Approach to the Medical Management of Assistance Cases
In normal circumstances our general policy is to put patient welfare first, having a patient treated locally where medical provision is appropriate and moving them if necessary to access a superior level of care or if the patient is going to need long term treatment / recovery which can be better provided in their country of residence. Nothing about the COVID-19 pandemic changes our preferred approach. Please however be aware of the following:
Local Requirements / Restrictions
Patients with COVID-19 can be swept up into local quarantining and treatment procedures and our ability to intervene can be limited. To quote the FCO: “You must follow the advice of local authorities. Your safety and security is the responsibility of the local authority where you are.”
We will still liaise with treating medics (and the patient) if possible / as appropriate, may be involved with paying hospital bills, etc. and will remain on standby to assist once a patient recovers, but it is worth highlighting this situation.
Transfers for COVID-19 Patients
Although most air ambulance operators will not take such cases we have several who are equipped with isolation pods and who are able to move COVID-19 patients. It should be noted however that the pods used are small, very claustrophobic and patients may need sedating for the journey: they are not generally considered suitable for long distance transfers. As there is very little room for intervention by the accompanying medical team, they are not suitable for serious ICU transfers either.
Furthermore, having the technical capability to move patients is one thing, but we are still dependent upon national authorities granting permission for an air ambulance to arrive; for a patient to leave; for the aircraft to fly over a country’s territory; for the air ambulance to land at the destination; for the patient to be allowed in to the country and for the waiving of any general requirements for those (i.e. air crews) entering or returning to a country to undergo any mandatory quarantine. We also need a hospital willing to accept such a patient.These permissions are not always granted and even where transfers are possible they can take some time to arrange. This makes them less suited to urgent ’emergency’ transfers than to moving stable patients.
Free From Infection Certificates
It is fairly standard now that for a patient to be accepted on to a commercial aircraft or ‘normal’ air ambulance they will need to present documentary evidence that they have tested negative for COVID-19. This is true for many / most countries, even those with few / no confirmed COVID-19 cases, and even in cases where there is no suspicion that the medical illness or incident is linked to the pandemic. The same requirements will apply to travel companions who may find it harder to get tested than the patient. Where such tests are not carried out a patient may still be able to fly in an ‘isolation pod’-equipped air ambulance, albeit at greater discomfort and expense.
International Travel Restrictions
The combination of bans on travel, entry / re-entry, self-isolation and / or quarantine requirements and the widespread cancellation of airline routes is making it very difficult for us to arrange ‘escorted repatriations’ for patients. (These generally involve a medic travelling with a patient on a commercial flight to get them home.)
Air ambulance transfers are commonly exempt from these restrictions as they are deemed ‘essential’, but we cannot guarantee that this will remain the case. Indeed, we are finding it increasingly the case that only the most serious of patients are being granted permission to transfer, sometimes only to their country of residence (rather than a regional centre of medical excellence) and in some cases only following the intervention of their government’s embassy.
Please also note that transfers for travel companions are not generally considered ‘essential’, and so will not generally be permitted to travel on the air ambulance with the patient as would often previously have been permitted. Children may be allowed to travel with a responsible adult on a case by case basis.
Ultimately it is in no one’s interest to completely prevent all travel, especially when such trips can be organised in such a way as to minimise any risk of infection to or by the air crew but for the time being there are heavy restrictions.
Local Medical Capabilities
In countries where medical providers are being overwhelmed by cases, especially where they are operating very stringent triage / admitting policies or where a lot of medics are themselves contracting the virus, accessing treatment for non-COVID-19 cases can be difficult or impossible.
In countries or regions where COVID-19 case numbers are genuinely low / non-existent, it should be possible to provide a ‘normal’ assistance service utilising whatever local medical provision exists.
The situation is different in different parts of the world and is changing frequently, so never has it been truer than now that all treatment and transfers are arranged on a case by case basis.