Case Study: Emergency defibrillation prior to flight
When a patient is running out of time, it is imperative that the medical team operates as one cohesive unit, even if that team is scattered on the ground far from the company headquarters. In the world of international air medical repatriation, physicians and nurses must be able to promptly make collegial and bold decisions which eventually save lives. AirLec Ambulance reports on a mission where fast decisions made all the difference.
Mission
Airlec Ambulance was notified about the mission from a client seeking to fly a patient from Algeria to France. The patient was in septic shock following an infection contracted in the hospital in Algeria, where he had just had a splenectomy. Sepsis is the consequence of a serious infection that starts locally and then spreads. It usually affects patients with weakened immune systems and generally occurs after a serious surgical procedure. The terrifying aspect of this infection is that it can kill patients very fast, and easily.
Our mission was to transfer the patient to a French hospital where he would get further surgery to stabilize him.
Medical preparation
We deployed a full team, consisting of a physician and a nurse specialized in intensive care, in order to bring the patient back to France. Our medical director was following the mission from France and maintained permanent communication with the team on the ground.
Our medical team arrived at the airport of Alger and waited for the patient, who was driven to the airport by ground ambulance. When he arrived on the tarmac, it transpired that the team could not immediately take off as it usually does – in fact, an immediate takeoff was absolutely out of question.
The blood pressure of the patient was at its lowest and his heart rate at its highest. To put it simply, the patient was about to die due to septicemia.
Inside the aircraft, but still on the tarmac, the team only had a few minutes to decide whether to defibrillate the patient immediately to avoid cardiac arrest and save his life.
Cardiac defibrillation is very common in hospitals, but is much less common in the context of air evacuation. And it is even less common to do it before the cardiac arrest, and not after.
All our aircraft are permanently equipped with intensive care and resuscitation devices, and our team is trained daily to take care of such issues. Nonetheless, dealing with defibrillation the case as explained above is extraordinarily rare.
Move quickly
The team performed a two-minute long electrocardiogram, and two minutes later, the medical director and the doctor decided to perform the defibrillation in the aircraft.
The patient’s life was saved thanks to a strong team spirit on one hand and a bold decision on the other. By virtue of being in constant communication, the medical director was able to support the doctor on the ground in the decision-making process. Pictures of the medical constants and medical information was exchanged and discussed in real time.
Deciding to perform a defibrillation in such a context was a bold one. Indeed, such medical procedures are rarely made in air evacuation before a cardiac arrest. Even if an aircraft is a Faraday Cage that prevents its occupants from being hit by electric charges, defibrillation remains a high-risk procedure. In this case, the procedure saved our patient’s life.
The defibrillation enabled the reconfiguration of heart rate and his hemodynamic constants returned to normal. The patient was stabilized and ready for a flight to France. The worst had been avoided.
After this 90-minute period on the tarmac to stabilize him, the medical team were finally able to take off and head for France with the patient. During the three-and-a-half-hour flight, the patient was kept in coma, but his heart rate was stable enough to endure the trip without any other remarkable trouble.
Upon landing in France, the patient was taken directly to the French hospital and got the surgery that he needed.