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Critical Communication with a Medical Escort Repatriation

by Joey 28. June 2013

Every day Commercial Medical Escorts faces different challenges in the efforts to bring patients back to their home country with a medical escort. These challenges include patients in obscure locations, patients in locations where our medical team will require a visa, different medical requirements, flight availability, and many more. Each medical evacuation receives individualized and specialized attention. Here is some insight to a case that proposed a challenge and how the team at Commercial Medical Escorts discovers a solution to bring the patient home safely and efficiently.


In 2011, a 79-year-old woman was traveling alone ona 12-night cruise on the Pacific Princess. During the cruise, the patient began to experience lower back pain, which she believed was coming from an injury sustained through dragging luggage around the harbour a few days earlier. Several days of continuous acute back pain that began to get increasingly worse prohibited the patient from leaving her cabin, effectively ruining her vacation. After being evaluated by the ship’s physician, it was determined that she was having chronic back pain and an X-ray showed a compression of FX L2. The patient had PMH (past medical history) of peripheral neuropathy, spinal stenosis and aortic stenosis. Whilst the physician recognized the need for the patient to return home, the cruise was currently at sea in the Mediterranean, quickly approaching the Port of Piraeus in Athens, Greece. The Pacific Princess would arrive into the port at 9:00 am on Saturday and would depart promptly at 4:00 pm the same day. The patient was travelling alone.

The physician’s medical recommendation was a nurse escort repatriation to the patient’s home with pain management. The medical escort provider received the request for transport at noon on Friday; all necessary arrangements had to be finalized quickly, as the nurse’s departing flight to Athens was at 4:30 pm on the Friday evening. If the nurse did not depart on the Friday evening flight, she would not have made it to Greece to meet the arriving ship; not meeting the ship would have required an unnecessary hospital visit for the patient, cost to the insurer and more complex paperwork for all involved.

The patient was currently on Coumadin and would need morphine for her pain during the repatriation; something that the treating physician would have to personally provide the flight nurse with upon arrival at the ship. For these reasons, it was critical that the nurse meet the ship prior to its departure.


The travel assistance company, as the insurance policy provider for the patient, was contacted. The treating physician communicated with the medical director at the travel assistance company to review the patient’s medical history and determine what would be needed for medical evacuation. The travel assistance company contacted a medical escort provider to provide a nurse escort for this case. Commercial Medical Escorts had to provide a quote in an efficient manner to be reviewed by the travel assistance company to ensure that the patient’s benefits covered the repatriation.

The nurse’s flight departed at 4:30 pm, and this was the only flight that would enable the nurse to get to the port in time. The flight would land in Athens at 12:20 pm, and the Port of Piraeus was one hour from the airport. Ground transportation was arranged to pick up the nurse at the airport and bring her directly to the Port of Piraeus, where she would be greeted by the port agent. After arranging the nurse’s flight, contact was made with the doctor on the Pacific Princess, whilst the ship was still sailing the Mediterranean Sea. The doctor was provided with a copy of the itinerary, the nurse escort’s name, passport number, passport expiration, and date of birth. All of this information was required for her to gain security clearance once she arrived at the dock. Commercial Medical Escorts Chief Flight Nurse maintained contact with the ship physician throughout the case management process. All necessary documents were obtained, including fit-to-fly documents for airline medical clearances. The patient’s medical condition and fit-to-fly documents were sent to the airline, at which point the airline noted the reservation, alerted the airport ground staff, and flight crews. Wheelchair assistance was confirmed for the patient, which would allow her to move quickly through the airports without having to walk long distances, and wait in long lines.

Meanwhile, the treating physician distributed medical disembarkation details to all the appropriate parties on the Pacific Princess. The patient remained within the medical centre until the arrival of the nurse escort. Arrangements were made through the Pacific Princess staff, the medical escort provider and port agent for the nurse to come onboard the ship when she arrived at the terminal. Commercial Medical Escorts communicated throughout the process with the treating physician to ensure all clearances had been made, and that upon the nurse’s arrival to the port, access to the ship and patient would be granted. As the nurse was boarding the ship to pick up the passenger, medicine (morphine for pain management) and all the necessary medical records, the cruise was already boarding passengers for its next departure, which was taking place in one hour.


