ITIC APAC 2026 | Medical Directors and Assistance Forum

The ITIJ team have been reporting from ITIC APAC in Singapore (15–17 June 2026), sharing the discussions that took place at the conference. Read all reports.

Dr Terry Nash, Medical Director, Retrieval Medics International

Nash focused on caring for older adult travellers, and the importance of pre-flight cognitive and risk assessment to ensure that they are in a suitable condition to be repatriated, as well as determining the best approach to caring for them in transit.

He noted a case conducted by Retrieval Medics International in which initial assessments of a 79-year-old patient “suggested a smooth mission”. However, mid-flight, the patient became combative, to the extent that there were concerns about staff safety, with the patient also displaying “persecutory delusions”, leading to a major diversion.

The case, explained Nash, highlights that “a single cognitive snapshot at the best hour of the best day is not a pre-flight mental state assessment”.

He added that it was fundamentally important to differentiate between the normal symptoms of ageing (slower word processing and memory functions), dementia (reduced cognitive reserve, lower but stable baseline, with a much higher risk of delirium), and delirium (acute and fluctuating, often missed, but requiring attention before transfer).

“Differentiate between the three before you build a care plan,” he explained. “Delirium means the patient is not ready, whereas patients with dementia may be fit to fly, and those with ordinary ageing symptoms may need a companion.”

Critical to caring for older patients is recognising the effect that the environments can have on them. Hospitals can make assessing patients difficult due to “noisy ward spaces, controlled light and noise, and interrupted sleep”.

Meanwhile, the situation during the journey may be no better, with patients experiencing “early morning departures, sensory overload, unfamiliar spaces, sleep deprivation, hunger, dehydration, and layovers”.

Nash recommended that to overcome such issues, and the potential for variation in patient condition throughout the day, assessors should “avoid saying ‘How is she today?’” in favour of broader questions such as “What is her best day? What is her worst day? What does her worst look like?”

He also advised that crew should make careful choices concerning their language choices to avoid ‘frailism’ – an assumption that those who are frail lack autonomy.

For example, said Nash: “Labelling behaviour as ‘aggressive’ removes the question ‘What is this person communicating?’ – the most important question in pre-flight and in-flight care.”

Garry Robinson, Flight Nurse Manager and Manager, Antarctic Services, AeroMed Pacific

Robinson’s presentation focused on his company’s provision of air medical services to Antarctica.

He noted that New Zealand – where AeroMed Pacific and its parent company, GCH Aviation, are based – has historically been used as an access point for many Antarctic expeditions – such as those of Robert Scott and Ernest Shackleton.

In the more modern era, Christchurch, New Zealand, is recognised as one of only five official “Antarctic gateway cities” around the world – the others being Hobart, Australia; Punta Arenas, Chile; Ushuaia, Argentina; and Cape Town, South Africa.

This position, Robinson explained, places New Zealand in an advantageous position to provide support to those travelling to the icy southern continent.

Such gateway cities are necessary in part because of the inherently difficult geography of Antarctica, which makes the provision of medical support difficult. Robinson noted that it was the “coldest, driest, and windiest continent, with the lowest recorded temperature on Earth at -89.2°C”.

It is also the “fifth largest continent”, he added, despite having little to no human inhabitants, other than scientific personnel at sites such as McMurdo Station, “which can accommodate up to 1,200 personnel in summer, but typically has around 150 personnel in winter”.

The station also has the largest medical facility, a 3km-long runway for wheeled aircraft and a ski runway, offering direct flights to Christchurch.

Within this context, Unicair’s Dr Alex Veldman described a case his company responded to in which a patient – who had arrived at the Amundsen–Scott South Pole Station seven days beforehand – reported blurred vision and a mild headache.

Following consultation, a plan was devised for the patient to be transferred to McMurdo Station for assessment via a ski-based aircraft, and then subsequently to Christchurch for further treatment.

GCH Aviation was contacted to facilitate admission to a hospital in Christchurch, and to support the transfer.

Dr Veldman explained that “weather can be difficult in Antarctica”, with many flights being delayed due to weather even in the summer season. “Some delays can be between two to 14 days,” he added.

Fortunately, conditions for this repatriation were good, with the patient arriving in a hospital in Christchurch 20 hours after presentation.

Dr Alex Veldman, Medical Director, Unicair

Dr Veldman’s presentation focused on a case in which Unicair transported an eight-month-old toddler suffering from a congenital heart condition – tetralogy of fallot – requiring an in-transit thrombolysis.

The child had an “absent pulmonary valve and a right ventricle to pulmonary artery (RV–PA) Gore-Tex conduit”, Dr Veldman explained, adding that the patient had also “undergone initial surgery in the UK” – including the placement of the RV–PA conduit, with the ventricular septal defect remaining open.

Unicair had received a request to transport the patient to Great Ormond Street Hospital (GOSH) due to the failure of the RV–PA conduit – something Dr Veldman explained is “not an uncommon problem”. He noted that around 29% of conduits fail, with one 2024 study finding children being at an especially high risk of conduit failure.

A key concern for the patient’s health was the risk of complications relating to the conduit obstruction – Dr Veldman stated that such issues were “rarely caused by thrombosis alone – although it can occur – [but are] primarily driven by structural degeneration and chronic narrowing over time”.

Additionally, on the day prior to transport, the infant’s oxygen requirement escalated rapidly, “necessitating endotracheal intubation and mechanical ventilation”.

In response to this, and recognising the risk of further haemodynamic collapse during the flight, the Unicair team prepared for a “comprehensive advanced paediatric cardiac transport, including recombinant tissue plasminogen activator for in-flight thrombolysis”.

Given the risks, Unicair altered its flight plan, with the destination changed from GOSH to the Bambino Gesù Children’s Hospital in Rome, with the patient ultimately being transported to London two months later for the conduit change, following a gradual recovery in Italy.

Dr Veldman concluded by stating that the case highlights that “pre-transport planning is paramount to a successful outcome” and that “a careful risk-benefit analysis is the foundation of responsible decision-making”.

He argued that when it comes to paediatric and neonatal cases, “parents need to be part of such considerations and subscribe to the action plan”, and that a “detailed knowledge of physiology can help to manage complex clinical scenarios”.