Medical evacuation is one of the most complicated and most expensive medical services for crew members. In this article, Dr. Ilya Rapoport, Medical Director at AP Companies Global Solutions, introduces a case study, based on a case that took place in 2019.
Background
Every year international cruise line companies bring thousands of guests and crew members from different countries, to new beautiful and remote areas of the world, commercial ships increase their routes to more and more difficult locations. Sometimes medical emergencies happen in very remote locations and in such cases, shipping company, medical assistance company and local healthcare provider have to work in a close cooperation in order to save the life and health of the patient, so that he comes back to his work or to his home country as soon as possible.
In the Pacific Ocean, local healthcare providers are very scarce, these facilities often provide only basic care, there are no professionals or relevant equipment to treat serious conditions, such as neurosurgery or modern rehabilitation.
The case
23.12 of 2019, around 23.00, AP Companies Global Solutions received a request to arrange medical help for the crew member of a big Cruise Ship, 30 year old, Bosnian citizen, Maria Hodzic (the name has been modified for the sake of GDPR purposes). The ship was on the way to Noumea, New Caledonia, in the middle of Pacific ocean. She suddenly suffered from the low paraplegia, which was a result (as it was discovered later) of the spinal stroke of a vascular origin.
Operational challenges and plan
Our plan was to deliver Maria to the New Caledonia Hospital, taking into account all visa and legal formalities, let the local doctors stabilize her condition and to diagnose her, then, once Maria was fit to fly, transfer her to Europe for further medical care and rehabilitation. In case of neurologic diseases and muscle impairment, it is of vital importance to start rehabilitation as soon as possible in order to restore the functions
It was clear that the patient would require either Air Ambulance transfer or a regular commercial flight with stretcher and medical escort. AP Companies started to check local air ambulance providers immediately. In AP Companies, we prefer to use our experienced in house medical team, rather than outsource it, so we found the right specialist who was holding all the relevant permissions and visas.
Transportation from the ship to the local hospital
AP Companies was considering several options on finding the quickest way to deliver patient from the ship to the hospital. Unfortunately, due to severe winds in the area, air evacuation was not possible and the Ships was approaching Noumea in 12 hours. Hence the decision was made to arrange a ground ambulance for the crew member upon her arrival to the Port for immediate transportation to the hospital in Noumea.
From the hospital in New Caledonia to Europe
AP Companies network team, carefully selected a hospital in Noumea, that would be the best option for the first aid and diagnostics, and the patient stayed in ICU of this hospital for one week. After that, Maria was transferred to a neurological ward, and initial FTF form was issued for an Air Ambulance transfer. The cost of Air Ambulance from Pacific to Europe, as you may imagine, was extremely high.
AP Companies is international medical assistance company with a wide experience of evacuations and one of the important points of every mission, is keeping the right balance and taking care of both: the patient and the insurer or employer.
AP Companies Medical team had a brief discussion with doctors from New Caledonia, and came to a conclusion that additional stay at hospital at Pacific and start of rehabilitation treatment there, will give the patient a possibility to travel to Europe in a business class seat at the regular flight. After this additional week of admission, the patient was able to walk with a walker and was ready to go to back to Europe.
Maria was Bosnian, but she requested to be hospitalized in one of the clinics in Switzerland, where she had a support from one of her family members, who was actually working in the rehabilitation hospital. The cruise line decided to provide this extra effort considering such a serious condition.
AP Companies selected the escort doctor, specialized in medical care and neurology, one of the most experienced specialists in evacuations in the company. The operations team, resolved all the questions with the airline, booked the flights, filled the relevant paperwork, everything was ready: air evacuation on commercial flight from New Caledonia to Switzerland, with a change of air craft in Tokyo, Maria was accompanied by medical specialist during her entire trip.
After a long flight, the patient successfully arrived to Geneva and was transfer to an emergency hospital in an ambulance, that was the agreed procedure, to make sure the Maria’s condition after the flight was good and no further emergency treatment is required. Everything was fine.
The patient was immediately admitted to one of the best Switzerland clinics for rehabilitation. Since the clinic was very well known for the quality of its services in the field of rehabilitation, it was a challenge to get the patient admitted with no waiting time, but AP Companies Network team is used to this challenges and managed to negotiate the quick admission.
Once in Switzerland, the crew member’s condition quickly improved, as she was already together with her family, she went through necessary treatment, and when she was fit to travel, AP Companies found the best qualified hospital in Croatia, where the member could get all required physiotherapy, hydrotherapy and other rehabilitation therapies, that helped her to get back her full mobility and return on board.
This case is a clear demonstration of how important it is to count on relevant professionals in medical assistance, and how these professionals may resolve such complex situations in the best and most efficient way for both: crew member and ship owner.
The views presented hereabove are only those of the author and not necessarily those of SAFETY4SEA and are for information sharing and discussion purposes only.
About Dr. Ilya Rapoport, MD, PhD Medical Director
Dr Ilya Rapoport, MD, PhD, Medical Director of AP Companies Global Solutions, graduated as a medical doctor from the Russian State Medical University and went on to study at Lund University, Sweden, and Oslo University, Norway, in the field of healthcare management and administration. He has vast experience in the management of multinational and multicultural teams of doctors in all fields of medical assistance, including medical evacuations and cost containment.
