Early this year we transported a patient from New York to Ohio. She was an older woman who wanted to be with her family during the last period of her life. I want to share the story with you because it’s a really poignant reminder, for me, of how special family is. And it reminds me that, in addition to getting our patients access to the medical care they need, one of the services we provide is reuniting patients with their families. Because being there matters. (It matters for the medical reasons I’ve written about, and it matters for the memories we get to make.)
It’s the niece of our patient, Elizabeth, who has so graciously shared with us her Aunt Frances’ journey since we transported her in an air ambulance to Ohio on January 8th, the day after her 88th birthday. Elizabeth and her family in Ohio had spent most of Christmas Day last year trying to find out where Frances had been sent after the hospital she was staying in discharged her. Turns out she was sent to what Elizabeth refers to as a “horrible” nursing home.
A few weeks after we safely transported Frances to be reunited with her family in Ohio, Elizabeth sent us a note thanking us for our help. “My dad wanted me to convey his gratitude for your help in what we all believe was saving the life of his sister.”
This July Elizabeth e-mailed us and said that after spending several months in rehab, Aunt Frances moved into an assisted living facility close to several members of the family. It was a difficult adjustment at first (Frances had lived independently for 65 years in Manhattan) but she did adjust and was able to enjoy the “sweetest aspects” of being with family. Her nephew and his wife had a baby boy (“the cutest thing on earth”) who, Elizabeth said, “probably came a little early just to be sure he got to meet his great auntie.”
In July, Elizabeth said, “We're not certain how long we'll have with Frances (she is on hospice now), but it is such a blessing to travel this part of the journey with her. That would not have been possible without the good work you do. Thank you once again, and if you have a chance, please let me know how everyone there is doing.”
Last week, we got another note from Elizabeth, this one bittersweet. She wrote:
I wanted to let you know that my Aunt Frances passed away last Friday. Her final two weeks were at a hospice inpatient facility, and she was not fully conscious during that time but I think she knew that we were there. On my last visit, I arrived just 15 minutes after she died. Fortunately, the chaplain was there, and she told me that Frances slipped away very softly. When I saw her, she looked truly at peace, with a gentle smile on her lips.
So, we've come to the end of a long, and sometimes exhausting, chapter in our family. There's work to do to settle her affairs, and we're looking forward to honoring her life with a memorial service in a couple of weeks; then we will have a lifetime of memories to cherish.
We were blessed to have the opportunity to share this part of Frances's journey, even the hardest days, and I want to thank you once again for everything you and your colleagues did that made it possible. It really is comforting to know that help appears when you need it most, from strangers who become friends.
It really is.
While media pundits and certain documentary filmmakers like to rant about the decline of the U.S. (in general, and our healthcare system in particular), the fact is that the quality of medical care in the U.S. far surpasses the quality of medical care in most other countries. So it shouldn’t come as a surprise when people abroad do everything they can to come to the U.S. for medical treatment.
That was the case for Maria, who came to New York, then to Houston, from Spain. We were first introduced to Maria when her daughter Amy called us. She explained that her mother had been having medical problems that, the family felt, weren’t being properly diagnosed at home. The family had the resources to pay out of pocket for medical transportation to the U.S. and medical care once Maria got here.
As is almost always true, Maria’s was a complicated case. First, there was the language barrier. To overcome it, we had our Pre-Transport Overview document (which we provide to all patients and their families as a way of letting them know what to expect before, during, and after the medical flight) translated into Spanish. We recognize how stressful times like these are for patients and their families; we wanted to alleviate the added stress that would have come with not being confident about what the English Pre-Transport Overview said.
Then, there was the fact that the hospital in New York City was concerned about admitting a patient from abroad – in particular, how the patient would pay for the expenses of her treatment; they were so used to going through insurance companies. Amy asked us to communicate with the hospital and help them understand that Maria had the means to pay for her care – even if it meant paying in advance (it did).
Then there was the issue of the visa. Like all foreign visitors, Maria needed permission to enter the U.S., and that process can take a long time. We worked with Amy to secure a temporary emergency medical visa for her mother. Once all of the arrangements were made, we flew Maria to New York in an international air ambulance. There, she was diagnosed with cancer – she hadn’t realized how sick she really was.
