The Challenges We Faced for Medical Repatriation of COVID-19 Patients
How our society used to function has changed drastically over the last few months. All of us are trying to adjust to the “new normal” in our lives and our place of work. Certain things, however, remain the way they were before the pandemic hit us. Whenever we face a challenging situation in our life, or at our workplace, we need to exhibit concrete decision-making capabilities with an honest and direct approach. In the following article, we are going to discuss the operational challenges we faced at Airjetline to carry out medical repatriation of COVID-19 patients, and how we have overcome them to continue operating.
Our Perilous Position
As an emergency medical service, our air ambulances in the UK have to follow the often complicated aviation laws of the EU. The Civil Aviation Authority (CAA) regulates these laws in the UK. Although a lot of emergency medical service operators outsource their aviation-related functions to other commercial companies, we maintain our company’s flight air crafts, pilots and air staff. Irrespective of how many air ambulances we operate in the UK, we employ our entire team of medical staff and contract or appoint our doctors.
It is important to mention such aspects because immaterial of when or where are our air ambulances used, we are independently and entirely responsible for taking our company’s decisions. It also means that we are answerable for delivering our services and ensuring the safety of our patients, our staff and the general public. Therefore at each step of our operations, we need to pay adequate attention to every minute information available regarding the virus and the pandemic. That enables us to thoroughly evaluate the dangers and take informed decisions for the benefit of our patients, employees and the entire healthcare society.
Summarisation of COVID-19
We all are aware that the virus has high rates of transmission via air droplets and physical contact. It spreads more than common flu as each coronavirus has the potential to infect another 2-2.5 individuals. On the other hand, common flu can further infect 1.3 people.
Different people respond differently to the virus once infected. Some people are completely asymptomatic. Some people display mild levels of infection that are very similar to the common flu such as fever, cold and breathing troubles. Others suffer from aggravated levels of flu with severe symptoms and need to be hospitalised or placed under intensive medical care. The number of people who have died all over the world because of COVID-19 infection is staggering. It clearly reflects the enormity of the disease.
We had accumulated data regarding the infection resulting from the virus and the suggested measures of prevention from WHO and other authorised organisations. We also listened to several news channels to get details of the challenges faced by other air ambulance companies in transporting coronavirus patients. These data enabled us to understand the intricacies of administering healthcare to symptomatic or asymptomatic COVID-19 patients within an enclosed environment. We applied all the information we had gathered to our fleet of air ambulances to transport COVID-19 patients. These are our principal considerations while assessing the risks involved during the process of transporting a patient infected by the coronavirus.
Why Did PPE Not Solve Anything?
While PPE has been very efficient in the prevention of infection amongst medical care personnel and doctors on the ground, it did not offer any solutions up in the air. If a patient needs to get transported with severe levels of Coronavirus infection, possibilities are that the patient’s conditions might deteriorate during the flight. In case a patient loses consciousness and needs intervention or administration of medical procedures to reinitiate breathing, chances are that the paramedics or doctors might need to administer Aerosol Generation Procedures such as CPR or manual ventilation. According to the guidance from Public Health England, all medical personnel should wear level 3 PPE during any such procedure.
Providing everyone with PPE did not make a viable solution because of two reasons. Level 3 PPE is not fire retardant according to the standards of aviation and thus cannot completely cover anybody on the flight. Nor could they wear the full face masks with visors which are essential to prevent infection via respiratory droplets. Furthermore, the full face masks cause hindrance in communications via microphones. That is why it becomes difficult for pilots to effectively communicate with ground control which automatically becomes a safety issue.
Maintaining distance can be a social norm nowadays, but it is impossible to follow inside an aircraft, especially between the medical staff and infected patients. Since the patient and everyone else is breathing the same recycled air, the risk of paramedics, doctors and pilots inside the air ambulance goes up manifold. Because of such reasons a lot of air ambulance helicopters in the UK had to stop their air operations and continue with their ground operations only.
There is no way to determine if a patient is suffering from coronavirus infection or not outside a hospital environment. As we stated earlier, many infected patients might be completely asymptomatic. So it is impossible to distinguish between an infected and a non-infected patient by a pre-hospital screening process. That is why it becomes necessary to transport all coronavirus patients or other patients the same way while maintaining the safety of the flight and medical crew.
We have recently purchased a few EpiShuttle units manufactured by EpiGuard for our fleet of air ambulances. These single-patient portable units are self-contained to provide a maximum level of safety to the patient as well as those on board the flight. These units can have their dedicated airflow system to maintain constant levels of oxygen and can be hooked with any type of life support system. They can get on any type of medical transportation such as aeroplanes, helicopters or ground ambulances. EpiShuttles have a mattress that provides comfort for patients up to 24 hours, and the see-through hardtop allows complete visibility between the patient and the surrounding environment.
EpiShuttles now allow us to continue our medical repatriation and regular operations without adding any further risks to our flight crew, medical staff, the healthcare community or the general public.