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Turkey Medevac
​case study 3


AIR AMBULANCE TURKEY

Air Ambulance Turkey Istanbul
​Transport report

Case 9

​

  • TRANSFER REPORT
    Patient`s Name, Surname: MLB
    DoB / sex: 01.06.1968 / M
    Anamnez: Cezayir’de XX tarihinde geçirdiği kazayı takiben, hasta 1 hafta sonra
    tedavi amacıyla Sousse / Tunus’ sevk edilmiş. Hastanın tedavisi 2,5 aydır Tunus’da devam
    etmekteymiş.
    Medikal Durum: Hasta spontan solunumda. GKS 6 olarak değerlendirilmiş. Hasta
    tetraplejik. Gastrostomiden besleniyor. Yatak yaraları mevcut. Eklem sertlikleri ve kas
    atrofisi başlamış..
    Transfer Sebepleri: hastanın tedavi eden doktoru, şu sebeplerle hastayı BAE’ne
    sevk etmiş;
     Eklem sertlikleri ve kas atrofisi nedeniyle fizyoterapi.
     Dekübitis ülserleri değerlendirmesi ve tedavisi için Plastik Cerrahi
     Düzenli ve dengeli, beslenmenin sağlanması
     Nörolojik Rehabilitasyon
    Yerinde Muayene:
    Genel durum orta. Hasta yarı-bilinçli (etraftaki uyaranları takip ediyor ama yanıtsız).
    Hasta tetraplejik ve eklem sertliği ve atrofi mevcut.
    GKS: Hasta tetraplejik olduğundan, doğru değerlendirilemiyor (ancak 8-9 civarı
    tahmin edildi).
    TA: 115/79 mmHg, N: 97/dak, SpO2: % 97 (oda havası), BT: 38.3*C. Son
    laboratuvar sonuçları normal sınırlarda idi.
    CV: Normal.
    Solunum sistemi: Trakeostomili. Hilar bölgelerde orta ronküsler.
    GIS: Gastrostomili. Ensure ile besleniyor.
    Uriner: Foley kateter mevcut ve idrar çıkışı mevcut.
    Cilt: Oksipital bölgede tedavi edilmiş dekübitis ülseri mevcut. Sakrum’da 15X20
    cm, tüm katları içeren dekübitis ülseri mevcut.
    Hazırlıklar: Ertesi Gün
    Hareketten önce, gastrostomy temizlendi ve inaktive edildi ve IV damar yolu açıldı.
    Sacral dekübitüs pansumanı hareket öncesinde değiştirildi. Vücut temizliği yapıldı ve alt
    bezi yenilendi.