So we arranged for Maria another air ambulance flight, from New York to a very well known cancer center in Houston, Texas, where she underwent further treatment. We went through the same rigmarole with the Texas hospital as we had in New York – they were not used to the idea that the patient would be paying in cash in full, and required that Maria pay upfront for her hospital stay. After receiving extensive treatment in Texas, Maria returned to Spain.
Every once in a while people will ask, “Well what makes MedFlight911different from any other air medical transport provider?” The biggest differentiator: we are invested in a successful outcome for patients and their families from Day 1. Some air ambulance companies are simply order takers and route planners. Clearly, we go far beyond that. (And we wouldn’t have it any other way.)
*This story, as are all of the stories we tell on this blog, is true. We did change the names of the patient and her family members, as well as the locations, to protect our client’s privacy.
Last week we wrote about the dangers of travelling with a sick or injured patient and no professional medical care. Shortly after we posted that blog, Can’t I Just Take My Sick/Injured Loved One on a Plane Myself? a friend sent me a link to a news article about a man who passed away on a flight from Singapore to New Zealand. For now, the story is that the man choked on a piece of beef, though his father said that he had a heart condition – which could well have contributed to or even caused his death.
There’s not really a “moral” to the story here – except for a congenital heart defect that the man, Robert Rippingale, had corrected in surgery at age 6 – it appears as if he was a healthy young man. While we always recommend that travelers with medical problems at least consider a commercial air medical escort or air ambulance, there’s no reason why otherwise healthy people would fly with professional medical support.
The story reminds me of how important it is that we all know how to properly perform the Heimlich maneuver. As a commenter on one article about the incident asked, “What happened to the Heimlich maneuver? Doesn't everyone know how to do this?” I thought so; I learned it in middle school – long before I was interested in becoming a paramedic.
According to news reports “A doctor and two nurses who were on-board the flight rushed to Rippingale's aid and performed CPR but couldn't save him.” We don’t know exactly what interventions the doctor and nurses performed on the man, or how long he had been choking before they got to him.
While medical professionals did respond (they don’t always in these circumstances) I haven’t heard yet what kind of doctor or nurses they were. A podiatrist is a doctor but has a very different skill set than a trauma surgeon, for example. Ditto for the nurses. That is not at all intended to disparage their service – again, a lot of medical professionals stay in their seats when calls for help are issued – it’s simply to say that they may not have the specialty medical training required for optimal response in an emergency situation.
Some airlines have their employees participate in MedAire’s medical training and equipment program. I’m not sure if this airline, Jetstar, does or not. MedAire provides medical training and support services to commercial airlines. If flight crew were trained by MedAire they would likely learn the basics of treating an airway obstruction: Heimlich maneuver, attempt to ventilate, attempt to suction or visualize (laryngoscope and suction or Magill's forceps). If that fails, and there happens to be an emergency physician or critical care paramedic or nurse on board, they might try a cricothyrotomy (putting a hole in the trachea just below the larynx with a scalpel or knife) – a procedure one local Arizona physician once performed on a plane.
While I think this should serve as a reminder to refresh our CPR certifications (which include the Heimlich maneuver), at the end of the day this was probably one of those circumstances that unfortunately happen and can’t really be avoided. Our hearts go out to the young man’s girlfriend, who was with him on the flight, and to his family.
The day started out with nary a glimmer of hope to get a bed for a patient in Canada looking to return home. 4 weeks in a California hospital, Michael wanted to return to his home in Canada. Too sick to go to his apartment, and not sick enough to get a physician in Canada to admit him, things weren't looking good. CEO Dee McCluskey tapped into all of his flight coordination and air ambualnce training and began a morning long search for that one person that would see the need and offer to help. That person came in the form of "Ruth" a nurse locator at a hospital in a large province in Canada. Hearing the situation and sensing the same need to make a difference, Ruth stepped away from the phone and within a few minutes, had pulled one of her physicians in on the call to see what she could do and the engines of hope began rumbling. Where would one find an accepting physician. one who had never seen the patient, knew nothing of him, other than what was transcribed on a few lines in his medical history? She would... Dr. C and not just one accepting physician but two. Just in case the patient didn't fit into the right parameter for the one physician's directive, there was another. Here was our answer! Dee sat back in my chair, a long morning of calls and frustration, hoping and praying for that one person that might say "I'll help." He looked across the office at his staff members as they peered in to see what, if anything had happened. I just smiled.
