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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.

Problem

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.

Solution

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.

Result

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.


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