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Moving With The Times | Assistance & Repatriation

View Full Article: Moving With The Times | Assistance & Repatriation

Time and cost savings are two important factors when planning a repatriation. Blake Yturralde and Jessica Peltz detail how using lie-flat beds onboard commercial airlines provide a swift and value-for-money repatriation options.

A decade ago, it was more likely that a patient would require international air ambulance services to return home after falling ill or being injured whilst travelling abroad. In that time, however, medical care globally has improved significantly, which has allowed patients to recuperate to a level of health that allows them to fly home using a commercial airline medical escort. This provides continued care at great cost savings over international air ambulance repatriation. However, some individuals will still require stretcher-type services, depending on their illness or injury. This article will talk about the different levels of care that a stretcher patient may require and transitioning the appropriate patient into a lie-fl at seat. However, there are obstacles to transporting the ill and injured on commercial lie-fl at seating, including logistics of loading and off loading the patient. Still, North American-based airlines do not currently offer stretcher services, but, as this article will point out, most North American airlines can accommodate suitable stretcher-type patients utilising international lie-fl at seating.

The use of a commercial airline stretcher is commonplace at this time on many airlines based outside of North America. A multitude of patient types can be safely transported via commercial stretcher, although the routes and availability are limited. Commercial stretchers are set up aft on the aircraft, and typical passengers are seated away from the stretcher (when possible), allowing some modicum of privacy. Some medical transport services will transfer advanced life support (cardiac monitor, ventilator, intravenous infusion pumps) patients safely on commercial stretcher services asdictated by the agency’s scope of care and policies and procedures. Basic life support (not requiring cardiac monitoring, mechanical ventilation or intravenous drips) patients are also transported on commercial stretchers. This patient group may include orthopaedic injuries with leg extension restrictions, paralysed patients, and stroke victims, among others. Due to the increasing availability of international fully lie-fl at seating on commercial carriers, many basic life support patients that would ordinarily be transported on a commercial stretcher can be safely transported on a lie-fl at seat. Within recent years, many or most of the major North American airlines have begun upgrading their products and
retro-fi tting their business and/or first class cabins with lie-fl at seating. However, at this time, the majority of lie-fl at seating on North American airlines is limited to the continuation of an international flight, making domestic lie-fl at seating.

However, as commercial repatriations become increasingly popular, the transition to lie-fl at seating for an appropriate patient that would ordinarily be transferred on a commercial stretcher will become evident. The rough a pre-fl ight medical report obtained by the medical transport company and a thorough screening process, it is possible to determine the level of appropriateness for patient transport using lie-fl at seating. With the above advanced life support scenario, that particular patient may not be an appropriate candidate for lie-fl at seating. It should be noted, though, that long-term ventilated individuals have been transported safely in business or first-class cabins, but each individual case must be thoroughly screened for suitability. Using the example of a stable quadriplegic or a patient that has been treated for pelvic fractures and/or hip fractures (i.e. a patient that cannot sit up), with the proper pre-fl ight planning and communication with the airlines, this patient can be safely transported on a liefl at seat as opposed to being restricted to the limited routings and airlines that off just stretcher services.

Because transporting patients that are unable to sit up or are non-ambulatory in the business or fi rst-class cabin has many logistical hurdles, the medical transport company must be in constant communication with the airline, ground ambulance crews and airport facilities. After obtaining airline medical clearance for the patient, the medical transport company must communicate with all parties involved to accomplish several crucial steps. Firstly, the aircraft’s equipment must be confirmed, due to the current process of changing their equipment from reclining to lie-fl at. Secondly, it is necessary to ensure that either the ground ambulance stretcher is allowed to the gate to enable the patient to be carried, with adequate equipment, to the lie-fl at seat; or that the ground ambulance is allowed onto the tarmac for high-lift to the aircraft. In North America, this is a particular challenge, as many airports do not allow the ground ambulance crew directly onto the tarmac and many of the North American airlines are not as progressive in their thinking around these special needs patients as airlines based elsewhere globally. Thirdly, the airport ground facilities must be involved to allow judicious check-in of the patient, and clearance through customs and immigration and security.For example, the ticketing agent may be required to board the ground ambulance for patient identifi cation. Finally, the escort company must work with the airline’s medical department to request special permission to allow the patient to remain in a fl at position for taxi, take-off and landing. In some cases, this decision may be left to the flight crew, but due diligence should be utilised to ensure the proper channels are used. It is also of great importance to ensure the escort is appraised of all logistical details to ensure a smooth and safe patient
transport.

By means of increased use of lie-fl at seating for patient transports on commercial carriers, the feasibility of continuity of care for a wider variety of patients becomes possible. Many smaller airports throughout the world do not have scheduled flights with stretcher and lie-fl at services. If the patient is being transported to or from an airport mirroring the above scenario, it is still possible to ensure cost savings by utilising an air ambulance to transport the patient to or from the larger airport to meet the aircraft with the appropriate equipment (stretcher or lie-fl at seating) versus an international air ambulance. With proper pre-flight planning and attention to detail, it is possible to transfer a patient in a lie-fl at seat who would typically have been transported on a commercial stretcher or air ambulance. By means of increased use of lie-fl at seating for patient transports on commercial carriers, the feasibility of continuity of care for a wider variety of patients becomes possible. At this time, the use of lie-fl at seating on North American airlines for basic stretcher-type patients is not widely used.

In North America, this is a particular challenge, as many airports do not allow the ground ambulance crew directly onto the tarmac and many of the North American airlines are not as
progressive in their thinking around these special needs patients as airlines based elsewhere globally

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