Every so often we’ll hear a story about a person dying on a commercial airline flight, or about a disabled, injured, or sick person getting bumped from a flight (or not being allowed to fly at all). It pains us to hear those stories because many of those situations could have been avoided if the patient had hired a professional air medical escort.
We understand why it’s tempting for a patient to try to fly alone, or for a patient’s loved ones to try to transport the patient themselves. The fact is that air medical transport can be expensive and that insurance doesn’t always cover the cost. But when something goes wrong at 35,000 feet, or even on the jet way, the cost of not having a medical escort can be far higher.
In the cases we’ve heard about where a patient was denied access to the flight, or even denied passage though security, it’s typically because of confusion about the proper documentation required to bring critical medical supplies past security and onto the airplane. We’ve heard stories of people denied their liquid medications, oxygen concentrators, and other medical necessities because they didn’t have the proper documentation (and rules can vary by country, airline, even airport).
In contrast, a professional medical flight provider has relationships with the medical assistance departments of all the major airlines, both domestic and international, to ensure that the patient’s medical escort has everything required to bring necessary medical equipment on board. At MedFlight911, we know the documentation that’s required, the people we need to talk to, and the steps we need to take to ensure that our patients and all of their medical supplies make it safely and comfortably onto the airplane.
What happens when a person has a medical emergency at 35,000 feet? Typically, a flight attendant will issue a call for a doctor, nurse or paramedic on board to volunteer to help. That volunteer would be provided access to the airplane’s medical emergency kit, which should include oxygen, basic monitoring equipment, a limited supply of injectable drugs, and oral medication to treat the patient until the flight lands.
Yet for various reasons, doctors are not always available (or willing) to help (in fact, according to an FAA study, medical professionals respond just 69 percent of the time). Commercial flight attendants should know how to use the medical equipment in the plane’s emergency kit, but are certainly not trained medical care providers.
Sometimes – typically in the most extreme emergencies – the pilot may decide to divert the airplane to a nearby airport (the cost potentially the responsibility of the patient). But the pilot won’t always decide to divert the plane, even in extreme emergencies (as in this recent case where a passenger had a heart attack soon after takeoff on a flight from London to Singapore).
When we arrange commercial air medical transports for our clients, the patient is accompanied by a critical care nurse, a critical care paramedic, or a physician – a medical professional who has the expertise and the equipment to handle a medical emergency should one arise. (That said, commercial air medical escorts are only an option for patients who are medically stable and meet certain physical standards. Critically ill or injured patients are best served by an air ambulance transport.)
For all of these reasons, it’s critical to think carefully about the potential risks associated with flying commercially without professional medical assistance if you’re sick or injured. Yes, there is a cost associated with a professional air medical escort (though it might be lower than you think, and insurance might cover the cost), but the costs of not getting medical help can be painfully high.
Last week we wrote about the 5 questions to ask an air ambulance provider as you navigate the process of finding air medical transport for your patient or loved one. Questions #4 was “What medical staff will be on the transport?” Some companies only have nurses, or paramedics, or EMTs. At MedFlight911, we will staff the medical flight with a medical crew appropriate for the situation. A standard air ambulance medical crew includes a critical care nurse and a critical care paramedic. Commercial air medical escorts and ground transport escorts are typically paramedics, critical care nurses, or physicians.
At MedFlight911, we believe in a patient-centric approach to medical transport, not a one-size-fits all. So just as we work to find the most effective and efficient mode of medical transport, we will staff the medical flight with the medical professionals necessary to keep the patient safe and comfortable – which of course depends on the patient’s situation. For the most critically-ill patients, we might staff the medical flight with a standard crew plus a physician or specialist. In other cases, including commercial air medical escorts for example, a critical care paramedic may provide just the level of care the patient needs.
