Terminal Medical Evacuation: ICU Charter Flight for Critically Ill Patient

Patient Overview:

A critically ill patient suffering from metastatic disease involving the liver, lungs, peritoneum, and skeletal muscles was admitted to KIMS Hospital, Hyderabad. The patient initially presented with fever and was later diagnosed with AlkD septic shock. This case required a high-risk ICU air ambulance transfer from Hyderabad to Angul, Odisha, as the patient’s condition deteriorated to a terminal stage.

Rapid Deterioration and Intensive Care Challenges:

Upon admission, the patient’s condition was critical. Septic shock was managed aggressively with broad-spectrum antibiotics, alongside supportive dialysis to manage multi-organ dysfunction. Despite intensive care, the patient’s condition gradually worsened. The patient developed severe hypotension and drowsiness, requiring continuous ICU monitoring and support.

Complications and Advanced Interventions:

A chest X-ray revealed a left lung collapse, leading to severe hypoxia. The decision was made to intubate the patient to secure the airway and provide adequate ventilation. Bronchoscopy showed thick, tenacious secretions that were obstructing the airways, necessitating aggressive pulmonary hygiene and aspiration. Samples were sent for culture to determine the exact pathogen, but the patient’s shock worsened despite escalating antibiotic therapy.

Preparation for Terminal Airlift:

The patient’s declining condition was marked by severe complications, including persistent hypotension, septic shock, and a non-responsive state to conventional treatments. The ICU team, led by a senior doctor, initiated a conversation with the family about palliative care options. Given the patient’s terminal prognosis and the family’s decision to have him spend his final days at home, a critical care charter flight was arranged.

Coordination and Execution of the ICU Charter Flight:

An ICU air ambulance, equipped with a dedicated doctor and EMT team, was arranged for the emergency transfer to the patient’s residence in Angul, Odisha. The patient remained intubated and on vasopressor support throughout the flight, with continuous monitoring of vital parameters. The medical team ensured all critical care protocols were followed, maintaining ventilator settings, fluid management, and antibiotic administration during the flight.

Final Moments: A Journey Home:

Upon reaching Angul, the patient was transferred from the air ambulance to a ground ambulance, carefully handled to avoid any further destabilization. The medical team coordinated with local healthcare providers to ensure a smooth transition. The patient, now in a familiar environment surrounded by loved ones, spent his final hours with dignity and comfort.

Conclusion: A Compassionate Choice in the Face of Terminal Illness:

This case highlights the complexities of managing a critically ill patient with metastatic disease, requiring meticulous planning for an ICU charter transfer. It underscores the importance of compassionate care, giving the patient the opportunity to be at home in his final moments, supported by family and a dedicated medical team.