Flying Team - Medevac: Voli Sanitari per rimpatrio di pazienti critici

VOLO UMANITARIO PER ATTIVITA' TRAPIANTOLOGICA: MISSIONE COMPIUTA. Domenica 27 febbraio 2011, in collaborazione con l'Ufficio Territoriale del Governo di Pavia, la Questura di Pavia, i Compartimenti Polizia Stradale di Pavia e Milano, il Consolato Italiano in Francia, la Presidenza del Consiglio dei Ministri e lo Stato Maggiore dell'Aeronautica Militare, abbiamo trasferito una paziente affetta da insufficienza respiratoria cronica globale secondaria a rigetto polmonare cronico (sindrome da bronchiolite obliterante) dopo trapianto polmonare bilaterale per ipertensione arteriosa polmonare in emorragia-teleangectasia ereditaria. La paziente, 40'enne originaria della provincia di Frosinone, è stata inserita nelle liste d'attesa del Centro Trapianti Organi Toracici dell'IRCCS Policlinico San Matteo di Pavia ma, in considerazione della limitata disponibilità di donazioni, dell'elevato numero di pazienti in lista d'attesa per un primo trapianto, dell'emogruppo e della taglia corporea della paziente, la stessa è stata rivalutata dal centro trapianti parigino che si è reso disponibile ad inserirla in lista d'attesa per il ri-trapianto prospettando una maggiore probabilità di eseguire l'intervento in tempi rapidi. Ad accompagnare la paziente dall'Unità Operativa di Malattie dell'Apparato Respiratorio del San Matteo di Pavia al Département de Chirurgie Thoracique Vasculaire et Transplantation Cardiopulmonaire Marie Lannelongue de Paris, un'equipe interdisciplinare del Flying Team - Medevac Service di Busnago Soccorso Onlus composta da medico anestesista-rianimatore, due infermieri di area critica e due tecnici dell'emergenza sanitaria oltre ad un'equipe sanitaria francese che ha preso in consegna la paziente all'Aéroports de Paris, Orly CGD. Approfondimenti

FLYING TEAM-MEDEVAC SERVICE is our operation division skilled in the organization and management of medical flights (also called "medical transfers by aircraft"). Depending on the clinical and logistic conditions, the medical transfert by aircraft is organized and proposed using schedule flights, aero-ambulances or helicopters with HEMS configuration. The istitutional activity of the flying team- medevac is:

- the study of the mission possibility

- to make an estimate of the costs to be beared (refund well-documented)

- the search of a more consistent medical staff for the patient's management

- the search of a spare bed in the place of destination

- the dispatch of the indispensable formalities to execute the flight transfert

- the availability of wheeled vehicles and their coordination

- the coordination of the Institutions and Hospital Departments involved

- the management of the necessary logistic for the patient's transfert

- the patient's transfert with medical escort

MISSION

To guarantee, at low costs, the access to the air transport for all the patients that need a” bed to bed “ transfert on medium and long trips. Recently, with the increase of fuel and a bigger competition between air vectors, together with the specifical agreements that BusnagoSoccorso has undertaken with some of the main european aircrafts, the flight transfert has become competitor also from an economical point of view. Naturally the first advantage of the flight transfert is the swiftness with which is it possible to reach the fixed destination besides other important and secondary betterments about the patient's confort, his less exposure at risks, his stress ( both physical and psychological)and his persistence outside a place of care. After 2 years of activity we have underlined as, in many occasions, thank to our own nature of being an ONLUS association, we have succeeded in proposing “all- inclusive” transfers with schedule flights at the same fares ( or rather with a few additional charge) foreseen for the trip made by an ambulance according to the kilometre refunds( refer to domestic flights with Alitalia, maximum fares came into force on 11/05/06, DGR VIII/2470/06 in Lombardy Region).

STAFF

The Medical Equipe that escorts the patient in all the phases of the mission, is normally composed by a doctor specialized in Anaesthesia and Reanimation and by a nurse from a Critical Area. In some particular cases, the presence of a Technical Operator- Rescue Helper, so as to assist the medical crew in the logistic aspects of the patient's assistance, is necessary. The members of the Flying Team are qualified in the patient's management on board by means of specific training sections.

EQUIPMENT

The Flying Team owns a technological and electromedical outfit ables to guarantee Intensive Care during all the flight also on schedule ones. All our electromedical equipments are certified for the use on board an aircraft and satisfy the requirements foreseen from the rules about flight safety and they are submitted to periodical certifications and controls.

The medical equipment is composed by:

- pumps syringe;

- monitor/defibrillator multiparameters with pacing, SPO2%,EtCO2, no intrusive blood pressure, pressures monitoring, 12 leads with a self-explanatory software and the possibility to transmit,also abroad, the ECG layout an the vital parameters<

- adult and pediatric lung ventilator with mounting: intermittent positive pressure ventilation, pressure controlled ventilation, pressure support ventilation, BPAP, CPAP;

- monitor BIS;

- necessaire for respiratory tracts advanced management ( traditional larynxscope, AirtraQ, laryngeal masks and kit for mini-tracheotomy);

- necessaire for the execution of emergency surgical manouvres ( pneumothorax dreinage, surgical traceability of venous access or respiratory tract, haemostasis management);

- drugs;

- remedies for the immobilization and transport.

WHICH PATIENTS CAN FLIGHT?

Accompanied medical air transport, particularly competitive on medium and long trips ( for example north-south of Italy) and for the places next to the airport, can be used by injured patients and by those afflicted by crhronical and acute pathologies. However, for some patients ( suffering pneumothorax, pneumoencephalon, heavy cardiopathies, some infectous pathologies) there's the necessity of doing a thorough and preventive consultation among the escort so as to obtain the concession of “nulla osta” for the flight both from the Flight Company and the Medical Institutions put at the head. The flight service can be used also by users with riduced mobility ( paraplegics) as well as patients under oxygen therapy.

ADMINISTRATIVE ASPECTS

Usually within 60 minutes from the phone-call, the Operation Centre is able to provide a detailed estimate of the costs that the customer ( Hospital Istitution, Company or Final User) might support. The budget, if not otherwise specified, is intended to be “ all inclusive”and includes for example:

- organization, management & coordination of the ones involved in the transfer( Hospitals, Airports, wheeled Vehicles and airplanes included);

- medical escort ( doctor specialized in Reanimation and Anaesthesia and a specialized nurse too);

- medical staff transferts;

- use and consumption of medical equipment, monitoring, infusion of drugs included;

- use and consumption of medical gases for oxygen theraphy;

- use of medical equipment for movement and transport;

- use of electromedicals;

- the cost of the charter flight or return tickets ( if on schedule flights) for the medical staff and single ticket for the patient( if on schedule flight, the use of the aircraft stretcher is included);

- airport taxes;

- costs of administrative management;

- board for medical escort;

- wheeled vehicles from and to the airport ( from where the patient is taken until the final destination);

The service is confirmed and taken into account when payed full.