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.
Medical Flight 101: Here’s Everything You Need to Know About Medical Flights
Medical Flight or medical air transportation has been around for a while now and has saved countless lives. More often than not, medical flights have been crucial in bringing emergency medical care to remote areas quickly. These flights also come in handy when someone needs to be moved between hospitals across the country.
However, there is a lot of ambiguity around medical air transportation. People often have questions like:
How much does it cost?
Will insurance cover the cost of the medical flight?
What services will be provided in the medical flight?
So if you are travelling to a remote location or see a probability of requiring a medical flight soon, it will benefit you to know the ABCs of the medical flight.
Here is a primer article on medical flights that will acquaint you with the basic facts and figures of the service. So, without further ado, let’s get on with it.
What is Medical Flight?
As is generally the case, whenever a critical patient requires emergency or intensive medical care, it becomes imperative to get them the necessary medical attention as quickly as possible. At times, such patients might be required to travel to another destination or their home country where the specialist treatment or doctor is located.
In such cases, medical flights are the usual option. In simpler terms, medical flights are like flying ambulances that help patients to travel safely in case of limited mobility or critical care.
To this measure, medical flight companies have a team of professionals on board to provide emergency care if a situation presents itself. Let’s take a look at what staff members should be present on a medical flight.
Types of Staff on Medical Flights
Most medical flights have a team of trained professionals on board to take care of the patient. Usually, medical air flights have a crew of two highlight skilled pilots, a flight nurse, a flight paramedic, and a respiratory specialist.
A flight nurse is different from a regular nurse as they specialize in air transport of critical patients. There are specialized nurses for flight, which have certifications like Critical Care Nursing (CCRN), Certified Flight Registered Nursing (CFRN), and Certified Transport Registered Nursing (CTRN), among others.
Similarly, a certified flight paramedic will have a special certification from the International Board of Specialty Certification. The flight paramedic training and certification includes over 1,200 hours of training along with a year or two of Emergency Medical Technician training.
It’s common to face respiratory issues during long flights due to altitude and cabin pressure. A National Board for Respiratory Care certified respiratory specialist must be present on the flight to provide care if such an issue presents itself.
Who Needs Medical Flight?
As mentioned before, patients who need to travel to a different facility or doctor can avail of medical flights. However, the reason might vary from person to person. The core logic remains the same, to have a certified, trained and experienced nurse to avoid mishaps during the travel.
Medical flights are sought out by individuals who need transportation to better facilities, evacuations, and more. Usually, these are people requiring specialized and critical medical assistance in a different location. Any medical transport over a distance of 250 miles calls for specialized medical transportation.
Individuals who have been in a critical accident, have had a stroke, been in a disaster in a remote location, trauma victims, organ replacement, and urgent surgery are some examples. Whatever be the reason, medical flights are designed to provide the support that the patient needs.
What Services Are Provided in a Medical Flight?
Medical flights are the same as commercial flights, except that they are outfitted to provide intensive care while in the air. Some of the services offered by medical flights are listed below:
As mentioned before, medical air transport will have a team of medical operatives on board to provide critical care. The team will include a flight nurse, paramedic, respiratory specialist, and highly skilled pilots.
Hospital to destination transfer (air and ground transportation)
The medical air transport services provide bedside to bedside transportation. This means from boarding the flight till reaching the actual destination; the team will be with the patient throughout the journey. The service will include air transport and an ambulance on the ground to reach the final destination.
Medical Tools and Instruments
An excellent medical air transport will have state-of-art medical equipment on board. These equipment are designed to meet any critical emergencies and are checked intensively before any trip. Standard equipment includes a heart monitor, portable incubator, IV pump, infusion pumps, and ECMO/IABP bracket, to name a few.
Bear in mind, medical flight services are inclusive of the above services and not limited to. Other usage cases include transporting coronavirus patients from remote and rural areas to a better facility in cities. Since COVID-19 patients require specialized treatment and containment, an air ambulance is an ideal solution.
How Much Does a Medical Flight Cost?
The cost of a medical flight is co-dependent on several factors. These include the mental and physical health of the patient, personal needs, equipment, date of travel, distance, and more. Usually, flying with a flight nurse is more cost-effective than booking an air ambulance.
There are non-emergency medical transport (NEMT) companies, which provide medical transport services on commercial flights. These companies take care of everything from flight arrangements to registered nurses to accompany the patient.
Considering the steep costs of medical air transport, one must avail insurance to cover a part of the cost. However, most insurance companies have stringent qualification protocols in place for air ambulance reimbursement.
To begin with, check your policy with a comprehensive health care insurer if the trip qualifies. You’ll need a physician’s documentation for the medical need for the reimbursement. Bear in mind, only a part of the cost will be covered by the insurance, and you’ll have to foot the rest of the bill.
If you have a sick family member, whom you want to fly to your city or the best health facility, it would be wise to look into NEMT and book a medical flight for them. It will ensure not only their comfort but also safety in case any emergency arises.
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