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Taking man in a emergency

This article is reprinted with permission from ITIJ Air Ambulance Review 2019.

Overcoming logistical challenges

CareJet describes a medical evacuation from Coron Island, Palawan, to Manila

CareJet is medical assistance and air ambulance provider in the Philippines, managing cases for over 65 travel insurance and medical assistance companies worldwide.

Conjuring up an image of an island paradise, many travelers will visualize an imposing. rugged, mountainous skyline, protecting the wild natural beauty of jungle-clad rocks, cascading down to golden sandy beaches. caressed by stunningly clear blue water. Sounds idyllic, doesn’t it?

For those of you that have visited the Philippines and, in particular the unspoiled beauty that is Colon Island. Palawan, you may feel that you’ve already found that paradise. Coron is growing in popularity with travelers seeking a stunning holiday escape mixed with a little bit of adventure – it is one of the most-visited destinations for wreck diving in the world and the sunken Japanese shipwrecks of World War II off Coron Island are listed in Forbes
Traveller Magazine’s top-10 best scuba diving sites.

If one of the pleasures of paradise is that you get away from the hustle and bustle of cities, traffic and pollution, then one of the few downsides is that should a significant medical emergency occur, you can find yourself isolated and requiring specialist support to transfer you to a suitable hospital for treatment.

When Trouble Strikes in Paradise

Our CareJet team was contacted on 26 March 2019 and advised of the need for a medical evacuation for a client from a hotel in the relatively remote location of Coron Island, Palawan. We were quickly able to perform a verbal medical consultation with our Medical Director to determine the nature of the emergency so that we could obtain the necessary approvals and documentation to ensure that the patient was fit to fly.

Following a fall, the patient had sustained a number of injuries, the most serious of which had been diagnosed as a fracture to the Medial Tibial Plateau.

With a clear understanding of the patient’s condition, we were able to select and prepare the appropriate medical team and brief them with a carefully crafted evacuation plan on the complexities of the patient evacuation, in particular the logistical challenges of the location and terrain on Coron Island.

On 28 March, our King Air 350 aircraft landed with the medical evacuation team at Busuanga Airport. We were met by our long-time ground ambulance partner on location in readiness for the drive to the patient’s hotel. Having completed numerous medical evacuations from the area in the past, the team knew already how challenging the evacuation was going to be.

Getting There

The outbound journey was a 55 km drive, which on a developed expressway in a metropolitan area would usually take around 45 minutes. The drive on Coron Island, however, was through a network of partly surfaced, provincial roads – zig ragging, extremely challenging terrain which meant it took more than two hours for the team to reach the destination. It’s at times like this that local knowledge is key co meeting expectations of insurers and their clients – a company unfamiliar with the route to the hospital may have given an unrealistic arrival time for the medical team, meaning disappointment and frustration for the customer.

The walkway from the parking area to the hotel itself added an additional challenge – it was a long, winding, uneven path consisting of a stone base that had been molded into steps – this was the only route that was available to transfer the patient from the hotel to the ground ambulance.

Having reached the patient, our medical team removed the temporary elastic banding and dressing to further evaluate the injury. There were significant swelling and redness on the left knee, and the leg was supported with a long leg posterior mold. Even after administering oral pain medication, the patient was still in significant discomfort. In order to avoid any further damage to the fractured area while being transported along the rugged terrain, the medical evacuation team decided to immobilize the patient’s left leg further. Moving the patient would be more complicated as a result, but their comfort and welfare, and minimizing further damage to the injury, were paramount.

From the Hotel to the Airport

Roller bandaging was re-applied and the patient was transferred onto a Vacuum Mattress
(VacMatt), and with the support of the hotel’s emergency support team, we were able to carry the patient several hundred meters back along the stone pathway to the ambulance.

Our medical team, with a clear understanding of how uneven and challenging the ride back to the airport would be in the ambulance, implemented the appropriate pain management protocol with continuous monitoring of the patient, and having intravenous pain medication (PRN) suitable for live patient’s weight ready, should it be required. In this instance, we were pleased that the additional protection around the injury and the expert driving skills of our partners meant that escalated pain management was unnecessary.

Transportation of the patient from the ambulance onto the aircraft brought another logistical challenge. The VacMatt was doing an excellent supporting job, so with one member of the team assisting from inside the aircraft, four other team members carried the patient on the VacMatt and carefully manoeuvered them through the narrow aircraft passenger door.

Flight Inbound

CareJet air ambulances are fitted out with critical care equipment and our team was able to make the patient comfortable for the flight back to Manila. Our ground ambulance partner in Manila was there to meet us and we completed the journey with the patient to a partner hospital. Makati Medical Center, a Joint Commission International-accredited tertiary hospital with stringent safety standards and excellent patient care.

The patient was very relieved to be settled at the hospital after the long journey and grateful to the CareJet Team for the professional way in which the evacuation had been managed. All that was needed now was a period of recovery and the journey to repatriate them to their home country

Meeting Client Needs

As travelers seek out new adventures in more remote parts of the world, it’s clear that emergency medical evacuation support is becoming increasingly important. Having multilingual case specialists working around the clock to assist travelers with doctors’ appointments, guarantees of payment, inpatient hospitalizations, outpatient consultations, and medical evacuations both in remote locations like this one but also in large cities, are key to ensuring a prompt service is offered to international insurance company partners.

Anthony Decoste is President and CEO of CareJet a leading air ambulance and medical assistance provider in the Philippines. He founded CareJet to make quality healthcare accessible to travelers all throughout the archipelago. A long time resident of the Philippines, Anthony holds a Doctor of Business Administration degree and serves on the boards of several non-profit organizations that aim to make healthcare accessible and affordable to the community.