Case Study 1: Melbourne to New Delhi
Western Hospital Melbourne to Maharaji Agrasen Hospital New Delhi India
A 25-year-old female suffered a severe hypoxic brain injury secondary to a cardiac arrest and post severe asthma attack. After 120 days her condition had not improved. In summary her conditions included:
Neurological
- Complex pain management neuropathy verses behavioral issues with extended periods of crying, grimacing, agitation and grinding of teeth, for which she required high dose sedation and analgesia.
Respiratory
- Biphasic stridor due to tracheostomy trauma clinically presenting with tracheal tug and nose flaring. A bronchoscopy showed airway oedema, collapse of supraglottic and glottis areas during inspiration with minimal vocal cord movement, however, no stenosis of laryngeal or tracheal was found.
- Asthma, bronchial spasm and breath holding treated with salbutamol and adrenaline nebulizers and benzodiazepine drug therapy.
- Apnea secondary to hypoxic brain injury.
- Sputum retention polling of salvia and poor swallowing.
- High dose dependency and resistance to benzodiazepine and narcotics, in a setting of asthma, hypoxic brain injury and compromised airway.
Medical Connect’s initially found the patient clinically not suitable for an Aero-Medical Repatriation (AMR) and was of the opinion that further consultation with the Respiratory Medicine, Ear Noise and Throat and Anesthetics specialists was required. A detail analysis of the patient was conducted to investigate the patient’s capacity for travel and the tests included: Computer Tomography, Bronchoscopy, new sedation and analgesic management. The hospital’s consultant’s academic opinions and Medical Connect’s specialist knowledge and practical experience in aviation allowed for the hazards to be identified and also enabled a detailed risk assessment to be conducted. Medical, business and legal risks were identified and discussed at length with the relevant stakeholders.
After two weeks of clinical reviews the patient was found to be suitable for an AMR. Medical Connect anticipated that the AMR was going to be challenging and required specialized risk management strategies, however, a safe repatriation was anticipated and she was safely reunited with her family in India.
At 12 months the patient remains in the care of family and is responding to family who are grateful for her return.
