Critical care transfer out of Soyo Angola

 Karien Basson 22 Dec 2020

A severely ill ICU patient taught me a lesson, which will stay with me a lifetime.

During the 12 years that I have flown as a flight nurse for Air Rescue Africa based in Johannesburg South Africa, there are many experiences that are special and that I will never forget.

One of them was a flight for an American gentleman who we evacuated out of Soyo, Angola. What started out as a 'potentially easy mission' turned out to be one of the most challenging, yet rewarding cases I had ever flown.

We got briefed the night before; the diagnosis was that of an elderly man who suffered from pneumonia, hypertension and cardiac failure. Activation was 3am the next day. Standard equipment for an air ambulance was packed, and we conducted a careful pre-flight discussion regarding our medical treatment plan as well as any extras we might need.

Soyo is not a port of entry so we had to have a quick fuel stop in Luanda, Angola, as well as clearing customs and immigration. We then set off to our final destination, Soyo, situated at the mouth of the Congo River, in the province of the Zaire, just north of Luanda.

We met the patient on the international apron accompanied by treating clinic personnel. They told us that he was found unconscious two days before by his colleagues, and was urgently transferred to their clinic. He was awake now, but not really responding, sitting on the ambulance stretcher in high fowlers to assist with his much laboured breathing. The doctor and myself conducted a quick but thorough examination, and we decided that it would be best to have him intubated and mechanically ventilated for the flight.

When we were ready, I approached him and gently took his face in both my hands to try and get him to understand what we would be doing with him next. He looked into my eyes and I said to him: "we will help you to breath now, we will make you sleep and then we are putting you on the air ambulance aircraft and safely take you to South Africa to get better care, do not be scared". For a split second I could see he fully comprehended the enormity of the situation, his eyes crinkled in the corners and he seemed to recognize me, as if he knew me and that he trusted me, he seemed relieved and grateful...and then it was gone and the glazed look returned to his eyes.

The flight was very eventful, just after we loaded him onto the aircraft he developed a pneumothorax and then a subsequent cardiac arrest. His heart stopped for a second time when we handed him over at the receiving facility in South Africa. This was incredibly challenging to manage in an aircraft, but we as a flight team undergo extensive regular training to manage complex situations in flight and work well under pressure. I was convinced he would not survive the night and I was sad for his family, being so far from home.

On our post flight debrief the next day I was surprised to learn that he was still alive, fully ventilated, but alive. I went back twice to the hospital to go and see him, but both times he was sedated and ventilated. About a month after the flight, I learned that he was to be taken back to the USA on a fully equipped long haul air ambulance aircraft, and I went to say goodbye. I was waiting at the lift in the hotel lobby when a pretty, small, elderly lady walked up to the lift with a big suitcase in her hands. I offered to help but she declined and said that it's empty. It's for her husband's clothes and that they will be returning to the USA later that day. I knew then that she was my patient's wife and when I told her who I was she couldn't stop crying, she just hugged me and kept thanking me. We walked into the ICU together and found him sitting up in his ICU bed, eating jelly. I was stunned, he looked amazing.

And when our eyes met, he gave me that same look that haunted me till that day, and it said: 'thank you'. And I thanked him in return for giving me the opportunity to learn and to grow, and to do what I love best.

Karien Basson

Karien Basson

Member of RCN Critical Care and Flight Nursing Forum

Base Manager and Flight Nurse for Air Rescue Africa

Karien has been a Flight Nurse for the last 12 years, commercially and medivac. She is trained as a Emergency nurse as well as having a Masters degree in intensive care nursing.

Page last updated - 22/12/2020