Remote emergency medical rescue - experience counts

Dr Charles Crawshaw - ACE Air & Ambulance • 27 November 2018

Zimbabwe-based emergency medical services company, ACE Air & Ambulance published the following story of their rescue of a patient severely injured by an elephant in a remote area, in the first issue (October 2018) of their monthly magazine Alpha One

Such situations are extremely rare, but Wild Zambezi shares this story in order to demonstrate that even in remote areas (like the Zambezi Valley), experienced and professional rescue services are on hand in the region to provide the highest levels of medical care should the need arise.

"Running an air ambulance service in Zimbabwe that specialises in remote recovery, inevitably means that the majority of our work load is for primary calls. Trauma makes up the lion’s share of this work. It will come as no surprise that wild animals feature in a significant number of these calls. Elephants top the list of offenders both due to the large number in the region and their unpredictability. 

On one particular day our call centre received a request just before 10am for the evacuation of a patient from a remote game park in a nearby country. The request was ‘to activate as soon as possible’. The medical details were that the patient had been injured by an elephant, that he had a deep laceration to the upper abdomen, an open fracture to his leg and a puncture wound to his thigh. His blood pressure was reported to be 76/69 mmHg with a pulse rate of 122. This indicated that he was in severe hypovolaemic shock.

The incident had occurred around 7am. The patient had been taken to a local clinic, which was adjacent to a dirt airstrip. The dirt airstrip was not suitable for anything other than light single engine aircraft, being at an altitude of 1000 metres and having a single dirt runway of just 600 metres.  This would not accommodate our King Air 350, King Air 200 or for that matter our King Air 90.

Our dispatchers quickly established that the nearest serviceable airport suitable for the King Air was some 80 kilometres from the clinic.  The 80 kilometre journey to the clinic was on poorly maintained dirt roads and it was estimated that by road it would take over two hours from the serviceable airport.

In many of these cases the biggest delay is in obtaining flight clearance into the country and onwards clearance, which in this case was to be South Africa. It may take many hours before clearance is given. In some African countries the clearance can only be given by the military and will only be granted with a letter from a local doctor (a problem when the patient is in a remote safari area with no doctors!). Fortunately, in this instance we had built up a good relationship with the relevant authorities and within an hour clearance was granted to fly the King Air into the serviceable airport.

Our ground team managed to locate a helicopter based at the serviceable airport and a plan was formulated to transfer our medical team and their equipment the 80 kilometres by helicopter once the King Air had landed and cleared customs. At the same time an ambulance was dispatched by our local service provider to make the two hour trip into the game park. It was anticipated that the medical team could stabilise the patient and he would then be transferred by road ambulance to the air ambulance.

The air ambulance took off from Harare one and a half hours after the initial call, landing at the serviceable airport just over an hour later. During this time our ground team had established, which hospital in South Africa could take the patient. They had arranged for an ambulance to meet the aircraft when it landed in South Africa. Most importantly they had obtained ‘Port Health Clearance’ from the South African authorities allowing us to bring the patient into their country.

The air ambulance carries jump bags packed with all the essential medical equipment. This equipment needed to be transferred to the helicopter, which was not configured for air ambulance work. In addition, the crew took an oxygen cylinder and portable ventilator.

The team arrived at the clinic at 1.30pm some six and a half hours after the injury. The history they received was that at around 7am that morning an elephant had attacked a safari vehicle and turned it over. The occupants had all jumped out of the vehicle and run away from the scene. The patient had stopped at some point to take a photograph of the incident and this caused the elephant to attack him.

The clinic turned out to be nothing more than a hut by the airstrip. Although there was a doctor and nurse in attendance no start had been made at resuscitation. They did not have any equipment to set up an intravenous drip nor did they have any pain killers.

The injuries were more severe than had been previously described. There was a degloving injury to the chest on the left. This exposed a number of fractured ribs, a contused, collapsed lung. Through this hole in the chest wall the heart was visible. The injury to the thigh was very extensive exposing the bone around the hip. There was a severe open fracture of the leg. In addition to the very low blood pressure and high pulse rate, which indicated hypovolaemic shock, he had a dangerously low oxygen saturation level.

The medical team started the patient on oxygen and established intravenous infusions before closing the chest wound and inserting a chest drain. This resulted in a normal oxygen saturation level and improvement in the patient’s blood pressure. After 11/4 hours it was felt that the patient’s condition was stable enough for him to be moved.

At this point it was felt that the journey out by road was not a reasonable option. The patient was still critically ill and in considerable pain when moved despite intravenous pain relief. If a road trip was to be undertaken it would have had to be done at a very slow speed. Not only would this result in a significant delay in getting him to the air ambulance but also there was the question as to whether the oxygen cylinder would last the trip.  A decision was taken to fly him out.

The helicopter was not suitable and was not configured to take a stretcher. A local safari operator made available a Cessna 208 and the patient was placed in a vacuum mattress, which supported him in the aircraft. Prior to this short flight insurance had to be put in place before it could go ahead.

The next issue that the team was confronted with was that the patient’s weight was at the upper limit of the air ambulance stretcher. This made loading and managing the chest drain in flight difficult. This problem was not helped by the bulky vacuum mattress used to support the patient and his fractures.

Once in the air ambulance the patient’s vital signs continued to improve and the team had a relatively uneventful flight to South Africa before finally handing over the patient to the waiting trauma team at 9pm that night.



Every case presents its own set of problems. Having an experienced ground team and the flight crew that are able to anticipate the problems and have the capacity to find solutions means that a way is always found to best serve the patient".

ACE Air-Ambulance accepts all international medical aid/insurance companies, as well as the following local medical aids. 

 

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