MedPark Medical Escort Center: Flight escort and life support team

At tens of thousands of feet above sea level, many passengers may be resting, unaware that one of their fellow travelers cannot stand, walk, stretch, or perform self-care. Moreover, the person is at risk of complications every second. A medical professional team is on board to closely monitor the vital signs and physiologic parameters.

They are the flight medical escort team. The goal is to ensure a safe journey even when facing severe air turbulence or unexpected circumstances. Today, we proudly introduce MedPark Medical Escort Center, led by Dr. Patima Puttaphaisan, who takes on the mantle of a flight physician. Let's keep reading to understand how they collaborate as a team to ensure safe air transportation.

Flying has physical and mental impacts

“Have you ever noticed how uncomfortable you were, feeling nauseous with dry mouth and throat and difficulty breathing? These symptoms are more pronounced in sick people. They may feel just a little tired at rest, but the symptoms worsen once aboard a flight due to lower oxygen tension, imparting a higher workload on the heart. The mental and physiological stresses can result in complications.”

Dr. Patima plainly explains when we are on a plane, bodily organ functions, including respiratory, cardiac, and circulatory functions, and the inflation of the lungs will differ from when we are on the ground. With lower cabin pressure and reduced oxygen tension, patients need special care and close monitoring throughout the entire flight. Many may be familiar with aviation doctors, escort doctors, medical escorts, and flight nurses—all are medical professionals accompanying patients on flights.

“We look after patients like doctors and nurses do on the ground. The difference is that we must know and understand the physical and mental impacts of flying on the patients. Under a flight emergency, we must be able to prevent complications, save patients' lives, and provide proper and effective care according to safety standards. Additional training courses are required to gain such skills and knowledge.”

On the path to becoming escort doctors or flight nurses, various training courses are waiting to be completed, including aviation physiology, advanced cardiovascular life support, aeromedical evacuation, emergency nurse specialist training, etc.

Minute-to-minute monitoring to maintain a stable condition

Before starting an aeromedical evacuation mission, the medical escort team assesses the fit-to-fly status of the patient and whether evacuation can proceed smoothly without complications. With limited space on board an aircraft preventing the tagging of extra medical equipment and accommodating only a few medical professionals, an evacuation plan needs to be exacting.

“After assessing the patient passes the fit to fly status, we then focus on what problems could arise and what is the worst-case scenario. We envisage the worst thing that can happen so we know who will be responsible for what in a particular circumstance. For example, I will be responsible for the patient's respiratory function. The nurse will take care of administering medications. In addition, a briefing on what signs need to be specifically focused or what is a warning sign indicating a change in a patient's condition.”

Dr. Patima provided examples of the individual task assignment within the team, emphasizing pre-planning before commencing an aeromedical evacuation to ensure a patient's condition is as stable as possible in an emergency.

“We need to meticulously plan on deciding what necessary device to carry. We may even call it mobile ICU in some cases. Most evacuations utilize air ambulance in the form of a private jet or small aircraft tailored specifically for transporting one patient. If all devices are ready onboard, how about the electricity supply? Assuming a 10-hour flight, we need to know how many batteries we must have, whether oxygen will be sufficient, and have a plan B if electricity runs out. The evacuation has to proceed as smoothly as possible.” 

Spreading its wings: MedPark glides patients home through air transportation

Everready for high-acuity and complex diseases, MedPark Hospital receives patient referrals from upcountry or overseas hospitals. To elevate the services to meet the acuity requirement, MedPark established its Medical Escort Center. Its mission is to transport patients by air to MedPark Hospital or their preferred destination, whether in their hometown or hospitals within or outside Thailand.

“Aircrafts used in medical transport include rotary-wing aircraft or helicopters and fixed-wing aircraft. Fixed-wing aircraft are of two types: private jet or air ambulance and airliner or commercial aircraft. Commercial airliners will fold down the rear passenger seats to create room for patient quarters. Only patients, doctors, and nurses are allowed in this area.”

“Due to weight limitation, the interior of a helicopter for medical transport has to be hollow and empty. We bring all necessary medical equipment, medications, and medical supplies ourselves. Suppose it is a medical transport for a critical patient with a tracheotomy tube connected to a ventilator; the equipment we supply would include a ventilator, a high-performance but lightweight blood pressure, and a pulse oximeter monitor. We also bring medications required for emergency during the flight.”

For medical transport on commercial airliners, the MedPark Medical Escort Center will dispatch a team to receive patients or send them off at Don Mueang and Suvarnabhumi International Airports. For medical transport through rotary-wing aircraft (helicopter), patients can be picked up and dropped off at MedPark Hospital via the helipad on the rooftop of the building, designed and built according to ICAO (International Civil Aviation Organization) standards. In addition, MedPark Hospital has been granted permission from CAAT (The Civil Aviation Authority of Thailand for the helipad landing of rotary aircraft for medical air transport, to which the hospital has signed a contract with a private medical transport helicopter provider.

