A complex mission from Bangladesh to the US
Air Alliance was notified about a seriously ill 46 year old woman in Dhaka/ Bangladesh. She had been infected with COVID-19 in February but was no longer considered infectious. However, due to her pre-existing medical illnesses (hypertension and chronic obstructive pulmonary disease) she had developed severe complications following Covid-19 and had become dependent on High Flow Nasal Oxygen (HFNO) and finally mechanical ventilation. She had already been moved to a better hospital in Dhaka with minimal progress, and her family requested that we urgently transfer her to Washington DC in the USA for further advanced treatment, where the oldest daughter worked as a medical doctor.
Medical qualification and field experience are key
The medical report indicated that the patient needed 75% inspired oxygen on the ground which would correspond to 100% oxygen in an aircraft cabin pressurised to an altitude of 5,000ft. The theoretical soluti on was to perform a sea-level flight, which was not possible due to more fuel stops and more necessary crew changes. One crew change half way in Cologne was necessary to avoid exceeding duty times of pilots and the medical team. In addition, the patient’s husband and two teenage daughters were keen to accompany the patient.
Our team estimted local situation in Dhaka (continuous care, equipment, training, etc.) and agreed to accept the mission as an evacuation flight as the patient would not have survived for much longer at her current location. The deployment of our long range Challenger 604 was essential to give the cabin space required. The longer range capabilities would reduce the number of refuelling stops required.
Our Group Medical Director Dr. Gert Muurling, a Consultant in Anaesthesiology and Intensive Care Medicine with more than 20 years of experience in air ambulance missions, covered the first part of the trip from Dhaka to Cologne together with experienced ICU nurse, Annett Krummel. Having arrived in Dhaka, the patient was in a much worse condition. She received 85% oxygen and family members told us it had never been lower. The ventilator was not set to a lung-protective mode and the ventilation tube was put in too deep. Constantly working on the lungs in combination with proper sedation, we were able to improve the patient throughout the flight. In Cologne a second anaesthesiology/ICU team (Dr. Kerstin Becker & Horst Paffrath) took over the clinical care for the remaining flight to Washington.
Medical improvement during the flight
During the first leg to Tashkent we inserted invasive monitoring lines, initiated frequent re-positioning to protect the skin from pressure damage, provided further intravenous fluids, and continued to improve the patient’s lung function. By the time we landed in Tashkent to re-fuel, the patient had responded positively to our interventions and shown significant improvement in her condition and by two hours into the second leg of the flight from Tashkent to Cologne we had been able to wean her oxygen requirement to 55% inspired oxygen. Ultimately, at the end of a 14.000 km flight, we were able to handover the patient in Washington in a clinically stable condition and far better than that in which we had accepted her. The outcome of this mission could only have been achieved with an appropriate aircraft and senior clinical staff with the necessary skill-set, experience and shared goals.
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