A day in the life of an air ambulance doctor
By Mark Rostron · April 11, 2014
Imagine the situation. You're severely injured and alone in a remote region of a foreign country where the only person that is your family, confidant and companion rolled into one is on the other end of the phone, millions of miles away. It's at this time where you would be truly grateful that you were in the competent and caring hands of Dr Mitesh Patel.
A highly qualified aviation doctor with CCAT (Clinical Considerations in Aeromedical Transport) certification, Dr Patel has over 10 years' experience dealing with just such scenarios where quite literally life or death decisions have to be made in seconds.
Today he juggles his clinical work at highly regarded London hospitals with 12-hour daily on-call duties for our in-house medical assistance service to safely and effectively evacuate Aetna plan members to a medical facility that can provide the appropriate care and treatment that their situation dictates.
I caught up with Dr Patel, to find out how he ended up working in this field and what a typical day holds in store for him.
MR: So where did it all begin?
DMP: I trained at London's Guy's, King's and St Thomas' Hospitals before working in the private sector for many years and qualified as an air ambulance doctor 11 years ago. A year ago, I was appointed to InterGlobal Assistance's (IGA) medical panel as an advisor, providing clinical support in the escalation of medical cases for Aetna members. Part of that role involves assessing a situation and advising IGA whether or not a particular case calls for a medical evacuation.
MR: Can you explain what a medical evacuation is?
DMP: Picture this… you've had a serious road traffic accident in Jakarta and the local emergency services are called to respond. A first response service attends the scene, does what they can to treat you and transports you to the nearest hospital. It's usually then that InterGlobal Assistance is alerted. Depending on our evaluation of your condition and the local hospital's adequacy to meet your needs, we may decide that your best chance of recovery is to transfer you by air or road to another hospital – this is called a medical evacuation.
MR: What's a normal day for you?
DMP: No day is ever a normal day. Besides working in different locations around the world and in challenging conditions, the thrill is never knowing what is going to happen from one day to the next. Each case is unique and every transfer a potential life or death situation. So we have to be constantly on our toes, ready to assist.
A successful repatriation is one where we don't have to do much at all. Provided it's planned properly everything should go according to plan. There are of course times when it hasn't. I remember an evacuation where we received incorrect information by the local authorities in regards to an evacuation from a cruise ship. When the evacuation crew arrived, they discovered the gentleman to be morbidly obese and the error in the medical reports was identified. Unfortunately the patient was too large to board the air ambulance that had been arranged. However, you must take these things in your stride. So we worked together to swiftly remedy the situation by sourcing a larger aircraft with special equipment.
MR: How many medical evacuations have you performed and where?
DMP: I've performed somewhere between 150-200 air ambulance, commercial and road transfers over the last 10 years all over the world. I've travelled as far afield as New Zealand to perform long haul evacuations, but in my capacity of working with InterGlobal Assistance, I generally travel no further than the Europe, Middle East and North Africa regions.
Any further and InterGlobal Assistance makes use of local medical evacuation teams who can reach the patient faster. In these situations I would provide support remotely by telephone as required, alternatively my colleague in New Zealand, Dr Denyer, Chief Medical Officer, or any of our panel of Doctors will manage the case. But ultimately the medical decision as to whether a member requires an air evacuation rests with either me or Dr Denyer.
MR: When you attend an evacuation, what team of people do you have to support you?
DMP: I tend to work alone. Not because I choose to, but quite often it's because the situation dictates. There is barely enough room in a Cessna light aircraft or Learjet for the pilot, the patient and the medical equipment, much less a host of medical staff. So when precious seconds count, it is better to have one professional making the decisions and performing the care. However, more and more evacuation cases are being carried out using commercial aircraft either in business class or with purpose-built medical units.
This not only allows for more space for medical staff and family of the patient to accompany them an evacuation, but also for more modern and bulkier medical equipment to be brought on board, making the situation less stressful for both the patient and family members.
Patient transfers by commercial airlines are preferable due to shorter flight times and increased cabin space with toilet facilities and hot meals available. Believe it or not these can be luxuries on Air Ambulance transfers! On certain long hauls flights such as to Australia or New Zealand, there can be up to two or three medical staff accompanying the patient, allowing them to take much needed breaks from administering patient care.
