Evacuation Medicine Brenda Reilly, MD Assistant Chief Emergency Medicine

Evacuation MedicineEvacuation Medicine

Brenda Reilly, MDBrenda Reilly, MD

Assistant ChiefAssistant Chief

Emergency MedicineEmergency Medicine

International SOSInternational SOS

Medical AssistanceMedical Assistance• TravelersTravelers• ExpatsExpats

Corporate SecurityCorporate Security 25 years25 years Revenues US $2 Billion 2009Revenues US $2 Billion 2009

International SOSInternational SOS

Provide evacuation insuranceProvide evacuation insurance• For private travelers/NGOsFor private travelers/NGOs• For Fortune 500 companies and their ex-For Fortune 500 companies and their ex-

pat employeespat employees• For US military personnel and their For US military personnel and their

families overseas (Tricare)families overseas (Tricare)• Oil rigs/Airlines-crews,pax/ShipsOil rigs/Airlines-crews,pax/Ships

Different JobsDifferent Jobs

Coordinating doctorCoordinating doctor Locum doctorLocum doctor Escort doctorEscort doctor TelemedicineTelemedicine TeachingTeaching SalesSales

Different Jobs: Coordinating doctorDifferent Jobs: Coordinating doctor

Take calls from membersTake calls from members

Arrange evacuationsArrange evacuations

Provide adviceProvide advice• Referrals to local providers and facilitiesReferrals to local providers and facilities• Advice on medical advice receivedAdvice on medical advice received• Medical adviceMedical advice

Coordinating DoctorCoordinating Doctor

EvacuationsEvacuations• PrivatePrivate

ICU equipped Lear jetsICU equipped Lear jets Doctor and Nurse escortsDoctor and Nurse escorts Equipment Equipment Arrange ambulance transfersArrange ambulance transfers Arrange receiving careArrange receiving care Immigration--tarmacImmigration--tarmac


EvacuationsEvacuations• Commercial carriersCommercial carriers

Stretcher vs seatedStretcher vs seated Equipment—no supplemental O2Equipment—no supplemental O2 Doctor and Nurse escortDoctor and Nurse escort Immigration through usual channels Immigration through usual channels Arrange ambulanceArrange ambulance Arrange receiving careArrange receiving care


Monitor medical care in NCMEMonitor medical care in NCME• Frequent communication with treating Frequent communication with treating

doctordoctor• Arrangements for return to work site or Arrangements for return to work site or

repatriationrepatriation• Arrangements for medical escort as Arrangements for medical escort as

indicatedindicated

Different Jobs: LocumDifferent Jobs: Locum

Cover ISOS Clinics*/ Alarm CentersCover ISOS Clinics*/ Alarm Centers• Beijing, Hong Kong, ChinaBeijing, Hong Kong, China• Phnom Penh, Cambodia*Phnom Penh, Cambodia*• Yangon, Myanmar* Yangon, Myanmar* • Sakhalin Island, Russia*Sakhalin Island, Russia*• Ho Chin Minh*, Hanoi, VietnamHo Chin Minh*, Hanoi, Vietnam• Bangkok, ThailandBangkok, Thailand• PhillyPhilly• Bali*, Jakarta, IndonesiaBali*, Jakarta, Indonesia

Different Jobs: Escort DoctorDifferent Jobs: Escort Doctor

Meet patient at hospital/at airportMeet patient at hospital/at airport ICU equipped Lear jetsICU equipped Lear jets Tarmac transfersTarmac transfers Bring to NCMEBring to NCME

Evacuation AircraftsEvacuation Aircrafts

ICU equipped with MD and ICU RN escortICU equipped with MD and ICU RN escort Lear 35 small crafts, crowdedLear 35 small crafts, crowded Lear 45 larger, seats 4 in addition to Lear 45 larger, seats 4 in addition to

patient stretcher area and doctor seat. patient stretcher area and doctor seat. Stabilize patientStabilize patient

• At the hospital if possibleAt the hospital if possible• On the tarmac if necessaryOn the tarmac if necessary• On the flight if urgent On the flight if urgent


Issues with flight medicine—examine Issues with flight medicine—examine the patient thoroughly before the patient thoroughly before boarding the jet!boarding the jet!• Perform all needed interventions prior to Perform all needed interventions prior to

take off:take off:• Tarmac intubationsTarmac intubations• Tarmac chest tubesTarmac chest tubes• Tarmac linesTarmac lines


Issues with flight medicineIssues with flight medicine• Take off and landing O2 concernsTake off and landing O2 concerns• Ambient noise makes it difficult to Ambient noise makes it difficult to

auscultateauscultate• Claustrophobic for some patients/family Claustrophobic for some patients/family

membersmembers• Bring enough O2 tanks!!Bring enough O2 tanks!!