Whichever staff configuration we determine is most efficient and effective for your patient or loved one, rest assured that every MedFlight911 medical flight crew member has met rigorous training standards, including initial orientation and continuing education. During the required medical flight initial orientation, our medical crews review:
Medical flight crews must also do at least 100 hours of continuing education per year on top of their standard certifications. That includes reviews of:
MedFlight911 is committed to providing the highest level of medical care to our patients. Staffing our air ambulance medical flights, commercial air medical escorts, and ground medical transports with professional, highly-trained medical crews is just one more way we do that.
Over the 30 years that we have been providing air medical transport services to patients around the world, we’ve come to understand pretty well what the experience is like for patients and their families. We understand that it’s a stressful, often scary time. We understand why most patients and family members don’t want to spend a lot of time calling around to different air ambulance providers to find the right one.
That said, we also recognize that you’re probably going to call at least two companies to ensure that you’re getting the right service for yourself of your loved one – as you well should. When you make those phone calls, what do you ask? Of course, the cost of the transport will likely be a factor in your decision, but it shouldn’t be the only factor. To help ensure that you find the right provider to meet your needs, here is a list of 5 questions to ask.
At MedFlight911, we don’t believe in a "one-size-fits-all" approach. Instead, we help you select the best transport solution based on the patient's medical condition, trip distance, budget, time constraints and other key factors. Our concern above all else is getting the patient transferred safely and expediently. We will work with you, the care provider, and the insurance company, if applicable, to determine the most effective way to accomplish that goal. For a general idea of which type of medical transport might be appropriate, see our blog article How Do I Decide Which Type of Medical Transport Is Right for Me (Or My Loved One)?
Whether the patient’s medical insurance provider will cover the medical flight or not depends on a range of factors, including the insurance provider, the policy, and the patient’s particular situation (see our blog article Does Insurance Cover Air Ambulance Service Part 2 – Medical Insurance for a discussion). We cannot guarantee coverage, but we will absolutely work with the patient’s insurance company to maximize the possibility of reimbursement.
At MedFlight911, it is our job to take care of every detail of the patient’s transport. Of course that includes coordinating with the patient’s healthcare providers – both at the “departing facility” (where the patient will be when we pick her up) and at the “receiving facility” (where we will be transporting the patient to). Our work with the patient’s healthcare provider begins at step 1 when we work together to determine the most effective form of medical transport for the patient.
Some companies only have nurses, or paramedics, or EMTs. At MedFlight911, we will staff the medical flight with a medical crew appropriate for the situation. A standard air ambulance medical crew includes a critical care nurse and a critical care paramedic. Commercial air medical escorts and ground transport escorts are typically paramedics, critical care nurses, or physicians. Please see our Air Medical Transport Crew page for more details.
The type of equipment that will be on the medical transport depends in large part of the type of transport. For example, an air ambulance is equipped with much more sophisticated critical care equipment than a commercial air medical escort would be. Once we’ve determined the appropriate type of medical transport, we’ll determine what kind of medical equipment will be necessary. Our air ambulances can be equipped with the full range of resources (see our Air Ambulance Equipment page for more detail).
We understand that entrusting your own care or the care of your family member to an air ambulance provider who you’ve never met in person can be scary. Using these 5 questions to begin your conversation with a provider will be a good step toward ensuring that you find the best medical flight provider for yourself or your loved one.
A couple of weeks ago we wrote about whether or not insurance covers air ambulance service. With health insurance companies, the discussion typically boils down to one factor: medical necessity. But medical necessity can be a matter of opinion. In some cases, for example, insurance companies have said that transporting a patient to be with family members for convalescent care is not medically necessary but rather “at the convenience of the family.” We’d like to challenge that notion.
Many medical professionals agree with us. In a number of reports on traumatic brain injury, spinal cord injury, and even chronic illness, medical researchers have found that being in a “normal” environment with family members and friends leads to a speedier recovery than being in an unfamiliar environment with unfamiliar people.
Many of the air ambulance medical flights that we provide are to reunite family members with their loved ones. In one case an older woman had been spending the winter in Arizona when she suffered a debilitating stroke; we arranged a medical flight for her back to the East Coast. In another case a man had been in Nebraska when his chronic breathing condition severely worsened; we arranged a commercial air medical escort back to Bulgaria.
