The doctors say our patient is “not fit to fly”: what can we do?

The good news: we almost always can help

The good news is that we can almost always help families in this kind of situation. And that’s because – under the right conditions, and using the right equipment, personnel and transportation – it’s almost always possible to repatriate patients safely and securely, even when they are very ill. Naturally there are certain medical circumstances where it is inadvisable to move a critically-ill patient, and this is something our Medical Director will assess when we review each case. But these cases are generally very rare. The problem is that local medics don’t always realise what’s possible with an experienced international repatriation company. To cite a few examples, EMS has repatriated patients who:

• have been gravely injured in warzones
• are suffering from a serious case of COVID
• have suffered a serious stroke or heart attack

So what kinds of arguments might prevent a patient from being repatriated, and how might we answer them? Here are some examples.

“It’s not medically safe for your patient to take a flight”

This is something families sometimes hear if their patient has suffered a stroke or a heart attack. One concern is that pressure changes could have a negative impact on the body and cause their condition to deteriorate. Another is that there may be less oxygen circulating on the aircraft than at ground level. In both cases, however, there are things we can do to ensure the patient’s safety. We carry oxygen supplies with us on the ambulances, and we monitor their oxygen levels constantly to make sure the environment is safe for them. In certain circumstances we can also fly at low altitude (a “sea-level flight”), where the pressure is similar to ground-level conditions. We can even carry oxygen with us on a commercial flight when a patient is travelling with a medical escort.

“Your patient could need emergency treatment at any time”

This may be true but… international repatriation experts are equipped to carry out emergency treatment if it’s needed during transit. We travel with a doctor, paramedic, nurse or team of specialised medics who are experienced at monitoring and treating patients on the road or in the air. We also use aircraft and vehicles that are fitted to “high-care” standards. Both the private air ambulances and road ambulances are essentially like mobile intensive care units (ICUs). An EMS road ambulance isn’t the same as a conventional city ambulance: it’s specifically designed to cater for emergency patients over very long distances (typically between 1,600km and 2,500km, but sometimes even over 4,000km).

“It’s simpler and more secure to remain in hospital”

In an ideal world, this would be true in every case. Unfortunately, there are many reasons why it isn’t always a patient’s best option. First, patients are often better off when they’re close to their families so they can be looked after while they’re in hospital. Secondly, hospitals abroad aren’t always up to the same standards as at home. For instance, they may not have specialist surgical equipment or expertise, or post-operative rehab facilities available. In fact, sadly, we often encounter situations where patients receive sub-standard care from the hospital. Even when the standards are acceptable, the staff may not speak the family’s own language; sometimes they can also be very difficult to reach for updates and details on the patient’s condition. All these situations can be extremely stressful for families.

What can EMS Air Ambulance & Medical Repatriation do?

If you find yourself in a situation like these, the first thing to say is: don’t panic. There are a number of things we can do to help you, or to advise you.

We can contact the foreign doctors on your behalf – our team always gets in touch with a patient’s local doctors, not just to arrange logistics but to get a detailed and up-to-date assessment of their current condition and treatment. It’s not always feasible, or desirable, to transport a sick patient. But if we think it is the responsible thing to do, we can speak to the local doctors and explain why, and how EMS can move and transport your patient safely. If there are language issues, we can bring in translators. There may also be a case for waiting until it’s possible to move your patient securely. If so, we can agree an appropriate schedule with you and with the hospital.

We can arrange a live medical assessment of your patient – there are times when families ask EMS to visit their patient beforehand to assess their medical condition in person. Of course, this only happens with the hospital’s permissions and cooperation. But it can be very helpful and reassuring to have a specialist on the ground, who is fully focused on your patient and able to look into their case in detail and see what can be done for them. We’ll be writing about a real-life situation just like this in an upcoming blog – look out for that later this month. With EMS at your patient’s bedside, you can be reassured that everything is being done to review their situation – and get them home if it’s possible.

Need help or advice about a relative, friend or colleague’s situation right now? Please get in touch with our team and they’ll be really glad to talk to you and explain what we can do. You can find all the details on our website Contact page, including international phone numbers, the EMS WhatsApp channel, and our email address. Whatever you need, we’re here to help.