Strategically planned – from Rayong to Geneva

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Report

A Rega crew begins a three-day jet mission to Thailand to bring a seriously ill patient back to Switzerland. Good organisation in advance is crucial to the success of the mission.

View into the cockpit of a Rega jet during flight. — Full cockpit: pilots Raphael Jenni, David Schenk and Daniela Bergamin en route to Thailand.

“Our patient is in intensive care and must be repatriated on a ventilator”, says Felix Schatter. It’s 7.30 a.m. Standing around the rectangular wooden table in the briefing room of the Rega Center alongside the flight physician are pilots Daniela Bergamin, Raphael Jenni and David Schenk, intensive care flight nurse Svenja Kägi and flight coordinator Monica De Santis. In an hour’s time, the five-man crew will set out on a three-day jet mission to repatriate a seriously ill man in Thailand. They’re currently discussing the mission. It’s not just the flight path, fuel stops and weather that are important to know, but also the health of the patient, the conditions at the destination airport and the cooperation with the local hospital. Following this exchange, all crew members have the same information at their disposal and are able to begin the mission fully prepared.

Clarifications with local doctors

In the days prior to the briefing, the Rega medical consultants undertook important groundwork. On behalf of the ETI Operations Center of the Touring Club Switzerland (TCS), they ascertained the medical condition of an 80-year-old man who is currently in hospital in Thailand having been diagnosed with severe pneumonia and septic shock. They have been communicating with the local doctors for several days in order to remotely assess the condition of the patient in intensive care. They have concluded that the man is well enough to travel. As soon as this becomes clear, the flight coordinators organise his repatriation to Switzerland. The dispatcher determines the flight paths. These aren’t always the shortest routes. For safety reasons, crisis and conflict zones must be avoided or flown over at a sufficiently high altitude. Only once the flight path has been determined can the necessary permissions be obtained to fly over the respective countries. What’s more, a separate permission is required for each take-off and landing. “We can’t set off without these”, says jet flight coordinator Jessica Herrmann. She prepared the mission to Thailand along with the dispatcher.

Rega staff preparing a device for transport. — Intensive care flight nurse Svenja Kägi brings Rega’s perfusors and ventilator to the patient.

Arranging the ambulance

As the permissions come in one by one, the team concentrates on all the other puzzle pieces such as the refuelling stop for the Rega ambulance jet in Mary (Turkmenistan), a taxi to take the crew from Rayong Airport (Thailand) to the hotel, and last but not least the ambulance, which will transport the patient from the hospital to the jet. Finally, the night before the mission, the flight coordinator summons the crew. Due to the long flight time, three pilots are required. They will take it in turns in the cockpit on the flight to Thailand. The team also includes a physician and an intensive care flight nurse.

Flying without air traffic controllers

The Rega jet refuels on the first stopover in Mary. The handling personnel are on hand and actively help out. Within less than an hour, the crew is back in the air over Afghanistan. “There’s no controlled airspace here. This means that there are no air traffic controllers on the ground to monitor our flight. Instead, we have to communicate our position every five minutes, while also listening in to make sure we’re aware of any other air traffic until we reach Pakistan”, explains Raphael Jenni.

A Rega flight physician performs a minor procedure inside an ambulance jet. — Small procedure in the Rega jet: flight physician Felix Schatter inserts an arterial line.

Visiting the patient

After two long flights of six hours each, the crew lands in Rayong before dawn. “The airport is small and quiet, everything went like clockwork. The ground crew were on hand to coordinate our arrival in Thailand and our taxi to the hotel was ready and waiting”, says Raphael Jenni. It’s still too early to travel to the hospital. So the crew head to the hotel for a few hours’ sleep. After a brief period of rest, flight physician Felix Schatter and intensive care flight nurse Svenja Kägi head to the hospital to visit the patient and better assess his condition. For a more comprehensive picture, they talk to the patient’s doctor and intensive care nurse at the hospital who then prepare the departure and discharge papers. The next morning, the medical crew returns to the hospital. They connect the perfusors and the pa tient’s ventilation tube to the Rega equipment. An ambulance then transports the patient and the medical team to the ambulance jet.

Monitoring blood pressure in real time

The man is loaded into the jet via the ramp specially developed for Rega and carefully placed on the intensive care bed inside the jet. The journey home begins. The flight path is the same as on the outbound leg, including a stopover in Mary to refuel. During the flight, Felix Schatter inserts an arterial line into the patient in order to monitor his blood pressure in real time and adjust the ventilator settings according to the blood gas analysis. The flight through six time zones goes without a hitch. The Rega jet lands safely in Geneva the following evening. An ambulance is ready and wait ing to transport the patient to a hospital where his treatment will continue. One final take-off and the Rega jet returns punctually to the Rega Center at Zurich Airport. Thanks to the excellent advance planning and professional crew, everything has run like clockwork.

These specialists make repatriation possible

Ground crew

Three separate teams of professionals work in shifts around the clock at the Rega Operations Center in order to ensure that the jet crews can transport patients safely back home:

Flight coordinator

If you call the Rega international emergency number on +41 333 333 333, you will get through to a flight coordinator. They coordinate and organise the repatriation according to the specifications of the medical consultants.

Medical consultant

Medical consultants talk with the doctors on location, as well as with the patient and their next-of-kin. They then decide if repatriation is necessary, and if so, when and how.

Dispatcher

Dispatchers plan the flight paths of the Rega jets including any stopovers, obtain overflight permits, coordinate with fuel suppliers and handling teams at the respective airfields, and provide the pilots with all the necessary flight documents before take-off.

Flight crew

Once the mission has been organised, the crew is summoned. The crew always comprises the following three professions:

Jet pilot

The Rega jet is always flown by two pilots, a commander and a co-pilot. For longer missions, there may be up to four pilots on board, who take it in turns in the cockpit.

Intensive care flight nurse

Together with the flight physician, the intensive care flight nurse guarantees the provision of professional medical care - from the time the patients enter their care abroad to when they are handed over at the Swiss hospital.

Flight physician

The flight physician bears the medical responsibility for the mission, ensures a smooth handover and optimal medical care during repatriation.