Aeromedical Evacation often shortened to Medevac is
the timely, efficient movement and en route care provided by highly trained
medical personnel to ill, wounded patients, neonates and infants from an area
with inadequate medical facility to one with better equipped facility.
The United States Army is arguably the first set
of people to use this lifesaving technique in Burma towards the end of the World
War II using the Sikorsky R-4B helicopter. The British also used it in Sinai
Peninsula when a Royal Aircraft Factory BE2 flew out a soldier in the Imperial
Camel Corp who had been shot in the ankle.
In modern times, aeromedical evacuation has gone
way beyond just evacuation in times of war and conflict to evacuation from
construction sites, remote sites, oil rigs, drills, mining sites to even
neonatal and infant transport for better medical specialist care.
In Nigeria, aeromedical evacuation is very new.
Initially it was exclusive to
expatriates in the Oil and Gas sector to repatriate them to their home
countries for better medical care and attention. However, today such services
are available and accessible commercially. I was privileged to be on one in my
home country.
The patient to be evacuated, Mr I.I, a 45 year
old Nigerian male with a background history of hypertension and type II
diabetes mellitus not regular on medications who had presented with a recent
history of right sided hemispheric stroke possibly ischaemic and was stabilized
in a hospital in his country home. His vitals as at the time of contacting the
aeromedical evacuation team was a blood pressure of 150/90 mmHg, temperature of
37.1 C, Pulse of 90/minute regular, synchronous with no radio-radial or
radio-femoral delays, respiratory rate of 18cycles/min and an SpO2 of 96-100%.
The patient was conscious, alert oriented in time. place and person with a
Glasgow Coma Score of 15/15. He was to be airlifted from Port Harcourt to Lagos
for specialist care.
The first thing that caught my attention was the
high level of commitment of the flight physicians on call. It was an early
morning evacuation but the response time was 23 minutes. The team comprised an
anaesthetist,
a senior flight physician,
myself, the paramedics, the pilot, co-pilot and the cabin crew. The anaesthetist
was given a clear role as the lead physician.
He read out the medical history of the patient
to be evacuated, possible aetiology, various modes by which such patients could
present, the complications, risks of flying such patients at various altitudes,
safety precautions to be taken and look-out signs on such patients. He stated
that all such details have been explained to the relatives of the patients and
they have signed a consent form with the legal team before we proceeded with
this evacuation.
Simultaneously, I could see the flight engineers
on the aircraft. I later found out that they were checking all the medical
equipments were fully functional, the batteries fully charged and that the Air
Transport Stretchers were comfortable for a non-ambulant patien
Just as we boarded, the lead physician took a
few minutes off to repeat a summary of the patient to the pilot, co-pilot and
cabin crew. Then we were cleared for take-off. Aboard, we took turns to refresh one another
on various topics in Advanced Cardiac Life Support. It was a 45 minutes flight.
On ground at the Port Harcourt Airport, the
patients was at the tarmac with a land ambulance, had an anaesthetist, 2 physicians
and a few paramedics. The lead physician again lead us to the patient,
introduced us one after the other to the team on ground, I was asked to do a
Pre-flight assessment of the patient. This included documenting the vital signs
of the patient, performing and documenting general physical examination as well
as systemic examination. Then the lead physician who was discussing with the on
ground physicians and relatives came over to do a run through of yet another
general physical examination but picked out only the affected systems for
examinations. He then explained to the patient the risk associated with flying
him, possible complications that could arise and the steps that have been taken
but to forestall and control.
He was then loaded into the air ambulance using
a vacuum stretcher. He had his face mask connected, Intravenous fluid was set
at 15drops/minute. One of paramedics were assigned to monitor the vitals of the
patient every 10 minutes.
On ground at the Lagos airport, the receiving
hospital had sent a land ambulance with paramedics to transport the patient
over. The lead physician again briefed them on the clinical state of the
patient after doing his Post-flight assessment.
We were then ushered to the airport lounge for a
debrief and brunch.
Dr Olutomiwa Ogunbona is a staff of Flying
Doctors Nigeria. www.flyingdoctorsnigeria.com/
The author takes full responsibility for
the article. All correspondence should be directed at the author via email at
tommyogunbona@gmail.com while drtommyflyingdoctors@gmail.com should be put in
copy.