Of course there are situations where the medical needs of the patient are not appropriate to commercial air transfer or indeed the logistical challenges presented favour the use of a privately chartered dedicated air ambulance service. All this must be properly considered before proceeding but we work efficiently to make those decisions rapidly.
MR: How do you go about orchestrating an evacuation when time is of the essence?
DMP: Especially in an emergency, it's all hands on deck to arrange the most appropriate mode of evacuation that provides both the required on-board medical assistance and speed of transfer to hospital. At this point, it's really about logistics, we must consider the total transfer time for the patient and not just the flight time! The closest airports should be considered for arrival and departure. We look at how the patient will travel and the distance of that journey, the time it will take (road conditions?) the flight time itself and transfer from the aircraft to hospital on arrival.
Alongside all this we will seek to make convenient arrangements for accommodating accompanying family members. All these factors play an important part in our decision-making process. As a general rule of thumb, small local airfields might accommodate air ambulance whereas larger international airports are generally necessary for commercial transfers. All evacuations and repatriations are performed as bed-to-bed transfers where the patient is accompanied by an appropriate medical transfer team throughout.
That aside and somewhat throwing the rule book out of the window, you almost develop a sixth sense as to whether or not a patient will be able to stand up to the rigours of a flight, or if they require more sedate transport like a cruise ship. This is in fact a type of medical evacuation that I have had to perform in the past.
MR: For most of us daily job satisfaction is of paramount importance. What's the most rewarding part of your job?
DMP: It's about being able to do the job to the best of my ability in challenging conditions, and the gratitude that I get from patients. When I am the only person they have contact with in a foreign country, and I am their only lifeline, it is not hard to see why they form a strong bond with me.
MR: And the hardest part?
DMP: The hardest part of my job is the bureaucracy that I have to deal with. For example in parts of the world you can't take certain drugs into the country. Customs officials often rifle through my medical bag hauling out what they consider to be dangerous medical instruments. Following long-haul flights, there's of course also the accompanying jet lag.
MR: What legacy would you like to leave behind?
DMP: At the end of the day it is about me making a difference in people's lives and knowing that I have done everything to the best of my ability to get them out safely and soundly, and then ensure that they get the best care available to make a full recovery. Maybe if given the chance, I'll write a book with helpful hints, tips and anecdotes that would hopefully assist others tasked with performing future evacuations when I am somewhere in the world relaxing with my feet up!
To end – Even though Dr Patel has a doctorate and extensive qualifications in emergency medicine that includes advanced life support for adults and children, he firmly believes that there is no substitute for experience.
More about InterGlobal Assistance
InterGlobal Assistance (IGA) operates in association with New Zealand-based assistance specialist First Assistance from centres in the UK and New Zealand to provide a 24/7, 365 days a year medical assistance service. IGA is the first point of contact for Aetna members in an emergency or for planned hospitalisation.
IGA covers all aspects of the assistance process, including providing advice from medical experts, arranging admittance to hospital, identifying specialists and arranging ambulances as well as organising the approval and payment of treatment. We also arrange evacuation of members for critical and non-critical conditions, where medically necessary, if adequate treatment cannot be provided locally.
Our in-house medical team and remote working panel of registered, practising physicians ensure that our members receive the highest professional standards of medical treatment whilst helping to challenge overtreatment and the inconvenience and cost of unnecessary medical investigations.
Dr Mitesh Patel is based in the UK alongside Chief Medical Officer, Dr Graham Denyer, in New Zealand. Between them, Drs Patel and Denyer strengthen our capacity to provide medical expertise at the highest level, 24hrs a day.
David Bull, InterGlobal Assistance Operations Manager, says:
"Our medical team gives us instant access to information about necessary and appropriate investigations, diagnosis and treatment plans for our members 24 hours a day. They are supported by a broad panel of practising doctors with varying specialities and a wealth of experience in healthcare around the world. This means we can provide appropriate medical assistance and support to our members whenever they are or need to be admitted to hospital, wherever in the world that may be."