ITIC Global 2021: Medical Directors' Forum

The ITIC Global Medical Directors' Forum is not about great successes, but rather about identifying frustrations and failures from which the industry can learn. Dr Bettina Vadera and Dr Alex Veldman chaired a discussion of challenging medical cases from around the world. 

Nicole Bootsma, Dr Jospeh Lelo, Dr Yann Rouaud and Dr Arnaud Derossi and Clive Gillard discuss the difficulties of transporting critically ill Covid-19 patients during the pandemic

Nicole Bootsma from Eurocross started off the session with a case study involving a 38-year-old female patient who was 25 weeks pregnant when she was admitted to hospital with Covid-19 whilst on holiday in Aruba. Her condition deteriorated rapidly, and she was transported to Colombia where there were more NICU beds available. Following 10 days of ventilation at their facility, the Colombian medical team had to perform an emergency Caesarean on the patient due to hypertension. After suffering from pulmonary haemorrhage and other complications, the baby died one week later.

Following the death of the baby the mother was transported by air ambulance operator Jetcall back to her city of residence, Rotterdam. Bootsma discussed the issues faced by the medical evacuation team when trying to organise this transfer back to Europe. Although they initially encountered problems trying to evacuate the patient to Colombia, she confirmed that it was far more challenging to organise the return journey to the Netherlands.

Next, Dr Joseph Lelo, Medical Director at AMREF Flying Doctors, talked through complications experienced during the transfer of a critically ill Covid-19 patient from Baghdad to his place of residence in Lagos, Nigeria. On the way to Nigeria, a stop off in Nairobi had been planned to allow for a change of crew and aircraft before the onward leg to Lagos. However, once the team arrived in Nairobi, they were informed that their landing permit for Nigeria had been cancelled and there was no longer a free ICU bed for the patient due to oversaturation of hospitals. Eventually, they managed to find a temporary spot in an ICU bed in Nairobi for the 49-year-old male.

The next day he was transferred to a hospital in Ghana, where he suffered cardiac arrest and passed away. Dr Lelo discussed moving patients in critical conditions, looking at risk versus benefit of transfer and making backup plans.

Dr Yann Rouaud, Medical Director at Groupe IMA, presented a case involving a three-year-old girl who became critically ill with Covid-19 whilst on holiday in Casablanca with her grandparents. Due to resistance and delays from Moroccan authorities, it took 20 days for Groupe IMA to receive the necessary permits to allow them to complete the air ambulance transfer of the child back to her parents in France. Dr Rouaud discussed the implications of such a large delay and explained the medical complications that occurred during and after her transfer.

To conclude the session, Dr Arnaud Derossi, Regional Medical Director at Assistance & Global Medical Transport, and Clive Gillard Director of Medical & Security Assistance Air Transport Services spoke about the work of repatriation teams transporting critical Covid-19 patients from overseas French territories to mainland France. Two types of evacuation missions were started, ‘light’ missions involving a Falcon 900 with three stretchers onboard, and ‘heavy’ missions using an Airbus A350-900 with capacity for 12 stretchers. For the ‘heavy’ missions, titled Hippocampe missions, medical co-ordination and most of the staffing was provided by the SAMU.

In 12 weeks, a total of 28 patients were successfully transported by the Falcon and 123 patients in six weeks by the Hippocampe mission. Dr Derossi and Gillard explained how family approval has caused some setbacks and limitations when gaining permission to transport patients. Apart from this, they confirmed that the operation has been a great success.