When Roger Brankton arrived in Singapore take part in a charity basketball event, he had only happy thoughts – do a good deed and enjoy the game! But the affable young man got more than he bargained for. Roger sustained C5/6 spine dislocation during the game. It was one of those freak accidents and he ended up with extreme flexion/extension injury to his cervical spine. The treating physician showed that there was a C5/6 posterior fracture and unstable spinal column.
Roger underwent a posterior fixation and stabilization and was extubated the next day. Assessment showed complete paralysis of the right upper arm while the left arm was able to perform some horizontal movements. Although he was, undoubtedly, receiving excellent care in Singapore, arrangements were made for Roger to be repatriated to London. Home is, as they say, where the heart is. Especially so when one has met with an unfortunate accident.
EMA GLOBAL To The Rescue
In order to get him back to London in the shortest time possible, without having to spend too much time on transit, a wing-to-wing transfer at Athens was arranged. This means that one air ambulance was used to transport him from Singapore to Rome where another air ambulance with its own medical team would be waiting to take him home to London. Using only one air ambulance would mean having to spend time in Rome for the flight crew to take their mandatory rest time.
What EMA GLOBAL Did
Prior to departure, EMA GLOBAL’s Medical Director and a senior nurse, together with the medical escort team, made one final assessment to ensure he was fit to take such an arduous journey. Roger, by that time, was able to sit up (albeit with a neck collar) and appears to be comfortable and was able to participate in the discussion. He had a slight fewer at that time (37.5 degree C) and still had some retained secretions in the upper airway but fortunately, that was not enough to jeopardize his tidal respiration. Vital signs then showed a HR 60/min, BP 150/70 with oxygen saturation at 97%. And the good news – he was eating normally.The medical escort team felt that he should be re-intubated and ventilate him for the repatriation. EMA GLOBAL’s Medical Director strongly recommended against this, highlighting the fact that the patient was a young man of only 22, had showed a lot of motivation to breathe on his own. In addition, his vital signs were normal. Other factors supporting his recommendation against intubation included:ABG done at room air showed PaO2 86 mmHg with normal pH and CO2. The air ambulance was equipped with nasal BIPAP to support him on flight if necessary. Endo tracheal tube would be most uncomfortable for him, requiring massive sedation. The medical escort then agreed that the patient need not be re-intubated for the flight to London.
The repatriation was uneventful. Whilst the abdominal binder was kept on throughout the flight home, the neck collar was released after take-off and re-applied before landing. The patient was sedated with Lexotan throughout the flight. Vital signs were normal and the oxygen saturation was above 96% with intranasal oxygen at 1.2L/min.
When you are on holiday in a beautiful and romantic setting, the last thing you expect is a medical emergency. But that was exactly what happened to James O’Reilly who was on his first trip to the Maldives. Walking on the beach in knee deep water, he suffered a very deep cut and started to bleed profusely. By the time he was taken to the Indira Memorial Hospital on Male, he had lost a lot of blood and was in shock. The tissue-deep laceration needed 12 stitches.
EMA GLOBAL was contacted and after an evaluation with James’ treating doctor during which it was revealed that he was diabetic, a decision was made to evacuate him to Singapore.
Just about 3 hours after EMA GLOBAL received the first call, an air-ambulance was airborne, with a medical team comprising an ICU-trained doctor and a nurse. Arriving in Male about 6 hours later, the medical team was whisked past immigration and taken to the hospital to assess the patient. James was still weak from loss of blood, running a high fever but his voice was barely audible. But at least he was stable so the team proceeded to prepare him for the evacuation. The flight to Singapore, with the patient under the constant care of the medical team was uneventful. As soon as the air-ambulance landed at Seletar, James was transferred to a waiting road-ambulance and admitted to the Gleneagles Hospital.
James was discharged barely four days later and repatriated to London with just a nurse escort. He confided to the medical team which took care of him that he is preparing to resume his disrupted holidays very soon.
We are sure the staff at the resort he was staying in will lay out the red carpet for his return!
