GPs raise queries on care record
Working for a medical assistance company provides Dr Tim Hammond with an exhilarating medical challenge, and the demand for doctors to do this work is increasing all the time
Medical assistance companies are the frontline service dealing with the medical needs of people falling ill overseas. These could be holidaymakers, business travellers or British expatriates living or working abroad.
The company I work for is CEGA Air Ambulance, based at Goodwood in Sussex. CEGA works for many of the major UK insurers providing 24/7 assistance, but also caters for private patients and the uninsured I was staggered to discover that over a third of British travellers still go abroad without travel insurance!
CEGA's 24-hour, multilingual call centre can take calls relating to anything from mosquito bites to major trauma, CVA, MI or death. Calls come in from anywhere in the world from the Channel Islands to Antarctica.
As the British public travels further afield to more and more remote locations, assistance companies are faced with some interesting logistical problems when those travellers need medical care.
My role in this logistical challenge is to provide the medical input into cases. I discuss the management of cases with treating doctors overseas and keep an eye on progress. I ensure patients are receiving adequate and appropriate care, but at the same time ensure they are not being exposed to unnecessary investigations or treatments at insurers' expense.
I look particularly at the more serious cases and make decisions, in conjunction with the doctors abroad, on when and how patients can best travel home.
On joining CEGA I attended a one-week residential course on Clinical Aspects of Aeromedical Transport at the University of Surrey that covered essential elements of flight physiology and aviation medicine, as well as giving a good introduction to the principles and problems of medical assistance and repatriation medicine.
The work is extremely varied and you can never predict what problems will confront you each day. I am now dealing with many cardiology, trauma and ITU cases and have also had to take on board a lot of broad knowledge of aviation medicine and physiology.
Operationally, all countries have different guidelines and procedures which is a potential minefield, although, medically, within Europe and US, there is a fair amount of consistency on medical management of major conditions. Facilities and availability of resources abroad vary enormously.
Of paramount importance to the patient, particularly in determining 'fitness to fly', is liaison with the treating doctor overseas. Unlike general practice, your personal contact with the patient can be limited and you are relying on the opinions of others, together with data that has been provided to you.
While I do accompany flights and have direct contact with patients, the majority of my work is dealing on the phone with other medical staff and CEGA's own staff who may be in-situ with the patient.
I am amazed at how many overseas doctors speak good English, but when we come across language barriers our team of linguists and translators is always available to help with calls and medical updates, enabling us to make informed decisions about repatriations.
Language problems mostly occur from the patient's perspective making communication with their treating medical team difficult.
A reassuring phone call from someone in their mother tongue is often a great relief to patients who can often feel frightened and isolated in a foreign hospital.
The objective of medical assistance companies is to provide a 'door to door' or in many cases a 'bed to bed' service for patients; the transfer and handover of records including notes made during the actual evacuation to hospital doctors and GPs is an essential part of this service.
An aircraft is a hostile environment and if patients are not stable on the ground they will not become so in flight. Great care is taken to ensure the patient is 'FTF' (fit to fly) and any necessary medical procedures (intubation/chest drain insertion/catheterisation, IV, cannulation etc) are done before the patient is put on to the aircraft.
Patients may be able to fly home on their original flights or may need to have new flights arranged. In this case, they may be able to come unescorted, or may need help from one of our flight nurses or doctors. If seriously ill, they may need repatriation by a full ITU-equipped air ambulance, depending on the case.
A close working relationship with aircrew and ground staff is important. When a patient is capable of being repatriated by scheduled airline, with an accompanying doctor or nurse, rather than by air ambulance, then we are in constant contact with the airline's own medical departments.
Aeronautical medicine is challenging and varied and with the British temperament for more and more widespread travel, it is an area of medicine that is increasingly in demand.
Tim Hammond is medical operations manager at CEGA and still does regular GP out-of-hours sessions within the NHS