Wing-to-wing repatriation of a stroke patient from Cyprus to the Netherlands

A 74-year-old Dutch female patient who suffered a small-sized brainstem ischemia required repatriation back to her home country – the Netherlands – from the Northern part of Cyprus on a stretcher. She had been treated in a university hospital for five days and then went back to it for flight assessment about seven days prior to the planned repatriation. Her doctor stated that she had motion sickness and ataxia. She was able to sit up for some time but not usually for more than an hour. She was cleared to fly in a lying position with oxygen support by her neurologist.

The patient was to fly from Ercan Airport in Northern Cyprus to Istanbul and then to Amsterdam. There was only one flight in each direction due to Covid-19 restrictions. Those flights were connecting with 75-minute layover in Istanbul Airport. The medical escort from the Netherlands would have difficulty flying to Cyprus directly because of the island’s Covid restrictions: they would have to go to quarantine for 15 days.

Covid-19 PCR test made plans complicated

marm’s medical escort was based in Istanbul and could fly to Lefkosa directly as long as they had a negative Covid-19 PCR test performed in the last 72 hours of their flight to Cyprus. However, this time they were not able to fly to the Netherlands due to EU restrictions. Therefore, it had to be a wing-towing connection with two medical escorts. One to go and pick up the patient and bring her to Istanbul and the second would take over in Istanbul and fly her to Amsterdam. Flights and reservations were made. marm’s escort had done a PCR test two days prior to the Cyprus flight. Thankfully, the test result came early, and they could fly on time. Upon arrival at Lefkosa Airport, all passengers were queued, scanned for temperature and had to do another PCR test. They were also asked to quarantine in their hotels for eight hours.

The team arrived at the city at 2:00 am and checked into their hotel at 3:30 am, and awaited confirmation from the Ministry of Health saying that the PCR was negative, so our escort could go out and visit the patient for pre-flight assessment. No significant neurological deficit other than ataxia and motion sickness were revealed. All appeared clear for the next day’s flight.

Transporting the patient

The following day the flight was scheduled to depart at 4:00 am. Our escort went to the ambulance station and was about to leave the hospital to pick up the patient when they received a call from Turkish Airlines, stating that the stretcher from Ercan to Istanbul was OK but the stretcher from Istanbul to Amsterdam was not. Due to a change of the aircraft type, the new flight was not able to accommodate a stretcher (although it was a bigger and newer B787 Dreamliner). We went to the patient anyway and discussed the plan with them. The patient agreed to fly stretcher from Ercan to Istanbul and then continue in flat-bed business class. However, Turkish Airlines could not do this since the reserved flight plan cannot be broken down. We even tried to fly to Istanbul immediately and stay there in a hotel or hospital for tomorrow’s flight, but could not do this either. There would be no flight that night.

The next day, everything went smoothly just as planned. We picked up the patient, performed antithrombosis prophylaxis and arrived at the airport early. We took off on time and arrived in Istanbul on time. However, there were no pillows or blankets on the airplane. Additionally, the two rows of seats just next to the stretcher were being reserved as a possible isolation area for ill passengers. Therefore, it was not possible to sit just next to the patient. The patient was unloaded and directly loaded to the Amsterdam flight. The marm escort communicated with the next escort doctor to meet him in the airplane. The handover was smooth and the Amsterdam flight took off on time with the patient on a stretcher.

Conclusion

Current Covid-19 restrictions vary from country to country and origin of the escort or patient, so missions require much better planning PCR testing in a timely manner is now a critical point for some routes. Delayed results may risk the whole mission. Flying patients on board commerical carriers has new restrictions, e.g. absence of any pillow or blankets, lack of alternate dietary choices and fluids, and not being able to sit next to the patient. Another issue to mention here is the frequent schedule changes and cancellations. We have a new onboard announcement now: ‘Dear passengers, when oxygen masks are dropped, please remove your face mask before you put on your oxygen mask!’