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Handling Changes in your Travel Plans

by Lux Joseph 6. July 2013

Summer is already here and so is one of the busiest travel times of the year. Whether you are looking to go on a summer vacation to Europe or in our case, bringing patients home that fell ill during their vacation travels flights are selling quickly and at a high rate. According to the latest Travelhorizons survey of 2,300 U.S. adults conducted by marketing services firm MMGY Global 70% of Americans plan to take at least one leisure trip between now and October 2013, compared to 65% in March 2007.  During your travels this summer, you hope that everything goes as planned, flights are not delayed or canceled, a natural disaster doesn’t hit, and that no other disruption happens to affect your journey. But what happens when something does happen to affect your travel? What are your rights as a traveler?

Being stranded at the airport during a natural disaster or any other related disruption causes frustration to you as the traveler. It is important to recognize that your ticket as a traveler represents a contract between you and the airline. Although airlines do not guarantee their schedules due to the large amount of unexpected challenges that can occur including weather, mechanical problems, and air traffic control delays, as part of a contract they must make reasonable efforts to fulfill their end of the bargain. Many airlines will do their best to re-accommodate you as schedules and availability permit, but waiting in that long line may limit your chance at the next soonest flight available.

As a traveler you must take control of the situation in a professional and responsible manner. At CME, we deal with cancelations and delays every week when transporting our patients back home.  Some tips that we have in regards to delays/cancelations include:

• Monitor you flight continuously- a great application to be used on your smart phone is Flight Aware. There are two applications, and the paid application shows real time updates including the connection times as flights are delayed

• Be respectful to the agent- it is not the agent’s fault that your flight is delayed or canceled. Although they represent the airline, they are not the cause so do not take the frustration out on them. The more courteous and polite you are the more likely they will do their best to find an alternate flight to meet your needs.

• Contacting the airline- if you are already at the airport, most likely you are standing in the long line to rebook your ticket. While in line, also contact the airline via their 1-800 number. In most cases if you are able to get in contact with an agent on the phone, they can at least make the changes and confirm you on a new flight so all you will need to do is have your new tickets issued. If you booked your flight with a travel agent, they can hold you on the next available flight as well

• Endorsing your ticket- you have finally reached the counter and the airline informs you that you cannot be rebooked until 2 days later. For most travelers, this would not be acceptable or reasonable. You can ask your airline to endorse your ticket on another carrier. Do the research and look at available flights on alternate carriers. The airline is not required to endorse your ticket, but it doesn’t hurt to ask. When an airline endorses another carrier, they are paying the other carrier to transport you to your destination.

• Understand the Department of Transportation (DOT) Rules- many times you may think everything is going as planned. You boarded your flight, listened to the flight briefing, are pushing back form the gate, and then are told then you are held on the tarmac for an infinite period of time. It is important to understand the rules set forth by the DOT and what the airlines a required to provide. The DOT prohibits airlines from keeping passengers on the tarmac for more than 3 hours on domestic flights unless the pilot otherwise feels there is a safely or security issue in. The airline is also required to provide food and water within two hours of being on the tarmac.

• Know the airline policy- no federal laws or requirements are in place that require airlines to provide any accommodation or meals due to delayed or canceled flights. Each airline does have its own policy and it is important to understand the policy so you do not look ignorant trying to demand something that you are not entitled to.

Cancelations and delays will always be a possibility when flying. Airlines are trying each and every day to seek ways to improve the system, but in most cases there are things that are out of their control. Being aware of your environment, rights as a passenger, and keeping composure, as a traveler will ensure a smooth journey to your destination.

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.

2nd Air Medical & Rescue China Congress 2013

by Lux Joseph 30. May 2013

Last year I had the opportunity to visit China for the very first time. From the moment I found out that I would be traveling to Beijing I started planning a visit to the Great Wall of China. I simply could not leave China without visiting the iconic wall and crossing one of the Seven Wonders of the World off my bucket list. When the day finally came I was more than ready. Armed with my Nikon, I headed for the Great Wall running on pure excitement and adrenaline. When I finally arrived at the Badaling section of the Great Wall, my excitement immediately turned to confusion, and then sheer terror. With all the facts that our tour guide had been spitting out at me, she failed to mention that the Great Wall is basically all stairs! Steep, thigh high, narrow steps, and a cliff off to one side. I stood there in my boot cut jeans, collared shirt, and dress shoes staring up at the death trap as hundreds of people walked around me in their hiking attire, with a single thought racing through my mind…”I’m going to fall!” Thankfully, I didn’t fall, but with hundreds of people climbing the stairs and a seemingly infinite amount of uneven steps, the possibility was very real. It wasn’t until this year during my second visit to China that I realized just how much I underestimated how dangerous the situation actually was.

Earlier this month, CME had the pleasure of attending the 2nd Air Medical & Rescue China Congress 2013 in Shanghai, China. The AMRCC is a conference and exhibition to promote the development of the air medical and rescue in China. I was surprised to discover that the aeromedical system in China is virtually nonexistent and had I actually experienced an accident while visiting the Great Wall, I most likely would have been waiting hours before help arrived. This is simply unacceptable. Chinese citizens suffer through these conditions on a daily basis. One speaker demonstrated the lack in response time to assist those in need of medical attention by sharing a story of a seventeen year old boy who was hurt in a motor vehicle accident. Although he was only five minutes from the hospital, it took the ambulance forty five minutes because of traffic, causing the boy to die. If helicopter EMS was available, the boy would have survived. To put things into perspective, the USA has a population of 300 million and over 12,000 helicopters readily available for air medical repatriation. Though the population of China is 4 times greater than the USA at 1.3 billion people, China only has roughly 200 helicopters. With those helicopters, China has a limited number of personnel that are qualified in aviation and air medicine. Helicopters in China make up less than 1% of helicopters in the world. These conditions set China’s aeromedical system about 50 years behind that of the USA. With a population of 1.3 billion, China should have closer to 50,000 helicopters to adequately assist individuals requiring air medical transportation.

Although more and more players are becoming involved in the AMRCC and their cause, support from the central government of China is necessary for a successful implementation of an air medical program. Unfortunately the Chinese government does not have an agency or unit that specifically focuses on emergency rescue. These deficiencies are what continue to set China behind other countries. Leaders within the industry and key individuals focused on the improvement of air rescue are taking the right steps to establish a model similar to the FBO in the United States, but there is no telling when this may be accomplished. I think what saddens me most about the conference is that everyone there seemed to have the right mindset, but as one delegate so eloquently put it, “Everyone in this room has the right idea, but it’s going to take a group of individuals to step forward and fund the cause if it is ever going to move forward, and I don’t think any of those people are here today.” One speaker went as far as to open his presentation by explaining that he would be using the same PowerPoint presentation that he used in 2011 during the first AMRCC conference because the same challenges and issues that existed 2 years ago are still present today. No one can deny that this is something that China needs desperately but the question still remains, who is going to pay? Although the ambition and drive is strong, there is currently little to no resources backing this project. Along with everyone present at the conference, I have high hopes for the development of a strong aeromedical system within China, but sadly I don’t see that happening for a very long time.

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