Newly-weds, Richard Toh and his bride, Emily had planned their honeymoon months ahead. And of course, it has to be in the most romantic place – Paradise on Earth – the Maldives. Unfortunately, Richard became very ill on the third day. He was severely constipated and started vomiting and running a very high fever. The resort staff arranged for him to see a doctor on Male Island where he was diagnosed with “possible intestinal contusion”. EMA GLOBAL was then contacted and a lengthy evaluation via a conference call was conducted. EMA GLOBAL concurred with the treating doctor in Male but felt that there could be a risk of perforation. It was during this evaluation that Richard revealed that he was playing football a day before he departed for his honeymoon and that during the game, he was kicked in the stomach by another player. EMA GLOBAL immediately launched an air ambulance to take him back to Singapore before further complication sets in.
Upon reached Male, the medical escort team comprising a gastroentologist and a nurse went immediately to assess the patient. The fever had not subsided. The team called back to EMA GLOBAL to consult with our medical panel who felt that the risk of perforation was very real and instructed the team to depart for Singapore immediately. That decision was probably the best wedding present the newly-weds have received for when they reached the receiving facility in Singapore, a scan confirmed that there was indeed a perforation.
Richard underwent emergency surgery which went very well. Four days later he was moved out of ICU where the medical escort team paid him a visit. He was sleeping but a grateful, Mrs.Toh thanked the team profusely, adding that Richard’s first words when he woke up after the surgery were “Sweetheart, let us go back to the Maldives and continue with the honeymoon!” What he did not know was that the resort manager had called up Mrs.Toh to ask after him and promised a complimentary stay when the couple was ready to resume their honeymoon!
Patient from Bangkok, diagnosed with severe heart and lung failure, was admitted to the Singapore General Hospital. Further complications resulted in a deterioration of his condition resulting in the inability of both organs to function. Patient was then put on the extracorporeal membrane oxygenation machine, a state-of-the-art medical equipment (commonly known by its acronym ECMO) designed to provide both organs with cardiac and respiratory support oxygen to the patient.
A month after admission, patient was advised by the treating doctors to return to Bangkok for continuation of treatment while waiting for a heart transplant. That was when EMA GLOBAL was first contacted by patient’s family with a request for a medical repatriation.
Preparation for the repatriation was arduous, particularly the delicate task of transferring the patient from the hospital’s ECMO to the mobile unit. And the road ambulance transfer from the hospital to the airport took a full two hours with the medical team keeping watch on the ECMO for any sign of distress from the patient. Finally the air ambulance took off for Bangkok.
It was an uneventful flight. Patient was transferred to a medical facility on arrival in Bangkok and just over 3 months later, he underwent a very successful heart transplant.
Against all odds, patient was given a new lease of life.
Living and building a career in the exotic Far East has been the dream of British man, Michael Moore. Michael had been doing just that in Singapore for the past 20 years when an unexpected medical situation turned his dream into a nightmare.
In November 2015, Michael suddenly exhibited severe weakness in his lower limbs. He was hospitalised, where his condition deteriorated while undergoing a series of tests. Michael was diagnosed with an idiopathic neuro-muscular disease causing him to lose control of all four limbs.
Michael’s family decided to repatriate him home to Brighton, United Kingdom for long term rehabilitative care. Michael consulted his insurer and his insurer agreed to cover the cost of his repatriation.
Michael’s insurer subsequently entrusted the complex and difficult mission of repatriating Michael to EMA GLOBAL. When EMA GLOBAL took on the case, arrangements were made for an experienced medical escort to provide bedside-to-beside care for Michael from Singapore to Brighton.
Having lost control of all four limbs, Michael would literally slide down and slip off his wheelchair. The frustrations turned the once very affable patient into an aggressive and abusive personality. A direct flight to Heathrow Airport was selected for this reason followed by a 6 hour transfer via land ambulance to a NHS hospital in Brighton.
During the 13 hour flight to London, Michael was made as comfortable as possible, lying down on a flat bed, and propped up with lots of pillows, and kept snug and warm with blankets. A special request was also asked of the flight crew to allow him to lie down all the way, even during landing at Heathrow.
Michael remained confused most of the time, despite taking the prescribed medications. He would at times be out of control, shouting and cursing. EMA GLOBAL’s medical escort had predicted this behaviour and ensured that his wife and the cabin crew were briefed on the best way to manage Michael and the situation.
