening and his prognosis was difficult to predict. At the request of the uncle of the children, who had travelled to Nis, and the slightly injured son, the uncertain health status of the father was kept secret from the rest of the family. They were afraid that an imminent psychological breakdown of the mother could threaten the entire repatriation. 
Medical clarification of the remaining injured family members revealed that the mother and the seriously injured 19-year-old twin son were fit for transport and could be flown to Austria for further treatment on a flight that day. For the two younger injured children, an immediate transport by air ambulance was indicated due to the severity of the organ contusions and severe craniocerebral trauma.

Plane refueling

A plan in place
Tyrol Air Ambulance shared all this information with the insurance company, so that they were able to take their decision about the order of the repatriations. The mother and the seriously injured twin son were repatriated to Austria the same day as originally planned. The insurance company requested an air ambulance transport for the father for the next day. Both younger children were to be transported by ground ambulance once their conditions had stabilised over the next few days. The slightly injured son was asked to drive back to Austria by car with his uncle, who accompanied and supported the family throughout the crisis.
In the meantime, the team at the Tyrol Air Ambulance operations control centre had informed the flight crew and had made all the necessary arrangements for the double transport (flight planning, ground transport arrangements, beds at the receiving hospital etc.). All went well and the flight was completed without incident. Mother and son were handed over to the receiving hospital in Austria without any difficulties. 
The flight medical team handed over all medical information to the new treating doctors, as well as details about the full extent of the accident, and the fact that the two patients were not aware of the uncertain health status of the father, who would arrive at the hospital the next day.
The repatriation of the father was planned for the following day. A disclaimer had to be obtained so that the ambulance flight could take place; this was necessary due to the severity of the diagnosis and the unpredictability of further developments in the patient’s condition. This declaration of liability should have been signed by the patient’s wife, but since this was not possible due to her own injuries (fractures of all four extremities), this task had to be taken on by the son. Thus, the real condition of the family father could also be kept ‘secret’.
The flight was performed without any difficulties, and the patient was transferred without further deterioration of his condition.

Review
We have not been informed if all the family members recovered, but we are happy to have at least contributed to the fact that they were able to receive the best treatment in Austria. Sometimes, the challenges of an air ambulance mission lie less in the organisational and logistical side of the mission, and more in the emotional nature of a case. This was certainly the case here due to the number of the people affected. Everyone, whether in the operations control center, the cockpit crew or medical crew, are deeply affected by such cases.