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Wing To Wing Repatriation of a Stroke Patient From Cyprus to The Netherlands in the COVID-19 Era


Introduction

Marm Assistance’s Medical Evacuation and Repatriation services department organizes bed to bed patient transfers with medical escorts including the management of all regular and unexpected medical and logistical assistance until the final destination is reached.



Case History

A 74 years old Dutch female patient who suffered a small sized brainstem ischemia about 35 days ago was required to be repatriated back to her home country Netherlands from Northern part of Cyprus on stretcher. She has been treated in University Hospital for 5 days and then went back to there for flight assessment about 7 days prior to the planned repatriation. Her doctor stated that she has motion sickness and ataxia. She was able to sit up for some time but not usually more than an hour. She was cleared to fly in lying position with oxygen support by her neurologist.



Limitations

Patient was to fly from Ercan Airport in Northern Cyprus to Istanbul and then to Amsterdam. There was only one flight due to COVID-19 restrictions in each direction. Those flights were connecting with 75 minutes interval in Istanbul Airport.

The Medical escort from the Netherlands would have difficulty to fly to Cyprus directly because of the Island’s COVID restrictions. He/she would have to go to quarantine for 15 days.

Marm Assistance’s medical escort was based Istanbul and could fly to Lefkosa directly as long as he has a negative COVID-19 PCR test performed in the last 72 hours of his flight to Cyprus. But this time he was not able to fly to the Netherlands due to EU restrictions. Therefore it had to be wing to wing connection with two medical escorts. One to go and pick up the patient and bring her to Istanbul and the second would take over in Istanbul and fly her to Amsterdam.



Solutions

Flights and reservations are made. Marm escort has applied to PCR test two days prior the Cyprus flight. Thankfully, the test resulted early and he could fly on time.

Upon arrival to Lefkosa Airport all passengers were queued, scanned for temperature and taken to a new PCR test. They were asked to not leave their hotels at least for 8 hours after arrival. At that time the PCR test would result. And if they are negative, they start their plans. Arriving at the city at 2 am and checking hotel at 03:30 am. It was not really difficult to abide this small quarantine. Then the Ministry of Health has sent an SMS to my mobile saying that my PCR was negative. So our escort could go out and visit the patient for pre-flight assessment.

The patient was an 84 years old female. No significant neurological deficit other than ataxia and motion sickness were revealed. All appeared clear for tomorrow’s flight.



The following day (in fact two days later) the flight was scheduled to depart at 04:00 am. Our escort went to the ambulance station and was about to leave the hospital to pick up the patient when received a call from Turkish Airlines, stating that the stretcher from Ercan to Istanbul was OK but the stretcher from Istanbul to Amsterdam was no really OK. Due to change of the aircraft type the new flight was not able to accommodate a stretcher (Although it was a bigger and newer B787 Dreamliner). We went to the patient’s address anyway and discussed the plan with them. Patient would agree to fly stretcher from Ercan to Istanbul and then continue in flat bed business class. However Turkish airlines could not do this since the reserved flight planed cannot be broken down. We even tried to fly to Istanbul now and stay there in a hotel or hospital for tomorrow’s flight, but TK could not do this either. There would be no flight tonight. So everyone went back to their business.


The next day, everything went smoothly as planned. Picked up the patient, performed antithrombosis prophylaxis and arrived at airport early. Took off on time and arrived in Istanbul on time. There were no pillows or blankets on the airplane. Additionally, the 2 rows of seats just next to the stretcher were being reserved as a possible isolation area for ill passengers. Therefore, it was not possible to sit just next to the patient. You would sit a little ahead of the seat. Patient was unloaded and directly loaded to the Amsterdam flight. Marm escort have communicated with the next escort doctor to meet him in the airplane. The handover was smooth. Amsterdam flight took off on time with the patient on stretcher

.

Conclusion

Current COVID-19 restrictions vary from country to country and origin of the escort or patient, so missions require much better planning and if necessary combined missions.

PCR testing on a timely manner is now a critical point for some routes. Delayed results may risk the whole mission

Flying patients on board have new restrictions e.g. absence of any pillow or blankets, lack of alternate dietary choices and fluids, not being able to sit next patient.

Another issue to mention here is the frequent schedule changes and cancellations.

We have a new onboard announcement now. Dear passengers when oxygen masks are dropped please remove your face mask before you put on your oxygen mask!...



Dr. Mevlut Cengiz

Marm Assistance, Turkey

mevlutc@marm.com.tr

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