Medilink International personnel are currently in the frontline organising the air ambulance transfers of Covid-19 patients across the globe, in particular from northern and central Africa to Europe. Our medevac operations are working to both repatriate patients to their home countries as well as to suitable third-country jurisdictions with the requisite and available healthcare capacity and capabilities to treat them urgently.

Medilink, as a provider of medical services to entities operating in often remote and extreme regions, has long experience built up over two decades in the specialist field of aeromedicine, including the medevac transfer of patients with infectious diseases. However, Covid-19 has instigated particularly demanding, stringent healthcare protocols in regard to patient well-being, medical care and transfers arising from evidence-based praxis and on-the-ground insights and experiences.

Here, we outline some of the key organisational, clinical and precautionary measures of relevance not only to medical staff similarly facing Covid-19 patient air transfer, but also to entities who find themselves needing to organise medevacs for staff who have tested positive for Covid-19, or who are suspected to be at risk as a result of exposure to the virus.

Pre-emptive and Early Diagnostics in Covid-19 Medevacs

Do not underestimate the seriousness of each diagnosed or suspected case of Covid-19, particularly if the patient is located in an under-developed or remote location without access to good quality medical provision. Some cases may be classed as asymptomatic, but only because the facilities do not exist to identify the issues and diagnose the problems.

At face value and at the outset, a patient either diagnosed with or suspected of having Covid-19 may seem well, however their condition may deteriorate very quickly. We advise medical and other frontline personnel involved in triage and early diagnostics to not take any chances.

In this particular pandemic, the repatriation of positive or suspected Covid-19 patients to their home countries should be considered and anticipated before their health deteriorates. The air transport of critical patients, especially those requiring to be ventilated and needing isolation chambers, pose innumerable challenges to the crew and to the patient.

Critical Organisational Factors in Successful Air Transfer of Covid-19 Patients

There are immense challenges in transferring Covid patients across national jurisdictions. Our advice is not to underestimate the bureaucratic complexities involved; Covid-19 transfers are public health cases and there are issues to deal with at each national border.

The transfer of Covid patients requires the authorization of public health authorities at both the sending and recipient destinations. We advise activating the bureaucratic process as soon as a case is identified as it can take time to obtain authorization.

Clinical Preparation for Air Ambulance Transfers of Covid Cases

Each entity involved in the medevac chain of command needs to know what they are dealing with and how to prepare and cope. Containment and isolation are imperative and strict protocols must be followed for use of isolation chambers.

Following the Covid-19 medevacs we have carried out to date, we have made various improvements to the chambers and updated our standard operating procedures in light our our recent experiences.

In addition to preparing the aero-medical flight crew, patients themselves must be briefed on what to anticipate; travelling in an isolation chamber is claustrophobic and an unknown experience for patients who need to be prepared for the mental, not just physical demands of the evacuation.

Medilink ensures its clinical governance team review all the steps in the mission. A careful pre-flight assessment is prepared in order to understand the patient’s real needs during transfer and to ensure robust plans are in place to prepare for a worst-case scenario.

Our planning runs from the preparation of the patient to enter the isolation chamber and the loading of the chamber on board, to the procedures and protocols for in-flight care, the unloading of the chamber at destination and patient handover to the receiving healthcare provider. Each stage in the air ambulance transfer is reviewed in detail by our clinical governance team to provide data and feedback on improved practice for future missions.

All Medilink missions were carried out successfully and in close collaboration with local health authorities in the countries concerned, and in accordance with the latest WHO technical guidance on Covid-19 prevention and control, including recommendations on personal protective equipment for all crew and the airway management of the patients.