Following a Covid19 repatriation mission every step of the way

Coronvirus has forced us all to find new ways to live and work – and for a company like European Air Ambulance (EAA), one of Europe’s foremost aeromedical service providers, developing Covid-secure transport methods has been absolutely crucial.

As Director of Sales and Marketing at EAA - I know just how much things have changed in the past year. But while I can ensure that our existing and potential clients know how we’ve adapted, I thought it was time to see our new Covid19 procedures in action first-hand - by joining the medical team on a repatriation mission.

I wanted to share the experience:

As part of my role at EAA, I know all the details of our Covid19 missions and understand the adaptations we have made to ensure safe transport in this new age of Coronavirus. I’m confident to sell this service within the travel insurance industry but I realised that as a non-medical person, it was also an important experience to actually be at least once on board the aircraft with our medical experts during a mission to transport a confirmed Covid19 patient.

So this month (February 2021) I joined an EAA team as they repatriated a patient from Skopje in Macedonia to Vienna. This was my first flight in exactly a year. The last time I was on board any aircraft was in February 2020 on my way back to Luxembourg from a conference in Dubai. Shortly after that trip the whole world changed of course, and in a way that we could never have predicted. 

From a professional point of view, there were no more flights for client visits, conferences or meetings – all of these moved online. And for the family we chose foreign trip to neighbouring country where we were able to travel by car. 

Who would have thought a year ago that the world would change in such a drastic way, with so many of the personal freedoms we have always taken for granted removed from us by the virus? I could see the irony that my first time back in the air was to accompany a Covid19 patient.

We took off from Luxembourg on a bright but cold February morning on one of EAA’s Learjet 45XRs, fully equipped with our Infectious Disease Unit (IDU) which enables us to safely transport highly infectious patients. 

It was designed for use with Ebola patients, but has been adapted to transport those with Covid-19. The unit is a versatile modular tent system, with room for the patient to lie down or sit. Medication, food and drink are placed inside the tent, and can be administered as required during the flight by medics outside using gloves built into the unit.

All EAA missions are crewed by a specialised and multilingual medical team of at least one physician and one flight nurse, who must be qualified in emergency medicine and undergo continuous training. Even the best planned and seemingly straightforward missions can run into complications, so our staff need to be able to deal with any potential medical situation that could develop during a repatriation.

On this flight it was Dr Paris Kontokostas and flight nurse Dominique Donner. It was fascinating to watch them at work and see the whole process ‘live’ - from the medical evaluation of the patient’s notes prior to boarding the plane, to the set-up of equipment in a way that not only matches our already high standards but takes into account the need for additional Covid precautions; from the handover with the teams on the ground at each end, to the professional but warm ‘bedside manner’ of our medics with the patient. 

All of us onboard, including the flight crew, wore FFP2 masks throughout the entire mission – this is an additional precaution we take on all our flights, and is more a protection from each other than the patient, who was of course to travel enclosed in the IDU.

Despite the masks, on the outward journey I was able to chat with Dr Kontokostas who told me how in 2015 he had been involved in the repatriation flight of an Ebola patient – and could therefore describe the similarities and differences with a Covid19 mission and the adaptations needed, as all infectious diseases require different procedures.

We landed in Skopje a short time later, where it was cold and very wet. The patient arrived short after in a ground ambulance to the airport tarmac and parked right next to the aircraft door, allowing us to minimise the transfer time in between vehicles. He was wearing a FFP2 mask, and the local medical team who accompanied him were in full-protection PPE. 

Meeting the patient, it became clear that our IDU was the only option for the transfer to Vienna and we had made the right decision on equipment. He was a tall, broad-shouldered and strongly-built man, and it wouldn’t have been possible to use any of the other isolation systems – such as the ISO-Pod or EPI-Shuttle – which would simply have been too small.

The size of the IDU is similar to a one-person tent, and we can also transport personal belongings inside it so the local team passed over the patient’s things – they were put in a bag, which was sealed, disinfected, placed in another bag and put inside the IDU on the ground.

The patient was well enough to walk onboard by himself, exiting the ground ambulance and entering the IDU tent inside the Learjet through an airlock tunnel placed between the two vehicles, ensuring he had no direct contact with the aircraft. The airlock was then closed, sealed and disinfected by the flight nurse before being folded back, and the whole team prepared for take off.

The patient was monitored throughout the 90-minute flight by Dr Kontokostas and Flight Nurse Donner. Despite him being inside the IDU and the medical team outside it, both parties could communicate normally and the arrangement didn’t affect the level of care he received. For some patients, intensive medical care is required during the flight and this can be administered via the built-in glove sections of the IDU – but although Covid-positive, this patient was in a better condition and thankfully the flight was uneventful.

After landing in a windy and icy Vienna, our pilot took the plane to a dedicated area of the airport, secured by an official escort of two security vehicles. With the engines off, Flight Nurse Donner - wearing full PPE - opened the airlock, extended the tunnel, and the patient was able to walk through straight out of our aircraft and into the ground ambulance where the Austrian medical crew waited (also in full PPE of course).

While Dr Kontokostas completed the medical handover, our nurse’s duties moved on to disinfecting the interior of the IDU to remove any trace of the virus in order to avoid unnecessary risks. The airlock was closed up and cleaned, the nurse was disinfected outside the aircraft by the doctor – and all the PPE worn during the flight was put into a separate container and disinfected again, ready to be incinerated back in Luxembourg (by an external accredited company), along with the IDU itself which was dismantled after landing.

Although this was a relatively straightforward mission medically-speaking, it was very useful for me to see the whole process from start to finish in this new era of Covid – which I have talked about many time but hadn’t experienced directly. It was impressive to see how clearly the processes were established so that the patient would not at any point come into direct contact with the aircraft interior and how the medical and flight teams were familiar and comfortable with the extensive Covid measures.

I know there are many concerns about travelling by air at the moment, but looking back at this mission, I have to say I personally felt safer sitting in the aircraft with a Covid19-positive patient inside the IDU, than being on a regular flight - where I would be wondering if the passenger next to me might be carrying the virus.

Covid19 is now part of our world – and we have to live with it on a daily basis. We cannot lower our guard in the fight against the virus and all its mutations, as despite all the progress it remains highly contagious and can prove fatal for some patients.

But society is adapting to it, and our travel insurance industry is rapidly finding new solutions to this new reality. The proof is there to see in an infectious disease mission like the one I joined – which would have been exceptional a year ago, but is now part of our regular service.

Author: Patrick Schomaker

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