With EMA GLOBAL managing the tense situation, Michael would calm down rapidly after a flare up. This initiative helped smoothen the long journey as Michael’s wife, unable to cope with both her husband’s illness and change in personality, started to exhibit signs of depression.
Upon arrival at Heathrow Airport, EMA GLOBAL discovered that the wheelchair assigned to Michael was completely unsuitable for a patient in his condition. The wheelchair was very narrow and did not have a single strap to secure a patient to the chair. This would be unsuitable for Michael who would slip off the chair. With Michael constantly slipping from the chair and his flailing limbs, it was going to be yet another long journey to Immigration and the Arrival hall.
However, resourcefulness saved the day when EMA GLOBAL’s medical escort decided to utilise a long scarf and three pieces of long plastic bags as props to secure Michael to the wheelchair. Although unconventional, this worked and the team finally made it through the Arrival hall where the ambulance crew awaited.
The ambulance crew wheeled Michael to the ambulance and transferred him to a stretcher for the long journey to Brighton. During the 6 hour ride, Michael was once again very restless and confused, and aggressive. He even refused assistance when he threatened to slip sideways off the stretcher. EMA GLOBAL’s medical escort once again handled the patient firmly and gently and managed to get the situation under control.
Finally after a long arduous journey, the team reached the receiving hospital where they were met by Michael's very anxious and loving parents. Michael’s wife was exceedingly relieved and grateful that EMA GLOBAL had managed to reach Brighton safely. Michael’s wife expressed her gratefulness for the comfort, reassurance and professionalism for EMA GLOBAL during the journey.
Singapore will be waiting for Michael Moore to return and continue building his future.
"This could have potentially been a fruitless task had the patient been evacuated using a different provider."
As soon as the patient went on the ventilator the possibility of evacuation to Singapore was being considered – primarily because of the relatively poor medical facilities in Maldives. A simple web search yielded EMA Global as one of the better Singaporean parties, and their response to the request for options, emailed at 0130 Singapore time, was almost immediate. Three emails later a ballpark figure of the overall cost was offered, and within 4 hours two options were offered along with ETAs for each.
However, a firm decision to airlift the patient remained pending until the patient’s doctor in Singapore was consulted. Upon consultation, the patient’s doctor ordered his immediate evacuation and recommended EMA Global as the provider. This reaffirmed that EMA Global’s web presence was on par with their reputation. Additionally, because they had readily provided options upon inquiry, confirmation of the evacuation simply meant the choosing of one of these options.
Also noteworthy is EMA Global’s assertion on preparing the paperwork for the operation even before the mission parameters were agreed upon. This could have potentially been a fruitless task had the patient been evacuated using a different provider. This diligence meant that within 20 hours from acceptance of the mission parameters, the flight touched down in Maldives.
The doctor and nurse whom EMA Global tasked to the operation were the best one could hope for. Both remained unequivocally professional throughout the many challenges posed by a hospital hampered by mediocre policies. Despite the heat and a challenging sea journey, which is currently unavoidable in reaching the airport from the capital city, the team ensured the patient’s safety.
No more than 6 hours passed after taking off from Maldives before the patient arrived at the hospital in Singapore, in the same condition as he was when he was moved from the hospital in Maldives. In total, it took less than 36 hours from the time the decision was made to airlift the patient to Singapore. Most importantly, the patient now has a chance of surviving life threatening medical complications, which would likely have not been appropriately treated at the hospital in Maldives.
Thank you for the follow up and I look forward to hearing more about his test results.
I would like to express my deep appreciation for the physician and nurse on the aircraft. I can't recall the physician's last name at the moment, but his first name is Eric (like me!). Please pass on his last name if available.
The physician and nurse are highly professional, pleasant and polite to talk with, and demonstrate excellent medical care. They appropriately expressed concern about the patient's breathing and airway and we all mutually decided to intubate the patient before boarding the flight. This was accomplished successfully through teamwork (BHC medical staff working together with the flight medical staff), which prevented inflight breathing emergencies for the patient.
This is the second time I have worked with "Dr. Eric", and both interactions have been very professional. I would be pleased to work with him again in the future. I request that my gratitude and appreciation be forwarded to his company and to him."
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