Escort Doctor CasesEscort Doctor CasesSamplesSamples

Former Vietnamese Prime MinisterFormer Vietnamese Prime Minister Cambodian Deputy Prime MinisterCambodian Deputy Prime Minister American soldiers in Iraq--psychAmerican soldiers in Iraq--psych Bangladeshi 3 year old--rare brain Bangladeshi 3 year old--rare brain

tumor to cancer center in TNtumor to cancer center in TN Australian 9 year old--severe spinal Australian 9 year old--severe spinal

cord injury sustained on holidaycord injury sustained on holiday American injured in Mumbai bomb American injured in Mumbai bomb

blastblast

Escort Doctor: Common Escort Doctor: Common EvacuationsEvacuations

Infectious diseases—dengue, Infectious diseases—dengue, malaria, entamoeba histolyticamalaria, entamoeba histolytica

Trauma--scooters/taxis/private Trauma--scooters/taxis/private vehicles/busesvehicles/buses

Terrorism/War/Natural Terrorism/War/Natural Disasters/Epidemics—Pakistan, India, Disasters/Epidemics—Pakistan, India, BaliBali

Mountain sickness—NepalMountain sickness—Nepal

Headaches on EvacuationsHeadaches on Evacuations

Dubious placesDubious places• Politically unstablePolitically unstable• Crime/corruption/bribesCrime/corruption/bribes• Access by planes often sporadicAccess by planes often sporadic

Medical care sub-standardMedical care sub-standard• Dirty hospitals; old broken eqpt; very Dirty hospitals; old broken eqpt; very

poor hygiene standardspoor hygiene standards

Headaches on EvacuationsHeadaches on Evacuations

DelaysDelays• Airport—small airports close or open Airport—small airports close or open

when they want. Visiting dignitaries when they want. Visiting dignitaries close airspace. Bribes.close airspace. Bribes.

• Hospital—Don’t like to lose a paying Hospital—Don’t like to lose a paying patientpatient

• Patient—deteriorates prior to departurePatient—deteriorates prior to departure• Logistical—weather, traffic, strikes, Logistical—weather, traffic, strikes,

equipment--Nepalequipment--Nepal• BRING ENOUGH O2!!BRING ENOUGH O2!!

Evacuation Perks!Evacuation Perks!

See and experience the worldSee and experience the world Drop off the patient and hit the Drop off the patient and hit the

beach/local attractionsbeach/local attractions Develop a broad skill set and Develop a broad skill set and

knowledge base—logistics, aviation knowledge base—logistics, aviation medicine, negotiating different medicine, negotiating different cultures…cultures…

Make friends all over the worldMake friends all over the world

Different Jobs: TelemedicineDifferent Jobs: TelemedicineShips at SeaShips at Sea

Take calls from ship Captain Take calls from ship Captain Advise on medical care on limited Advise on medical care on limited

medical cachemedical cache Daily updatesDaily updates Evacuate to NCME if urgentEvacuate to NCME if urgent

• Helicopter/reroute shipHelicopter/reroute ship• Stabilize locally, evacuate if neededStabilize locally, evacuate if needed

Different Jobs: TelemedicineDifferent Jobs: TelemedicineOil RigsOil Rigs

Oil rigsOil rigs• Dangerous jobs/equipmentDangerous jobs/equipment• Limited cacheLimited cache• Medics trained locallyMedics trained locally• Scheduled supply boats or helicoptersScheduled supply boats or helicopters• Helicopters: Poor access to rigs at nightHelicopters: Poor access to rigs at night• Weather considerationsWeather considerations

Different Jobs: TelemedicineDifferent Jobs: TelemedicineAircraft CarriersAircraft Carriers

Commercial aircraftCommercial aircraft• Language difficultiesLanguage difficulties• Cache limitationsCache limitations

Standardized bag/medsStandardized bag/meds

• Skills of flight crewSkills of flight crew• Poor telephone connectionPoor telephone connection

Telemedicine: AircraftsTelemedicine: Aircrafts

Travelers may decline assistanceTravelers may decline assistance Some airline personnel well trained—Some airline personnel well trained—

Sing airlines--AED, good protocol, Sing airlines--AED, good protocol, standardized presentation. Others standardized presentation. Others not.not.

Often a doctor on boardOften a doctor on board

Telemedicine: DiversionsTelemedicine: Diversions

Do you divert the plane?Do you divert the plane? Where is the NCME?Where is the NCME? Factor in time to get to receiving Factor in time to get to receiving

care.care.

Different Jobs: TeachingDifferent Jobs: Teaching

Medics on oil rigs/Captains on shipsMedics on oil rigs/Captains on ships• ACLSACLS• Basic medicineBasic medicine• Basic minor surgical techniquesBasic minor surgical techniques• MedsMeds• Live case-by-case teaching on phoneLive case-by-case teaching on phone

Different Jobs: Sales SupportDifferent Jobs: Sales Support

Talk about work as escort doctorTalk about work as escort doctor Answer questions regarding what we Answer questions regarding what we

dodo Provide information, question and Provide information, question and

answer sessions for clientsanswer sessions for clients• Designated ISOS clinics for special Designated ISOS clinics for special

events—e.g., annual meetings, Olympicsevents—e.g., annual meetings, Olympics• Students abroad—University as clientStudents abroad—University as client

Explore OptionsExplore Options

American trained doctors are highly American trained doctors are highly regarded and highly sought around regarded and highly sought around the worldthe world

International Trauma ConferenceInternational Trauma ConferenceSingapore, Feb 2009Singapore, Feb 2009

Major John Oh—US Army Surgeon, Major John Oh—US Army Surgeon, AfghanistanAfghanistan

http://militarytimes.com/http://militarytimes.com/multimedia/video/808163493/multimedia/video/808163493/

Documents

Evacuation Medicine Brenda Reilly, MD Assistant Chief Emergency Medicine