ITIC Global 2026 | Medical directors and assistance forum

The ITIJ team have been reporting live from ITIC Global in Istanbul this week (1–5 November 2026), sharing the discussions that take place at the conference. Read all reports.

Dr Winston Jong, Group CEO and Group Medical Director of EMA Global, opened this session by introducing the panel.

Dawn Heeger, Senior Medical Case Manager and Flight Nurse, Royal College of Nursing Critical Care and Flight Nursing Forum

Heeger was the first to take to the stage. She started by speaking about a case study involving the repatriation of a 78-year-old female following a mental health crisis while travelling overseas on a cruise. She discussed the term ‘fit to fly’, posing the question: “Does that automatically mean a patient is safe to repatriate?”

She noted that medical fitness was only one part of the decision and noted that it was paramount to consider whether the risks could be safely managed throughout the entire repatriation journey.  

Safe repatriation involves more than determining whether a patient is fit to fly

In the case study mentioned, this encompassed the transfer from the hospital, airport and security processes, boarding, two flight sectors, a four-hour layover, the aircraft environment, and the final handover.

The patient had a history of bipolar disorder and a previously documented suicide attempt, meaning this history was relevant to risk assessment.

The case presented several assistance challenges, including issues surrounding insurance cover, limited clinical information, and restricted direct communication with the patient. During the assessment, the team recognised the importance of giving the patient time and space to build rapport and help her feel comfortable with the transfer process.

In assessing whether the flight doctor and flight nurse could safely manage the risks of the journey together, they had to consider the risk to self, risk to others, clinical deterioration and aviation and operational risks. The patient becoming acutely distressed, agitated, paranoid or suicidal during transfer, especially airborne, was an important consideration.

The repatriation was completed successfully, with the patient handed over to a team from her local hospital, including two psychiatrists and two mental health nurses, for further assessment.

Heeger concluded that safe repatriation involves more than determining whether a patient is fit to fly, highlighting the importance of building trust, observing patients over time and making shared clinical decisions to assess and manage potential risks throughout the journey and decide whether it is safe to proceed with repatriation.

Julien Josseaume, Deputy CMO, Redion

The next speaker on the panel, Josseaume, discussed the medical repatriation of a severely ill patient from French Polynesia to Paris aboard a commercial aircraft, with a full intensive care unit (ICU) set up on board for the 22-hour journey, which included a stopover at Los Angeles International Airport (LAX), US.

He began by outlining the general challenges of arranging medical repatriations from remote French Polynesia. These include limited local clinical resources, the time-critical nature of many cases, limited alternative options, and the lack of routinely available long-distance air ambulance services. Although New Zealand is geographically closer, passport and visa restrictions can make it a difficult alternative. He explained that Redion’s solution was to arrange emergency repatriations to France using commercial flights.

Josseaume looked at a specific case where a patient was repatriated from the remote island of Tahiti to a specialist centre in Paris, on a scheduled commercial flight. The patient presented with symptoms of headaches and seizures and, following a CT scan, was found to have suffered a severe subarachnoid haemorrhage (SAH), with bleeding into all four brain ventricles and associated hydrocephalus (a build-up of cerebrospinal fluid). He required advanced neurological care throughout the transfer.

The patient was successfully repatriated to the Rothschild Foundation Hospital in Paris, where they had access to specialist neuroradiology services and treatment. Following endovascular treatment, they returned to Tahiti two months later.

Josseaume discussed the challenges of transporting a critically ill patient on a commercial flight, outlining the medical team required – a double-escort ICU team comprising a physician and nurse – and the specialist equipment needed. He also highlighted the administrative, medical, technical, logistical, and cultural considerations involved in long-distance repatriation.

In this particular case, he focused on the multiple risks associated with the patient’s subarachnoid haemorrhage (SAH), and the challenges of maintaining neuroprotection during the flight to prevent secondary brain injury.

He finished by outlining Redion French Polynesia’s three-pillar operational model: 24/7 medical regulation, a 24/7 operations platform, and a support network based in Paris, providing medical follow-up, administrative assistance, language and cultural support, and help for patients’ families.

Josseaume concluded that, while French Polynesia’s remote location can make access to specialist care challenging, Redion’s repatriation solutions help bridge this gap by connecting patients with the expertise and treatment they need.

An audience member asked how airlines ensure passenger safety when patients are transported with extensive ICU equipment on board commercial flights, particularly given the risk of equipment moving during turbulence. They noted that, unlike private air ambulances, commercial aircraft do not necessarily have the same dedicated fittings and restraints for securing medical equipment.

Josseaume explained that Redion has agreements in place with commercial airlines to facilitate these transfers, adding that incidents involving equipment on board were rare.

An audience member asked whether additional staff were deployed to prevent fatigue during long-distance transfers. Josseaume explained that the layover in LAX was short but acknowledged that staff fatigue remained an important consideration, adding that deploying additional team members was something the company could look into in the future.

Dr Lucy Obolensky, Medical Director, Phoenix Aviation

Dr Obolensky, the third and final speaker, presented a medical evacuation case involving a 75-year-old US tourist who became critically ill while visiting Tanzania. She described how Phoenix’s medical team coordinated the evacuation to Nairobi, navigating a challenging environment characterised by long distances, remote air strips, limited communications, and inadequate local medical facilities.

She explained that the main challenge was not the patient’s clinical condition alone, but the complexity of the location and the number of organisations that needed to work together to complete the evacuation safely.

Better pre-travel screening could help prevent emergencies and the need for repatriations altogether

The patient was in Kogatende, in the far north of the Serengeti near the Kenyan border, when he developed acute respiratory distress. His medical history included bronchiectasis, hypertension, dyslipidaemia, and a significant smoking history, suggesting underlying chronic lung disease, potentially alongside chronic obstructive pulmonary disease (COPD).

Local medical facilities were extremely limited, and the patient was deteriorating rapidly. Following heavy rainfall, rotary-wing aircraft provided the only viable means of reaching him, requiring coordination with unfamiliar aircraft and crews.

On arrival, the medical team stabilised the patient before transferring him to Kilimanjaro International Airport, where he continued to Nairobi aboard a medium-sized, medically equipped jet.

Dr Obolensky attributed the successful evacuation to experienced local partners, a single medical assistance team coordinating clinical, aviation and insurance decisions, a prompt insurance guarantee, and continuous communication between all parties.

She also highlighted the challenges posed by the remote location, limited medical facilities, and poor communication channels, which required satellite communication devices. The case demonstrated the importance of strong multi-agency coordination and adapting evacuation plans to local conditions and available resources.

Dr Obolensky touched on the broader challenges of operating across East Africa, including safety and security concerns, permit requirements, adverse weather, and ground-level risks such as wildlife. She highlighted the importance of retaining experienced staff and addressing misconceptions around evacuation capabilities, noting that having insurance does not mean a patient can be safely evacuated from any location at any time.

She concluded by highlighting the importance of collaboration, planning around local conditions, and early communication, noting that in remote environments “every hour matters”. She also stressed the need to retain experienced, skilled personnel and for clearer communication between insurers, travel companies, and clients about the limitations of evacuation. She added that better pre-travel screening could help prevent emergencies and the need for repatriations altogether.