Background

A 47 year old Indian seafarer in a German hospital requiring medical repatriation. Presented with fatigue, abdominal cramps, vomiting and shortness of breath. No significant past medical history

Hospital Assessment

  • Blood tests revealed liver dysfunction and infection
  • CT scan revealed a pancreatic tumour with metastatic spread to the liver
  • Patient malnourished with poor oral intake and absorption
  • Patient weak with reduced exercise tolerance
  • Abdominal fluid collection (ascites)

Hospital Treatment

  • Commenced on intravenous antibiotics
  • Commenced on supplementary nutrition
  • Biopsy indicated (patient declined as wished in home country)
  • Palliative chemotherapy advised (patient wished any treatment in home country)
  • Draining of ascitic fluid by needle aspiration
  • Supportive therapies

Med ResQ – Case Review Summary

This patient was initially identified locally as requiring a nurse escort. New information provided a few days before the proposed repatriation indicated that the patient was less stable with a high risk of rapid deterioration, but still within a window of stability for transfer. The patient was receiving palliative care only and would likely succumb to his condition within a short space of time. The escort type was changed to a Doctor in view of increasing instability and the potential for complications during flight.

Med ResQ Repatriation

  • The patient continued to deteriorate prior to repatriation with significant pain and further reduced mobility.
  • The Med ResQ doctor worked with hospital staff to optimise and prepare the patient for transfer
  • Further drainage of ascites was requested before flight
  • Doctor and patient transferred by ambulance to the airport for 2 sector business class flight
  • Patient required significant observation and treatment throughout transfer
  • Admitted to local hospital in India where he saw his family before passing away a few days later

 

Learning Outcomes

It is important to remain open minded about the type of escort that may be required for a repatriation and to balance this against new medical information. Changing the escort type before a repatriation from a nurse to a doctor prevented a failed repatriation which would have incurred costs and delays and would also have meant that the patient would likely not have made it home to be with his family when he passed away.