EMA Finland’s Medical Director Tuomas Hiltunen talks about international patient transport operations. Hiltunen, who has worked at EMA since 2012, is a specialist in anesthesiology and intensive care, who also has a special qualification in first aid. He has been involved in dozens of ambulance flights.
EMA carries out hundreds of patient transports between different countries every year. They can be repatriations of Finns from the world on scheduled flights or ambulance flights, or ambulance flights from an international destination to another international destination. In addition to patient transport, EMA’s travel emergency service also offers medical consultation and treatment supervision for Finns hospitalized abroad.
“About a hundred ambulance flights are made annually. The majority of Finns’ repatriation flights are made on regular scheduled flights, where the patient can be accompanied by a nurse, a doctor or a team of several people, Hiltunen says.”
The decision about when a patient needs an ambulance flight and when a regular scheduled flight with additional arrangements is sufficient is not a simple one. It is influenced by many factors, but the most important is the medical risk assessment. Sometimes a situation may arise where the patient’s condition would allow traveling on a scheduled flight, but due to his geographical location, an ambulance flight is the only option.
Before the plane’s wings take off, a lot of preparatory work has been done. Transferring a patient who needs an ambulance flight from one country to another requires a huge logistical arrangement, which the coordinators working at EMA sometimes do even with short notice. Schedules and routes are agreed with the flight operator, and in addition, we find out where possible stopovers, refueling and overnight stays can be made. In addition, special needs for patient care on the flight and transport arrangements in the destination country are arranged.
Intensive care thousands of meters high in the sky
The reasons one might need an ambulance flight can be, for example, acute brain events, infections, diseases of the heart and circulatory system, cancer and injuries. An ambulance flight can provide hospital-level treatment, and every flight is ready for intensive care.
Most often, an ambulance flight has one patient, a doctor and a nurse tending to them, but up to four patients can be transported on the same flight. When flying at an altitude of thousands of meters, several special features must be taken into account in patient care.
“The low-oxygen environment of an airplane is the biggest risk factor. In a plane, the air is thinner and the conditions correspond to the same as if you were two thousand meters above sea level. A healthy person may not notice it, but for a patient who already has a severe oxygenation disorder, this is a key issue, Hiltunen says.”
Another significant factor in an airplane is the low-pressure environment.
“In a low pressure environment, all air filled cavities expand. If there is air in a place where it shouldn’t be, it can become life-threatening.”
If the patient has air inside the skull or a so-called pneumothorax, it usually prevents flying. However, if the patient has to be transferred, the plane cannot fly at normal altitude. In such situations, we fly at a lower than normal so-called sea-level altitude, so that the air pressure in the cabin corresponds to sea level.
The coronavirus creates bumps in the road
The coronavirus pandemic has also been reflected in EMA’s operations, because there are almost no Finnish passengers in the world due to the virus. In the early stages of the pandemic, EMA discharged several Finnish coronavirus patients, but as the situation has progressed, the focus has shifted to international coronavirus patients. Most of EMA’s flights this year have been commissioned by multinational operators and international organizations. The destinations have been, for example, the regions of the Middle East and Africa.
“EMA has done well here, and with the crisis we have gained an even firmer footing in the international arena than before, says Hiltunen.”
Corona has been seen in patient transport in many different ways. It affects both the logistical arrangements and the treatment of the patient during transport.
“When we started making the first flights right in March, no one had any definite information about the virus and its contagiousness. Even though we knew our security level was top-notch, it was stressful. Now that we better understand how the virus spreads and how to deal with it, we can approach the matter with common sense, Hiltunen says.”
In the treatment of coronavirus patients, it is necessary to use an isolation unit, which is challenging for the medical staff to work with. Caring for the patient becomes limited, and all procedures must be anticipated and planned carefully in advance.
The virus can also be seen in the treatment of non-corona patients. Normally, the EMA staff picks up the patient from the hospital and after the flight transports him to the hospital in the destination country, but this year they have moved mostly from the airport to avoid exposure to another corona virus. Searching for stopover and rest places has also been more complicated than before.
“At its worst, it felt like half the world was literally closed, says Hiltunen.”
Interesting tasks in a special operating environment
Years of experience both in primary care in Finland and at EMA in an international operating environment have made Hiltunen no longer startled by the slightest thing. Although very challenging situations have come up, solving them is rewarding. Work is counterbalanced by family and hobbies, which include, for example, moving in the mountains.
“I guess you could say that I’ve seen everything and a little more. If there is something I consider a challenge, it is that we secure the conditions for our operations. In the world, the competition in ambulance flight and medical assistance operations is fierce.”
Thanks to the unique and interesting operating environment, working at EMA keeps Hiltunen in its grip after almost ten years at the company.
“No one else in Finland does this, and not many in the world either. We have a fairly small and dynamic team, and the management system is agile. We can develop and regulate our own activities together with an international network. Quality requirements, competition and industry certification keep us constantly involved in development.”
- Operationally responsible for EMA’s travel emergency service, EMA First Aid medical management and organizing international trainings of the European Resuscitation Council (ERC) in Finland.
- Education, a specialist in anesthesiology and first aid with a special qualification in first aid. Before joining EMA, worked for e.g. in the medical helicopter and in the first aid medical unit.
- Board member of the Finnish Resuscitation Council.