CASE STUDY: Crossing three continents on land, sea and air

Evacuated to the Port of Ceuta, a Spanish port city located on a peninsula bordering Morocco, the patient was picked up by ground ambulance to be transferred to a nearby hospital for further evaluation. Still suffering from acute chest pain and a deteriorating condition, the patient suddenly went into cardiac arrest ventricular fibrillation in the ground ambulance. Quickly reacting to his life-or-death situation, the ground ambulance crew successfully resuscitated him at the second defibrillation attempt. The crew member was then intubated and rushed to the hospital’s emergency room, where he was diagnosed with an inferior-posterior myocardial infarction. As a cath lab was not available on-site, the patient was given fibrinolytic treatment and was subsequently stabilised in the intensive care unit (ICU).

At this stage, Redstar Aviation was contacted and tasked with the repatriation of the patient. With the Port of Ceuta not having an airport, the team at Redstar Aviation immediately began to investigate to find the closest suitable airport. The airport of Gibraltar was initially considered the best option; however, due to the immigration requirements, the patient would have had to request a visa to enter the country, which would have caused administrational hurdles and a delay to the transport. Thus the airport of Jerez in Spain was chosen as the ideal pick-up location as the patient was already on Spanish soil and no additional immigration procedure had to be followed. Consequently, the ground transportation to reach the airport would be extended by 1.5 hours compared with Gibraltar. Still considering this the better option, the team at Redstar Aviation took an unusual approach and decided to transport the patient by ferry across the Strait of Gibraltar to Jerez. The idea was to load the patient into a ground ambulance and have the team and patient cross over to Jerez by boat, which would allow for a smooth and quick alternative to a full ground transport.

A comprehensive plan was quickly put into place and the team at Redstar Aviation started to make the final arrangements for a seamless transport. Pre-positioning to Jerez the day before with a fully equipped ICU aircraft, Redstar Aviation’s team set off on an unusual journey. Leading up to the day of repatriation, the treating team had attempted to wean the patient off mechanical ventilation and sedation several times; however, the patient did not tolerate it and was highly agitated when being woken up. Therefore, it was decided to keep him ventilated and under continuous sedation and analgesia. Unfortunately, the continuous administration of these medications triggered hypotension, which therefore required continuous noradrenaline drip for adequate perfusion.

Once Redstar Aviation’s medical crew arrived at the local hospital, the patient was thoroughly assessed and deemed fit for transport. After handover, the patient was loaded into a waiting ICU ground ambulance and – accompanied by Redstar Aviation’s team – started his journey back to Türkiye.

In usual circumstances, a ground ambulance journey from the hospital to the airport does not include a journey with a ferry which sticks to a strict timetable. Normally, a slight delay or early arrival at the airport with the patient can easily be managed by altering the take-off time of an air ambulance aircraft that is dedicated to a specific patient. However, when there is a ferry crossing involved, the timing of departure from the hospital had to be coordinated to the dot. If the ferry was missed, the next one would depart 2.5 hours later and, if arrival at the port was too early, a critically ill patient would be left waiting for an extended time.

Due to Redstar Aviation’s excellent network, the local assistance partner had already notified the ferry service beforehand, and the ferry was thus expecting the patient and ambulance. Arrival at the port was just on time, with all other vehicles and passengers already embarked. A space at the very front of the ferry was reserved for the ambulance so that upon arrival at the Port of Algeciras, the ambulance would be first off.

The ferry crossing experience was rather like a flight at cruising altitude in the sense that there was a calm, gliding movement across the water, which is a stark contrast to a classic bumpy ground-ambulance ride.

After a one-hour ferry ride across the Strait of Gibraltar, and then a 1.5-hour ground trip, Redstar Aviation’s crew and the patient safely made their way to the airport, where a Learjet 45XR was already waiting to take off. Upon loading the patient onto the aircraft in a stable condition, the team took off back to Türkiye. With a smooth flight and a flight time of just over five hours, the aircraft touched down at Istanbul Airport, where a ground ambulance was already waiting to transport the patient to a renowned Turkish hospital, where he was admitted to the ICU for further care.

A truly unique repatriation for the team at Redstar Aviation which not only included providing outstanding critical care across continents but also managing a journey by land, sea and air. One down – and many more to come!