How Medical Repatriation Works, Step by Step

When someone falls ill or is injured abroad, the family's first question is how to get them home. Medical repatriation is the process of doing exactly that: bringing a patient back to their home country, or somewhere they can receive ongoing care, safely and with the right support along the way. It is rarely just a flight. This guide walks through each stage the way a case actually runs, from the first call to the hospital bed at home, so you know what to expect and how you can help.

Step 1: The first call

Most repatriations start with a call from a family member, a case manager, or a travel insurer's assistance company. The first conversation covers the basics: where the patient is, what happened, how they are doing now, where they need to go, and whether there is travel insurance. Our coordination team takes these calls around the clock.

If there is travel insurance, let the insurer know early. Repatriation benefits usually need the insurer's approval before anything is booked, and we coordinate directly with insurers and assistance companies so the family doesn't have to sit in the middle.

Step 2: The clinical review

Before anything is booked, our clinical team talks to the treating team abroad and reviews the medical records: the diagnosis, the current condition, test results, medications, mobility, and whether the patient needs oxygen. The question isn't whether the patient has fully recovered. It is whether they are stable enough to fly on a scheduled airline with clinical support, and what that support needs to be.

The review ends in an honest recommendation. For most patients that is a medical escort on commercial flights. A few who must lie flat on a long international flight may need a commercial stretcher, where a route allows one. Some need a short wait to stabilize first, and a small number genuinely need an air ambulance. If the patient isn't ready to fly, we say so.

The review also decides who travels with the patient: a flight nurse, a critical-care paramedic, a physician, or a team, matched to the case. A patient on continuous oxygen needs someone who can manage it for every hour of the journey; a psychiatric patient needs an escort with psychiatric experience.

Step 3: Airline clearance, oxygen and equipment

Airlines don't accept a patient on a doctor's letter alone. Their own medical department has to clear the passenger, usually on a form called the MEDIF, with the treating physician completing the medical section. Oxygen, a stretcher and medical equipment all need approval in advance, and some requests are declined, so a good plan has a fallback. Our guide to airline medical clearance explains how it works.

Step 4: Passports, visas and permissions

The patient needs valid travel documents to come home, and the escort needs permission to enter the country where the patient is. Some countries issue visas on arrival or online; others take weeks, so an urgent case may need an expedited visa or an escort who can enter without one. Our Ghana case study turned on exactly that.

If the patient's passport has been lost or has expired, or local authorities are involved, the patient's embassy or consulate can usually help, including with an emergency travel document. Working with embassies and consulates is part of how we run international cases.

Step 5: Building the route and booking the flights

With the patient cleared, we build the route: as few connections as possible, the right aircraft, seats that suit the patient's condition, enough time at each connection, and an overnight stop if the journey is too long to do in one go. Fly CME, our IATA-accredited in-house travel agency, books every leg on every carrier, including tickets for a family member who wants to travel with the patient.

Step 6: The bed at the other end

A patient should never land without somewhere to go. Before departure, we confirm where the patient will be admitted: a hospital, a rehab facility, a nursing home, or home with the right support in place. For a hospital, that means an accepting physician and a bed. For a patient going home on oxygen, it can mean a home oxygen concentrator waiting when they arrive. Families can help a great deal here by talking early to the patient's own doctor at home.

Step 7: Ground transfers at both ends

The flight is only the middle of the journey. At the start, the patient travels from the hospital to the airport by ambulance, wheelchair van or stretcher van, and is helped through check-in, security and boarding. At the end, a vehicle is waiting to take them straight to the receiving facility or home.

For patients leaving from or coming home to South Florida, the ground legs are handled by our sister company, Essential Transport Assistance.

Step 8: Travel day

On the day, the escort meets the patient at the bedside, reviews their condition with the treating team, and takes over their care. From there, the escort stays with the patient through the ground transfer, the airport, every flight and every connection, managing medications, oxygen and monitoring, until they hand the patient over at the destination: bedside to bedside.

Plans change on the ground. A discharge is delayed, a facility is difficult to work with, a flight is cancelled. When that happens, the escort on site and our coordination team at home solve it together, while the family deals only with us.

How long does it take?

It depends on the patient's clinical readiness, the airline's clearance, flight availability and any visas. A straightforward case moves quickly once the patient is cleared to fly; a stretcher, a slow visa, or a patient who needs more time to stabilize takes longer. We give a realistic timeline once we know the case, and we keep you updated as it moves.

Who pays?

If the patient has travel insurance with a medical evacuation or repatriation benefit, the insurer usually pays once its medical team agrees the patient should come home. Without insurance, families pay privately. Our medical escort cost guide explains what drives the price.

How families can help

• Share the medical records, or give us permission to speak to the treating team, as early as possible
• Tell us about any travel insurance, with the policy and claim numbers
• Check where the patient's passport is and when it expires
• Tell us where the patient needs to go, and who their doctor at home is
• Let us know if a family member wants to fly with them
• Choose one family member as the point of contact, so nothing gets lost

Send us the situation and we'll come back with a clinical read and a clear plan to bring them home.