An  obese, hypertensive, diabetic patient in severe hypoxaemic respiratory failure with COVID-19 pneumonitis hospitalised in Bamako, Mali. His employer agreed to transfer to an ICU in Paris for a higher level of medical treatment. Despite meticulous planning, significant challenges still had to be overcome.

Air Alliance rapidly assembled an international medical team consisting of their UK Medical Director, Dr Neil Crooks and two experienced ICU nurses from Germany and the Netherlands. All three with extensive experience in the aeromedical transfer of critically ill patients.

The ability to draw upon multi-national expertise in aeromedical repatriation and evacuation was borne out of an initiative launched in 2017 - ‘Medicine without Borders’. Led by Group Medical Director Dr Gert Muurling, the core aims were to increase the pool of Air Alliance medics across Europe and integrate differing skills into a collective group standard. This allows a flexible fleet of dedicated air ambulance teams to deploy quickly from bases in Germany and the UK.

Air Alliance employed the EpiShuttle for this evacuation. This modern hard-shell mobile isolation unit offers the space for such a large patient and a level of clinical safety which extends to haemorrhagic fevers such as Ebola.

 

For this particular mission, the immigration restrictions in Mali demanded that the aircraft, flight and medical crews had to remain at the airport, eliminating the possibility of an overnight stop-over. Increasing the number of pilots from two to three extended the duty time to 18 hours for the Challenger 604. As part of the Air Alliance fleet, the Challenger 604 provides a long flying range, adequate space for personnel and accommodates the extensive range of specialised medical equipment necessary for a critical care evacuation.

As the patient was already receiving 15 litres per minute of oxygen via mask-CPAP, a request was made to the treating hospital for the patient to be intubated and ventilated in preparation for transfer. Unfortunately, he was transferred to the airport on more than 15 litres per minute of oxygen via mask-CPAP.   Furthermore, the ground ambulance did not have a sufficient oxygen supply and shortly after arrival at the aircraft it was depleted.

The Air Alliance medical team intubated the patient in the ground ambulance, before carefully moving him to the safety of the EpiShuttle.  Around them, gusting winds, sandstorms and looming thunder increased the challenge and sense of urgency.

Fitted with electric lifting gear, the Challenger 604 is ideally suited to use with the EpiShuttle transporting an obese patient.  There was no shelter afforded to the aircraft by nearby buildings and initially, elevation to the aircraft door proved problematic. The hands of the entire crew were needed to stabilise the lift and complete the transfer safely.

 

 

Before initiating the aircraft's departure, the pilot carefully plotted a course to avoid entering into the teeth of the storm, zig-zagging to reach more stable weather conditions for the safety of both crew and patient.

Leaving behind the challenges in Mali, the remaining flight to Paris proceeded without complications and the patient safely handed over to the Parisienne transfer team from a major teaching hospital.

 

Notes

Air Alliance acquired the EpiShuttle in 2020. The unit is an innovation designed by the University of Oslo to provide space and safety for highly-infectious medical cases.

The Challenger 604 is the largest aircraft in the extensive Air Alliance fleet, capable of accommodating two ICU cases and the necessary medical teams.

Group Medical Director Gert Muurling is a Dutch national, medically trained as Consultant in Intensive Care Medicine  & Anaesthesia in Germany and an experienced multi-lingual ICU specialist in the air ambulance arena. For many years, he served as an auditor in EURAMI.

UK Medical Director, Dr Neil Crooks, is a British Consultant in Intensive Care Medicine  & Anaesthesia, trained in London, Edinburgh and Birmingham.