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The Risks of Premature Patient Transport
by Kip Gibbs, Assist America’s Vice President of Global Operations

“Why can’t we move him today? I just checked on-line and there are plenty of available flights!"

“We can’t stay here: these doctors aren’t trained right and don’t know what they’re doing!”

“She’s feeling much better today, so we’re just going to take her out of the hospital and wait at the hotel until you can arrange her transport home.”

When confronted with medical emergencies while away from home, it’s not surprising that people, even the most experienced travelers, can become overly anxious and worried. It’s only natural. However, that is the precise time that calm and controlled expertise is needed to sort through the details and formulate sound plans with the patient’s best interests in mind.

Among the key tasks for an assistance company are medically supervised evacuation and repatriation. The formulation of transport plans is multi-tiered and must take into consideration a variety of factors including the degree of the patient’s stability, the level of care provided by the treating facility and medical team, and the length of time the patient must travel. The plans are dependent upon a number of factors such as required medical clearance from an airline and acceptance on the receiving end by a medical setting like a rehabilitation center. Even the weather factors into the plan. Additionally, there are other matters to contend with such as underlying illnesses, passport and visas considerations, and language and cultural barriers. All said it’s a complicated process.

So, when an anxious traveler is confronted with a complicated process, the end result can be frustration, which unfortunately clears a path for hasty decisions such as demands for premature travel home.

Unstable medical conditions present an obstacle to repatriation. If a patient is being treated appropriately then any travel plan would usually wait until it is established that the patient could withstand the rigors of the transport. Even though it is an inconvenience to the patient and family for the patient to be hospitalized far from home, to extract the patient from a clinically secure environment before it’s safe to do so can put the patient at risk, sometimes great risk - up to and including death. There was once a case in Bulgaria where an elderly patient had a simple appendectomy performed in a seaside city. Due to a surgical error, the patient’s bowel was perforated and the resulting infection quickly became life threatening. As that patient began to suffer multisystem failure, he was evacuated to nearby Istanbul where he was hospitalized for a month as he slowly recovered and stabilized. His family was extremely eager for him to return home to the US, and so they pressed for early discharge from the hospital. However, to do so would have compromised his already precarious condition even further. The family was persuaded to wait, the patient survived and was eventually safely repatriated under medical supervision.

People accustomed to high quality health care can be wary of care elsewhere, especially abroad in unfamiliar surroundings. It is a myth that high-level care can only be provided in the US, and while many understand that intellectually, their judgment can be challenged when faced with dire emergencies abroad. Consider the following:

1) According to Traveler’s Digest, over 450,000 people go to Thailand every year expressly for receiving medical treatment. There is an array of high-level treatment options there at low cost, so this is an ideal place for patients in emergency situations.

2) Hospitals in South Africa have long been considered desirable evacuation destinations for patients in sub-Saharan Africa. South Africa is where the first human heart transplant took place in 1967 when Lewis Washkansky received a heart at Groote Schuur Hospital.

3) The UAE has a well developed healthcare system with excellent standards. Medical facilities in Dubai and Abu Dhabi are accustomed to expatriate and foreign patients. In fact, much of the medical staff there is foreign trained.

The list goes on: India, Israel, Singapore...these are but a few examples where high-level medical attention can be obtained.

Still, it is understandable how patients and their families feel about the comforts of home. In fact, some may go as far as discharging themselves from hospitals against medical advice in an effort to get home more quickly. Generally speaking, this is a bad idea, particularly when it’s been established that further hospitalization is critical for the patient’s stability and recovery. Under these circumstances an assistance company might opt to withdraw from the mission.

There is a saying that time heals all wounds. Perhaps not always true, but time is often necessary for a patient to be in a safe position to travel. Moving a patient before he or she is ready carries risks, and the decision should not be taken lightly.


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