Universal Air Evac, an air ambulance company based in Lanseria, Johannesburg is no stranger to critical missionsand urgent repatriation operations. With over four decades of combined experience within its management team, the company has successfully conducted numerous life-saving flights across Africa and internationally. A recent mission, however, highlighted the importance of their rigorous training protocols and the seamless communication required to ensure success in life or death circumstances.
In a seemingly routine evacuation along the East African Coast, a fixed-wing aircraft was dispatched to transfer a patient initially reported as stable. The patient, believed to be awaiting pickup at the referring hospital, was instead found to be in a critical condition, improperly managed, and rapidly deteriorating in an ambulance, already waiting at the airport.
With the situation escalating rapidly on the tarmac, the medevac team sprang into action. Despite the unexpected turn of events, they swiftly intervened, deploying their expertise to stabilise the patient and initiate life-saving interventions.
This stark disparity between the initial report and the actual condition of the patient came as a surprise to the team who had to, in the moment, make critical decisions and utilise their years of experience and skills to stabilise the patient there, on the tarmac. This example between medical reports and actual patient conditions being miscommunicated, however, is not uncommon in emergency medical evacuations, especially throughout Africa.
As the team reflected on this specific mission, the importance of rigorous training, unwavering teamwork, and critical decision making within the team was highlighted.
“In this environment, where we cannot always control communication from other parties, is where the motto ‘prepare for the worst, and hope for the best’ serves as a guiding light, ensuring a team prepared for anything they may find, every time”, commented Shane Marais, General Manager.
Communication Challenges in Multilingual Africa
One of the foremost challenges encountered during medical evacuations in Africa is the plethora of language barriers that exist across the region. This is a continent where some regions predominantly speak Portuguese while others favour French. English, while spoken across a lot of the continent can be very broken, or completely non-existent entirely. This is also not mentioning the numerous local languages and dialects within each country, making the task of conveying critical medical information becomes exponentially complex.
Compounding this issue is the involvement of third-party intermediaries between the medical team and local healthcare providers. Paramedics, medical insurance parties and services on the ground could perhaps speak a different dialect and unintentionally convey incorrect information. While these intermediaries play a vital role in facilitating communication, there exists an inherent risk of misinterpretation or distortion as information passes through multiple linguistic filters.
Resource Constraints in Rural Africa
In rural and smaller towns across Africa, healthcare resources are often plagued by scarcity and inadequacy. This reality was starkly evident in this case when the team encountered this patient in an ambulance without any monitoring equipment or oxygen and with an incorrectly placed endotracheal tube. When it comes to repatriations in more rural Africa, the air ambulance team will actually arrive equipped with more advanced medical devices than what is available on the ground.
Moreover, the scarcity of healthcare personnel on the ground in these areas compounds the challenge. In some instances, the available staff members in the medical centres, or even driving the ambulance may lack sufficient training to handle critical situations, further exacerbating the risk to patients.
The team will therefore need to be fully prepared for a full medical intervention. In addition to this case, the Universal Air Evac team have often found themselves not only providing specialised medical care but also filling critical gaps in resource availability and expertise on the missions. This metaphorical “wearing of several hats” ensures that every patient receives the highest standard of care, regardless of their location or the limitations of the local healthcare infrastructure.
Emotional Decisions and Their Impact
In the face of dire circumstances and limited resources, families often make emotional and uninformed decisions in an attempt to save the lives of their loved ones. In this case, a decision was made by the family to transport the patient to the airport in a bid to save time. While their intentions were undoubtedly fuelled by a desire to expedite the process and increase the chances of survival, this decision inadvertently compromised the patient’s stability and put him in a dangerous life-threatening position. By the time the patient reached the aircraft and tarmac, he was in a critical condition, which meant that the air ambulance crew’s approach had to shift drastically from stabilisation to life-saving mode.
While it is natural for emotions to guide decision-making in such situations, it’s crucial to recognise the potential risks involved. Not only did this decision increase the patient’s vulnerability, but it also escalated the complexities of the mission entirely.
Overcoming the Adversity to Save Lives
In the face of various potentially lethal challenges, the Universal Air Evac team demonstrated perseverance, ultimately succeeding in stabilising the patient and facilitating his transport to South Africa for further care. It highlighted the absolute importance of preparedness and training to manage these highly complex circumstances. A key example of the level of preparedness is the fact that the team has set medical bags and equipment ready within the facilities at all times, ready for the next mission. Moreover, the importance of taking decisive actions in the absence of reliable communication channels cannot be overstated. As in this case, the team must take matters into their own hands, directly liaising with doctors or leveraging available resources to deliver optimal care.
Despite the challenges posed by the limited crew and the need to improvise in critical situations, the team’s adaptability and resourcefulness remain steadfast, exemplifying their unwavering dedication to their life-saving mission. By navigating the complexities of medical evacuations in Africa and beyond, this remarkable team continues to save lives and bring travellers home to their families.
