What is flight nursing?

Most of the patients needing repatriating are British holidaymakers so much of the work focuses around Europe especially Spain, France, Italy and Greece with the USA and Canada next in popularity. However, with cheap air travel and people becoming more adventurous in their travel plans, exotic locations are common e.g. the Caribbean, Far East and Asia. There is a small market for reverse repatriations i.e. returning Americans and Canadians to their home countries.

Holiday insurance makes up the majority of how work is generated, followed by corporate contracts, and private arrangements, including embassies, government agencies etc.

The armed services, principally the RAF, also provide aeromedical repatriation services.

What are assistance companies?

Assistance companies are independent companies who are usually contracted out by insurance companies to assist passengers who experience difficulties whilst abroad. They engage a medical team of doctors, nurses and operational support staff to undertake the medical and nursing decisions. These decisions will be:

  • to either assist locally and receive treatment
  • treat and repatriate early
  • or to treat and continue the holiday

Assistance companies answerable directly to one of many insurance underwriters allocate work to medical crews employed by assistance companies. The assistance companies are based mostly in the outer London areas e.g. Croydon, Wandsworth, Purley. There is one in Haywards Heath, another in Halifax and a couple in the Guildford area.

What is Repatriation?

Repatriation is the process of returning the patient home, usually with medical or nursing assistance and this decision is medically led, when it is safe to move the patient taking into account the patient's condition

The aim is simply the safe transfer of patients from one point to another usually from one country to their country of residence (very occasionally not by air but overland, by ferry and train) without detriment to the patient's condition.

To undertake a safe repatriation you are given as much information on the patient as is available, though sometimes this is limited and it is not unusual for this information to be quite inaccurate as the nurse discovers on assessing the patient at 'resort'. It is, however, the nurse's responsibility to decide on equipment required prior to departure and to check that the equipment is in full serviceable order which entails spending time in the assistance company equipment room prior to proceeding to the point of departure as well as returning it on completion of the repatriation.

Role of the in-flight nurse

The prime function of the nurse is to ensure the safety of the patient. The nurses role is to assess, monitor and intervene as appropriate in patients. Initially your assessment takes place before you actually meet your patient, and take over the care. Whilst with the patient, nurses provide the care in the setting they are in.

Nurses undertake most of the repatriations single-handedly travelling by commercial airline occasionally by air taxi (often in small turboprop single pilot aircraft). Sometimes a doctor and nurse are sent, occasionally two nurses for the longer hauls i.e. Australasia etc. Alternatively nurses will be sent with a doctor on air ambulance repatriations using a small dedicated aircraft, e.g. Lear jets, and equipping the aircraft accordingly using equipment from the assistance company including supplementary oxygen (O2) cylinders as required is the responsibility of the medical escorts.

What type of patients get repatriated?

Patients with medical conditions of the patients vary. Many are medical problems e.g. CVA, MI, angina, pneumonia, COAD. orthopaedic problems, burns and multiple traumas are common. All ages are catered for including neonates. Psychiatry is dealt with on a regular basis sometimes in conjunction with physical problems. Some patients return seated with wheelchair assistance in the airport, others return by stretcher on either commercial aircraft or air ambulance/air taxi.

Other responsibilities of flight nurse

As well as being accountable for the patient the medical escort is responsible for the obtaining of tickets (prepaid), patients luggage/property, overseeing arrangements made by overseas hospitals regarding ambulance transfers to airports etc., the well being of accompanying relatives and the handover to receiving hospital if appropriate (some patients are taken directly to their homes). The escort is usually required to give a door to door service so duties only stop once the patient is safely at home or in the receiving hospital. Hours can be extremely long and this needs to be taken into account when deciding to take on repatriations.
 
Jump to:

Catherine Gates, RN Freelance In-flight Nurse