  • Hasta, yatak örtüleri ve underpedler ile desteklenmiş vakum sedyeye alındı daha
    sonar da sırt tahtası üzerine yerleştirildi (vakum sedye sadece yüklemeler ve indirmeler
    sırasında vakumlandı, bunun dışındaki dönemlerde matres olarak kullanıldı). Hasta TA ve
    SpO2 açısından takibe alındı. IV damar yolu ve idrar sondası aktif idi.
    Transfer:
    Yoğun bakım sağlıkçısı bulunan kara ambulansı uygun şekilde organize edilmişti ve
    saat 04:45’de hazır idi. Hasta yüklendi ve Sousse’dan transfer saat 05:15’de yukarıda
    belirtilen medical durumda başladı.
    Sousse’dan Tunis’e transfer sırasında beklenmedik bir sorun gelişmedi. Hasta stabil
    idi.
    Zaman
    TA/ mmHg
    Nb/ dak
    SpO2 %
    SS /dak
    05:00
    115/70
    106
    96
    24
    Ortalama
    112/70
    112
    96
    24
    09:00
    108/77
    112
    98
    24
    Tunis havalimanında, resmi işlemler uzun sürdü ancak ambulans ekibinin de
    yardımıyla halledildi. Havalimanıda, hastanın underpedleri ve alt bezi değiştirildi.
    Hasta saat 10:45’de uçağa yüklendi.
    Zaman(Tunus)
    TA/ mmHg
    Nb/ dak
    SpO2 %
    SS /dak
    10:45
    113/71
    114
    96
    24
    Tıbbi muayenede; medikal durumda bir değişiklik tesbit edilmedi.
    11:30
    106/71
    113
    94
    22
    O2, 2lt/dak başlandı.
    12:00
    105/71
    118
    97
    24
    Ortalama
    108/73
    110
    97
    23
    13:45 (15:45)
    İstanbul’a inildi
    110/82
    111
    95
    20
    Uçuş sırasında hasta stabil idi. 350cc infüzyon verildi ve idrar çıkışı 250 cc idi.
    Hastaya belli aralıklarla aspirasyon yapıldı.
    Hasta transit hasta odasına alındı. Muayenede, gelişmiş patoloji yoktu. İstanbul’da,
    hastanın vücut bakımı yapıldı ve hijyenik temizlik uygulandı. Alt bezi ve underpedler
    değiştirildi. Hastaya dekübitis ülserleri içi pozisyonlar verildi.
    Müşahade sırasında; sıvı alımı 200cc, idrar çıkışı 150cc idi. Ateş: 37,5*C idi ve
    Parasetamol infüzyonu uygulandı. Trakeostomi bakımı ve aspirasyon yapıldı.
  • Zaman (TR)
    TA/ mmHg
    Nb/ dak
    SpO2 %
    SS /dak
    16:00
    115/70
    106
    96
    24
    Ortalama
    114/73
    107
    96
    24
    19:00
    117/79
    114
    95
    24
    19:45’de, hasta Dubai uçuşu için yüklendi. Muayenede her hangi bir sorun tesbit
    edilmedi ve hasta stabil idi.
    Zaman (TR)
    TA/ mmHg
    Nb/ dak
    SpO2 %
    SS /dak
    19:45
    108/76
    112
    95
    24
    Muayenede; medikal durumda bir değişiklik tesbit edilmedi.
    O2, 2lt/dak başlandı
    Ortalama
    111/78
    108
    97
    24
    24:45 (01:45)
    Dubai’ye inildi
    113/80
    100
    95
    24
    Uçuş sırasında hasta stabil idi. Sıvı girişi 350 cc ve idrar çıkışı 200cc idi.
    Ertesi Gün
    Havalimanında, havalimanı sağlkı ekibi tarafından karşılandık ve kliniğe alındık.
    Ambulans ekibi burada idi. Kayıt işlemlerini giriş işlemlerini takiben klinikten ayrıldık.
    Hasta stabil idi v eek problem mevcut değildi.
    Zaman (Dubai)
    TA/ mmHg
    Nb/ dak
    SpO2 %
    SS /dak
    02:30
    112/78
    103
    93
    26
    04:00 XXX Sağlık Merkezinde, doktorlu bir ekip beklemekte idi.
    Hasta gerekli bilgiler ve medical dökümanlar ile teslim edildi.
    Best Regards

