Bali-Dubai a resuscitation at 30,000 feet

Dario Zampella recounts his experience as a flight nurse

Years ago, I did not imagine that my passion could merge with medicine and emergency medical care.

My company AIR AMBULANCE Group, in addition to air ambulance service on Bombardier Learjet 45s, offered me another way to experience my profession: medical repatriation missions on scheduled flights.

Medical repatriations on scheduled flights consist of medical and nursing care of people who have been affected by illness or trauma during a stay abroad. After a longer or shorter hospitalization and complying with strict airline diktats, patients are given the opportunity to repatriate on scheduled flights.

Repatriation is coordinated by the operations office on a bed-to-bed basis (hospital bed to hospital bed). The difference with air ambulance service is the cooperation with the most renowned airlines such as Emirates, Etihad Airways, Lufthansa, ITA Airways. In these cases we fly on very common Boeing 787s or Airbus A380s sometimes outfitted with an aviation stretcher, sometimes simply on comfortable business class seats.

Our missions begin with the submission of the medical report, the patient’s medical record completed by the attending physician during hospitalization. The case is carefully evaluated by AIR AMBULANCE Group’s medical director and the medical director of the airline we are partnering with for the mission. From this moment on, the medical flight crew and the logistics team get together and plan all the steps of the mission: starting from the electromedicals and drugs through the type of ground transportation and finally the management of the reference contacts in primis with the medical team that is treating our patient at that moment.

Briefing done, material checklist done, passport in hand and off we go!

The beauty of this service is to travel a lot and see, albeit for a short time, places you never imagined you would know. The feeling of living more lives than others is tangible; in a short time I have been to Brazil, the United States and even twice to Bali.

Although I have only ever worked as an out-of-hospital emergency nurse, the personal relationship with patients has always been very important to me. In my many years in emergency medicine, I have learned to establish trusting relationships in minutes or in the most severe cases, seconds; but this service allows me to live in close contact with the patient many more hours than I ever have before.

Among the most incredible episodes that have happened to me a special mention definitely has a Bali – Stockholm mission a few months ago.

Flight Denpasar (Bali) – Dubai 2:30 A.M.

Took off four hours ago, still five hours to go before arrival. Comfortably seated in business class are myself, fellow physician-anesthesiologist and patient.

My attention is drawn to a flight attendant who runs up to one of his colleagues right next to us to tell him that there is an illness on board. At that point I stand up and offer our availability to help them. We secure the patient to the attentions of a flight attendant, grab our backpacks, and are accompanied by the passenger who urgently needed help. Upon entering the aisle, we notice that flight attendants are administering CPR and have already applied the automated external defibrillator.

As is the case with ACLS providers the roles do not always fit the title, although an anesthesiologist of the highest professionalism and enviable experience was with me I had the privilege of being a team leader on a cardiac arrest at thirty thousand feet altitude.

I confirmed the condition of ACC, the correct plate position, and supported the good BLSD practiced by the flight attendants.

My concern was managing the alternation to cardiac massage by the indefatigable flight attendants, my colleague preferred venous route management and I managed the airway with advanced preps.

Si vis pacem, para bellum

It is a Latin locution that has always accompanied me in my clinical practice, particularly this time it served in being ready even out of context to practice full-scale resuscitation. Having the equipment state-of-the-art and ready for the extreme resuscitative emergency is a prerogative I have always sought in the companies I have been fortunate to work with.

In AIR AMBULANCE Group, I have found the sensitivity and attention to making the operators free to give their best in their performance, and those who know the field, many times, depend on the devices and drugs that are made available by the companies.

Management of cardiac arrest in the out-of-hospital setting by definition involves all providers leaving the comfort zone. The bulk of advanced emergency training originated for the in-hospital setting: the fault of the hospital-centric system of the Italian university. My luck over the years has been to find “visionary” training centers, such as intubatiEM, specializing for the out-of-hospital that tended to stress my performance as much as possible to allow me to make mistakes in simulation and not make them in service.

No resuscitation is the same as another

I admit it was not the most uncomfortable scenario I have ever encountered but coordinating multiple operators of different nationalities in a small space in this case was my challenge.

I have been studying the psychological approach in emergency health care for years. After reading a lot and talking with excellent professionals, I realized that one way forward is the approach that pilots have during aviation emergencies: aviate, navigate, communicate says a lot.

An extremely satisfying moment was when the commander took me aside to shake my hand and congratulate me; to be recognized as valuable outside of one’s context by those trained to handle aviation emergencies was exciting.

Life as a flight nurse on both air ambulance and airline flights is giving me a lot: the missions are exciting, the people I have met are extraordinary, and most importantly, having a chance to demonstrate my skills in a context of excellence gives me a lot of satisfaction.

Dario Zampella

Flight Nurse AIR AMBULANCE Group

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