Evacuation Medicine

1. Brenda Reilly, MD Assistant Chief Emergency Medicine Evacuation Medicine

2. International SOS • Medical Assistance • Travelers • Expats • Corporate Security • 25 years • Revenues US $2 Billion 2009

3. International SOS • Provide evacuation insurance • For private travelers/NGOs • For Fortune 500 companies and their ex-pat employees • For US military personnel and their families overseas (Tricare) • Oil rigs/Airlines-crews,pax/Ships

4. Different Jobs • Coordinating doctor • Locum doctor • Escort doctor • Telemedicine • Teaching • Sales

5. Different Jobs: Coordinating doctor Take calls from members Arrange evacuations Provide advice • Referrals to local providers and facilities • Advice on medical advice received • Medical advice

6. Coordinating Doctor • Evacuations • Private • ICU equipped Lear jets • Doctor and Nurse escorts • Equipment • Arrange ambulance transfers • Arrange receiving care • Immigration--tarmac

7. Coordinating Doctor • Evacuations • Commercial carriers • Stretcher vs seated • Equipment—no supplemental O2 • Doctor and Nurse escort • Immigration through usual channels • Arrange ambulance • Arrange receiving care

8. Coordinating Doctor • Monitor medical care in NCME • Frequent communication with treating doctor • Arrangements for return to work site or repatriation • Arrangements for medical escort as indicated

9. Cover ISOS Clinics*/ Alarm Centers Beijing, Hong Kong, China Phnom Penh, Cambodia* Yangon, Myanmar* Sakhalin Island, Russia* Ho Chin Minh*, Hanoi, Vietnam Bangkok, Thailand Philly Bali*, Jakarta, Indonesia Different Jobs: Locum

10. Different Jobs: Escort Doctor • Meet patient at hospital/at airport • ICU equipped Lear jets • Tarmac transfers • Bring to NCME

11. Evacuation Aircrafts • ICU equipped with MD and ICU RN escort • Lear 35 small crafts, crowded • Lear 45 larger, seats 4 in addition to patient stretcher area and doctor seat. • Stabilize patient • At the hospital if possible • On the tarmac if necessary • On the flight if urgent

12. Different Jobs: Escort Doctor Issues with flight medicine—examine the patient thoroughly before boarding the jet! Perform all needed interventions prior to take off: Tarmac intubations Tarmac chest tubes Tarmac lines

13. Different Jobs: Escort Doctor • Issues with flight medicine • Take off and landing O2 concerns • Ambient noise makes it difficult to auscultate • Claustrophobic for some patients/family members • Bring enough O2 tanks!!

14. Escort Doctor CasesSamples • Former Vietnamese Prime Minister • Cambodian Deputy Prime Minister • American soldiers in Iraq--psych • Bangladeshi 3 year old--rare brain tumor to cancer center in TN • Australian 9 year old--severe spinal cord injury sustained on holiday • American injured in Mumbai bomb blast

15. Escort Doctor: Common Evacuations • Infectious diseases—dengue, malaria, entamoeba histolytica • Trauma--scooters/taxis/private vehicles/buses • Terrorism/War/Natural Disasters/Epidemics—Pakistan, India, Bali • Mountain sickness—Nepal

16. Headaches on Evacuations • Dubious places • Politically unstable • Crime/corruption/bribes • Access by planes often sporadic • Medical care sub-standard • Dirty hospitals; old broken eqpt; very poor hygiene standards

17. Headaches on Evacuations Delays • Airport—small airports close or open when they want. Visiting dignitaries close airspace. Bribes. • Hospital—Don’t like to lose a paying patient • Patient—deteriorates prior to departure • Logistical—weather, traffic, strikes, equipment--Nepal • BRING ENOUGH O2!!

18. Evacuation Perks! • See and experience the world • Drop off the patient and hit the beach/local attractions • Develop a broad skill set and knowledge base—logistics, aviation medicine, negotiating different cultures… • Make friends all over the world

19. Different Jobs: TelemedicineShips at Sea • Take calls from ship Captain • Advise on medical care on limited medical cache • Daily updates • Evacuate to NCME if urgent • Helicopter/reroute ship • Stabilize locally, evacuate if needed

20. Oil rigs Dangerous jobs/equipment Limited cache Medics trained locally Scheduled supply boats or helicopters Helicopters: Poor access to rigs at night Weather considerations Different Jobs: TelemedicineOil Rigs

21. Different Jobs: TelemedicineAircraft Carriers • Commercial aircraft • Language difficulties • Cache limitations • Standardized bag/meds • Skills of flight crew • Poor telephone connection

22. Telemedicine: Aircrafts • Travelers may decline assistance • Some airline personnel well trained—Sing airlines--AED, good protocol, standardized presentation. Others not. • Often a doctor on board

23. Telemedicine: Diversions • Do you divert the plane? • Where is the NCME? • Factor in time to get to receiving care.

24. Different Jobs: Teaching • Medics on oil rigs/Captains on ships • ACLS • Basic medicine • Basic minor surgical techniques • Meds • Live case-by-case teaching on phone

25. Different Jobs: Sales Support • Talk about work as escort doctor • Answer questions regarding what we do • Provide information, question and answer sessions for clients • Designated ISOS clinics for special events—e.g., annual meetings, Olympics • Students abroad—University as client

26. Explore Options • American trained doctors are highly regarded and highly sought around the world

27. International Trauma ConferenceSingapore, Feb 2009 • Major John Oh—US Army Surgeon, Afghanistan • http://militarytimes.com/multimedia/video/808163493/