“There is a room adjacent to the helipad dedicated to emergency procedures. When a helicopter lands, our doctor and nurses on stand-by can provide immediate medical attention. Patients can be whisked from the helipad to the emergency department, ICU, operating room, or cath lab via a dedicated, extra-large lift that comfortably accommodates a hospital bed and many people, allowing doctors or nurses to perform CPR within the lift.” 
 
Medical transport: A mission that relies on collaboration with a singular goal
Medical air transport of a patient requires multi-departmental team collaboration. Dr. Pattima outlines the steps and preparations before greenlighting an air transport process.

“For patients wishing to receive treatment at MedPark Hospital or return to their home countries, our staff will acknowledge the request and contact the center. Our nurse coordinator will gather the initial health information of the patient and forward it to a flight physician, who will assess for the suitable mode of air transport: commercial or chartered airliners. Then the flight physician will perform a fit-to-fly check and assess whether the patient's condition would require, in addition to a flight nurse, an accompanying doctor, and whether family members will accompany the patients.”

The nurse coordinator liaises with an airline or chartered airliner provider to coordinate and map out the transport process, informing the airline of the patient's implanted medical devices and the equipment the hospital brings for patient care during the flight.

Next, we liaise with the destination hospital to inform them what they should prepare for receiving the patient. Both parties will agree on the handover venue -- at the airport, on board the airliner, or at the destination hospital. Both hospitals exchange the name and phone number of the contact person at each meeting point, as well as the arrival times.  

Flight nurses and their roles in air medical transport 

Flight nurses play a crucial role in air medical transport. Lt. Sirinapa “Jom” Sukcharoen, a member of the flight nurse team at MedPark Escort Medical Center, possesses valuable expertise and extensive experience in providing first-aid care at trauma scenes. She is a graduate of the first class of the Emergency Nurse Practitioner program from the Faculty of Medicine at Siriraj Hospital, Mahidol University.

“Every minute is life and death to patients and must be saved. Therefore, we constantly train and take courses to ensure we can work quickly and efficiently, race against time, and maintain composure in every situation. For example, the Emergency Nursing Course has equipped us with the skills to use various tools and equipment effectively in pre-hospital emergencies that affect patients' lives, such as inserting breathing tubes, using automated external defibrillators (AEDs), and administering life-saving medications.”

The specific curriculum for air medical transports includes the courses of the Royal Thai Airforce Institute of Aviation Medicine, the National Institute of Emergency Medicine, and the Police General Hospital. Every flight nurse in our team has completed these training courses and possesses knowledge of advanced emergency medical management, advanced cardiovascular life support, and skills in liaison and teamwork.

Have the best preventive plan in advance

In addition to the abovementioned knowledge, flight nurses must possess a wide range of basic medical knowledge spanning various medical specialties. During a mission, you may come across patients with different medical conditions. You do not have the liberty to choose which patient to treat.

“We stumble upon patients with diverse diseases. Therefore, we must have working knowledge in various specialties like obstetrics and gynecology, internal medicine, surgery, and pediatrics. And patients may suffer from physical and mental ailments. Working aboard an aircraft, problem-solving skills are crucial for addressing issues like severe turbulence, sudden drop in altitude, and the patient developing complications, such as breathlessness, panic attacks, and more.” Jom added.

Jom added that for ground transport of critical patients, additional support from nearby hospitals or hospitals on the way is possible; on airliners, we cannot get help in midair.  

“We must anticipate potential problems and set up preventive plans in advance. Because if something goes wrong in midair, nobody can bring us medical devices or supplies.”

The key factors contributing to a smooth flight operation are always preparedness, problem-solving skills, teamwork, and language proficiency. We must communicate effectively with airport personnel, medical teams at the destination, and hospital staff. Clear lines of communication are paramount for ensuring seamless patient handovers throughout the medical evacuation process.

Regular review and continuous improvement

Jom shares her experience with air medical transport on a commercial airliner during a night flight to a Gulf Country.  

“The flight took seven and a half hours. Since the patient cannot sit in a wheelchair, a stretcher was necessary. We were the first group to board the plane and were allocated seats at the rear near a door. The airline folded nine seats to accommodate and secure the stretcher. Flight safety required securing the patient with three safety belts across the chest, abdomen, and legs. Our team positioned themselves near the patient's head to monitor breathing.”

Once we activated the actual transport process, there were things needing further review. The team is always sharing information to improve work efficiency. Khun Jom gave an example of the use of oxygen tanks.

“Before the departure, we requested the airline to supply oxygen tanks for the flight. We calculated the required oxygen tanks based on the patient's oxygen requirement in L/min. Once onboard, we double-check for the sufficiency of the plane's oxygen tanks. Another limitation was lighting; we could not turn on the light too bright for fear of disturbing other passengers. Moving oxygen cylinders from the storage compartment must be done with utmost care in dim light.”

Khun Jom concluded by expressing her admiration for the team's work ethic, highlighting their strong teamwork, friendly demeanor, unity, and dedication to serving customers globally. She emphasized, “Whether you are a Medpark customer or someone interested in using our services, near or far, we are happy to arrange transportation for you.”