The flight nurse arrived into Athens on time and after going through customs and immigration, ground transportation took her to Port of Piraeus. Upon arrival at the port, the flight nurse was greeted by the port agent, who paged the ship for the treating physician. The patient was seated up in a wheelchair, alert, and very excited to see the nurse who would accompany her home. The treating physician and the nurse exchanged medical information, and then the flight nurse was given the pain medication prescribed to the patient as well as the fit-to-fly letter and discharge paperwork.

The patient and the medical escort were escorted off the ship whilst crew members assisted with the patient’s luggage, and ground transportation then took the nurse and the patient to the airport hotel, where two adjoining rooms had been arranged. At the hotel, the flight nurse assisted the patient with in-room dining, and the following day the flight nurse transported the patient from Athens, Greece to Atlanta, Georgia, in the US. The patient experienced no issues throughout the transport in business class seats and was delivered home safely.

Delta Jumbo Jet encounters a near miss over New York

by Lux Joseph 21. June 2013

Everyone has heard the statistics regarding the safety of flying. It has become common sense to most of us that traveling to and from work in our cars everyday poses a greater threat to us than hoping on a flight to visit our relatives out of state. However, the threat was greater than anyone could have anticipated for the passengers aboard Delta’s 747 Jumbo Jet and a Shuttle America Embraer aircraft as they experienced a near collision while flying over NYC on Jun 13. 

As a Platinum Medallion holder with Delta, this story is particularly difficult for me to swallow, as more than 99% of my travels take place on a Delta flight. Although I am by no means afraid of flying, I think that everyone keeps the possibility of a crash in the back of his or her mind when flying. Though we brush off the fear and trust that we are in good hands, incidents such as the one that took place 8 days ago leave many of us with an unsettling feeling in the pit of our stomachs and many unanswered questions.

To everyone’s relief, both planes landed safely. Nevertheless, the close call was considerable enough to spark a federal investigation. The ‘Federal Aviation Administration’ revealed to CNN that “At their closest, the two planes were separated by about half a mile horizontally and about 200 feet vertically. They were required to have separation of three miles horizontally or 1,000 feet vertically.”

I think the most disturbing fact of all is that apparently, similar close encounters have occurred sporadically throughout the last couple of years and seem to be on the rise. With a trip to San Diego approaching fast, this story definitely has me thinking a lot more about the hands I place my life in every time I step onto an airplane. What I am most curious about is what takes place during these investigations? If discovered that someone is at fault, what then?

Had the parallel outcome occurred while both planes were at full capacity, there could have been more than 480 fatalities. In an industry that handles the lives of millions of people every day, there is no room for mistakes, even on the smallest scale. What is being done to prevent these incidents from happening in the future and what can we learn for these near-fatal mistakes? If the system airlines rely on is powered by communication, where is the miscommunication?

Though the industry is said to be the safest it has ever been; this is no time to relax. Much improvement is needed to guarantee the safety of all passengers and with scores of problems at hand; the race is far from over.





French Air Traffic Control Strike Ends

by Lux Joseph 14. June 2013

After a two-day strike that resulted in more than 2,000 cancelled flights, French air traffic controllers’ return to their towers. Though the strike has subsided, the chaos continues.

The strike commenced Tuesday around noon and continued throughout Wednesday with the participation of almost every air traffic controller in France. The issue provoking the strike was the European Union’s plans for a “Single European Sky”, a system designed to utilize the airspace and air traffic management system both within and outside of Europe. Although the new system is expected to benefit all airspace users, workers fear that this will impose a negative impact on their working conditions as well as present safety issues. The strike ended prematurely after the European Commission agreed to postpone their “SES” plans. Though the workers returned to work on Thursday, they made it clear that if their requirements are not met, there will be another strike in the future.

While the chaos surrounding the strike began to settle down Thursday morning, the travel industry within France was hit by another blow. This directly followed the passing of the air traffic control strike when another strike seemed to simultaneously emerge from its ashes as railway workers walked off the job, leaving 70% of train voyages canceled. The strike quickly ended after a deal was reached before midnight, but the ordeal only added to the already exasperating atmosphere.

Everything seems to be returning to normal in France, but this is quite possibly just the eye of the storm. Events like this have become a trend throughout Europe and until these companies and their employees’ can reach a common ground and work collectively as one, battle lines will continue to be drawn and it will be the consumers who suffer.

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