Case 10


TRANSFER REPORT
Patient`s Name, Surname: MLB DoB / sex: 01.06.1968 / M
Medical History: Following a traffic accident occurred on XX in Algeria, the patient was transferred to Sousse/Tunus for treatment after a week in Algeria. Since 2,5 months, the patient’s treatment continued in Tunus.
Medical Condition: The patient is spontaneous respiration. GCS was assesed 6. The patient was tetraplegic. Feeding from gastrostomy. Has bed wounds. Artricular stiffness and muscular atrophy started.
Transfer Reason(s): Patient’s TD recommended the patient to be transferred to UAE for;
  •   Physiotherapy for articular stiffness and muscular atrophy.
  •   Plastic Surgery assessment and treatment for decubitus ulcers.
  •   Regular and balanced nutrition can be obtained.
  •   Neurologic rehabilitation.
    Examination on Site: XX
    General condition medium. The patient semi-conscious (following the activities around but not cooperative). Patient is tetraplegic and articular stiffness and atrophy present.
    GCS: As the patient is tetraplegic, could not be correctly assessed (but estimated to be around 8-9).
    BP: 115/79 mmHg, P: 97/min, SpO2: 97% (room air), BT: 38.3*C. last laboratory results are within normal limits.
    CV: Normal.
    Respiratory system: The patient has tracheostomy. Mild ronchuses at hilar areas.
    GIS: The patient has Gastrostomy. Feeded with ensure.
    Urinary: Patient has Foley catheter and urine output present.
    Skin: Healed decubitus at occipital area. Over sacrum; 15x20cm decubitus ulcer including all skin layers present.
    Preparations: Next day
    Before departure, Gastrostomy was cleaned and inactivated and IV line opened. The dressing of sacral decubitus is changed before departure. Body cleaning done and diaper changed.
The patient was taken onto vacuum mattress supported by bed sheets and underpeds, then onto spine board (vacuum mattress was used as vacuum only during loadings and unloading, otherwise as mattress only). Patient was monitorized with BP and SpO2. IV line and urine catheter were active.
Transfer:
Ground ambulance with an ICU medic was well organized and ready at 04:45. The patient was loaded and transfer started from Sousse at 05:15 with above medical condition.
During travel from Sousse to Tunis, there was no unexpected problem developed. The patient was stable.
At Tunis airport, the paperwork took long time but sorted out by ambulance team. At the airport, the Underpeds and diaper of the patient was changed.
The patient was loaded into the plane at 10:45.
Time
BP/ mmHg
P/ min
SpO2 %
RR /min

05:00
115/70
106
96
24

Avarage
112/70
112
96
24

09:00
108/77
112
98
24
Time (Tunus)
BP/ mmHg
P/ min
SpO2 %
RR /min

10:45
113/71
114
96
24

On medical examination; no change on medical condition detected.

11:30
106/71
113
94
22

O2, 2lt/min started.

12:00
105/71
118
97
24

Avarage
108/73
110
97
23

13:45 (15:45) Landed İstanbul
110/82
111
95
20
The patient was stable during the flight. 350cc infusion was done and urine output was 250cc. suction to tracheostomy were done intermittantly.
The patient was taken to airside patient room. At the examination, there was no pathology developed. In İstanbul, patient’s body cleaning done and hygienic care was given. Diaper and underpeds changed. The patient’s lying positions given for decubitus.
During the observation; Input: 200cc, Urine Output: 150cc. BT: 37.5*C. 500 mg Paracetamol infusion was given. Tracheostomy care and suctions were done.
Time (Turkey)
BP/ mmHg
P/ min
SpO2 %
RR /min

16:00
115/70
106
96
24

Avarage
114/73
107
96
24

19:00
117/79
114
95
24
At 19:45, the patient was loaded for Dubai flight. On the examination, the patient didn’t have any problem and he was stable.
Time (Turkey)
BP/ mmHg
P/ min
SpO2 %
RR /min

19:45
108/76
112
95
24

On medical examination; no change on medical condition detected.

O2, 2lt/min started.

Avarage
111/78
108
97
24

24:45 (01:45) Landed Dubai
113/80
100
95
24
During the flight, the patient was stable. Input: 350 ml, Urine output: 200ml.
Next Day
We were met by Airport Clinic team and taken to Clinic. Ambulance team was present. Following the paperwork, we left Clinic. Patient was stable and no additional problem was present.
04:00 At the XXX Center, the team with a Doctor was waiting.
The patient was given over with all the necessary information and medical documents.
Best Regards
Time (Dubai)
BP/ mmHg
P/ min
SpO2 %
RR /min

02:30
112/78
103
93
26

​

Medevac Turkey

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