Being with family members in a “normal” environment (rather than in a facility with no familiar faces) matters on a number of levels. In part, it takes away the anxiety we all feel when we’re alone and lets the patient concentrate on recovery. Being with family can also give patients a boost of strength and determination – both key factors in recovery.
So from our perspective, at least, being with loved ones when recovering from a traumatic injury or illness is not a matter of convenience; it’s a matter of necessity.
If you think you need an air ambulance to transport yourself or a loved one, there are some pieces of information you’ll need to gather as you begin to make arrangements. When you call MedFlight911, we’ll listen carefully to your situation and ask the questions that will give us a complete understanding of your loved one’s needs. Together, we’ll look at all of the factors that determine which type of medical air transport is best, and MedFlight911 will give you options.
We’ll ask you for a number of medical documents that are necessary for us to quickly and efficiently determine the best type of medical transport for your loved one. The information we’ll need includes:
Based on that medical information, we’ll talk about the best medical transport options, and rule out which options are not viable based on the patient’s current condition.
We’ll also ask a number of questions that will help us determine the best medical transport for yourself or your loved one (“best” meaning the fastest, lowest-cost solution that will transport you safely – see How Do I Decide Which Type of Medical Transport Is Right for Me?). A few of the key questions we’ll want to discuss are:
Once we’ve had that initial conversation, we’ll take care of the rest:
We get that this is a scary, stressful time. We also get that we’re not going to make it easy or fun. But we do promise that we will take care of all of the transport details so you don’t have to worry about them. This is an overview of our process. If you think you or a loved one needs medical air transport, give us a call today at 888-359-1911 or request an air ambulance transfer online.
I read the other day that the University of Wisconsin is collaborating with health officials in Georgia, Michigan, Minnesota, and Washington on a study aimed at understanding what triggers stress in caregivers. Called Tailored Caregiver Assessment and Referral, or TCARE, the goal is to give people an understanding about how to making caring for a loved one easier. It’s important work: more than 65 million Americans provide care to a loved one.
The story caught my attention because many of the patients who use our air ambulance service require some form of convalescent care (designed to help people recover from serious illness, surgery or injury). Whether you’re taking care of a parent, a spouse, a child, or some other loved one, the fact is that being solely responsible for every aspect of a person’s care 24/7, no matter how much we love that person, can be really hard.
1. Accept help. As a caregiver, you are a hero for sure, but you don’t have to be Superman. When neighbors offer to bring over a hot meal, say yes! If you have children, remember when they were newborns: you probably didn’t fret over letting some things slide (the running joke is that new parents haven’t brushed their teeth in a week) and, more importantly, over asking for (and accepting) help. Let other people help you shoulder the responsibility.
2. Don’t give in to guilt. Caregiver guilt can be particularly painful, but you’ll realize that if you accept your feelings instead of pushing them aside they will actually lose a lot of their power. “I should be able to do this on my own.” “I shouldn’t feel mad/sad/resentful.” Therapists call these “shaming shoulds” – and they don’t do anyone any good. As the Family Caregiver Alliance points out: “You are not selfish to think about yourself and your needs and feelings. Although caregivers feel guilty when they get angry or frustrated, these feelings are ok and a way to know how well you are coping.”
3. Join a support group. The Mayo Clinic points out that “a support group can be a great source for encouragement and advice from others in similar situations. It can also be a good place to make new friends.” Your weekly support group meeting can be a great “excuse” to get out of the house. For more regular support, join an online caregivers’ support forum.
4. Take time for yourself. Our medical flight crews, who experience similar stressors, especially on long international medical flights, make time off a priority. They realize that if they don’t rest and relax after a medical transport, they will burn out. According to the Family Caregiver Alliance, “One of the stressors of caregiving is seeing no end to the situation. Having a life and connections outside of caregiving helps you to maintain perspective, so that caregiving doesn't become your only reality.”
Some of our patients and families have called us heroes, but the real heroes are the caregivers who are by the patient’s side day in and day out. But remember, you’re not superhuman. Not only do you deserve to take care of yourself, too, but doing so will make you a better caregiver for your loved one.