The staff member/EVD patient in the context of medical

evacuation by air ambulance: rights and duties of the patient

and chain of survival.Dr. Jean-Jacques BERNATAS

Regional Staff Physician WHO/EURO

Workshop of private air ambulance providers on medical evacuation of patients with Ebola virus Disease, Luxembourg, 01 October 2014 European Commision, Health and Consumers Directorate-General

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"Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the WHO. WHO does not guarantee the accuracy of the data included in this

paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with WHO official terms."

The context

• Global humanitarian crisis, not just the problem of the African continent,

• Local population affected by thousands in a context of urban setting in developing countries

• Local healthcare facilities devastated, international transport disrupted,

• Individual commitment to assist the affected population:  

• requires an individual strong commitment, and may meet the foundations of the humanitarian action that usually inspire most of our staff,

• the context may also be appealing for "wild" individuals, who are prone to take unacceptable risks for them and for the others around,

• It never happened before, so no one knows what the daily life will be, and no one is really fully prepared

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The bill of rights of the patient (1)

• Definition of a patient: a potential, possible, probable or confirmed case.

• Rights, before being a case:

• Access to prevention: training (practice with minimal theory), equipment (medical kit, water&soap, hands sanitizer, condoms, ...),

• Access to up-to-date information

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The bill of rights of the patient (2)When becoming sick or highly exposed to the risk: access to appropriate care:

• Based on clear, available, evidence-based algorithms,

• Under the lead of an experienced medical team, using the appropriate equipment and following the recommended procedures in appropriate healthcare facilities

• Access to accurate, updated, evidence-based medical information, 24/7

• Psychological support/counseling available 24/7

• All care to be free of charge, under the coverage of the employer,

• This is where medevac takes place4

The bill of rights of the patient (3):

After recovery: to benefit from a constant support from the employer and its medical services:

• Long-term basis monitoring (medico-psycho-social),

• Counseling, PTSD management on a long-term basis,

• Classification as work-related accident,

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The duties of the staff member before being a case:

• Never overestimate her/his capacity and skills. Self assessment is not enough. Requires an external support. Coaching is an approach.

• Tell the truth about any kind of possible limitation (personal, family, health, pregnancy, ...).

• Understand the importance of the rules and policy, and commit to adhere to them (administrative sanction must strictly apply, just at the level of the threat).

• Commited to be a team player, under the lead of an experienced, firm but supportive team leader,

• Ever report any potential accidental exposure, on work place and also in personal life (including sexual exposure). Not reporting may be considered as a criminal offence, putting others' life at stake.

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The duties of the patient exposed to high risk of contamination or becoming a case:

• No delay in reporting the exposure and any symptoms belonging to the approved case definition; comply with the procedure of notification

• Actively prevent secondary infection in following the procedure in place, especially in refraining any contact with anyone else,

• Adhere to the treatment and follow any piece of advice given by the medical team officially in charge of the care,

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The place of medevac in the EVD patient's management:

• As of now: 

• very limited options for a sick patient,

• the soonest the best, up to right away after a confirmed high-risk exposure

• Nationality-dependent process for admission to the receiving hospital

• In the future:

• Implementation of high-standard ICU by developed countries in the heart of the affected areas,

• Simplification of medevac of asymptomatic patients exposed to high-risk

• Extension of the capacity of private operators to medevac symptomatic patients

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Conclusion• Education to risk management at the very individual level to non

specialist of risk management,

• Decision of fitness to work to be carefully taken, whatever the pressure might be,

• Importance of the very simple rules to never ever forget and apply: work-life balance, hands hygiene, prevention of diseases, prevention of road accidents,

• To debrief with the medical services, and try to draw lessons from this experience is instrumental to improve the procedures in place (CQA),

• Team work, on staff member/patient's side, as well as on employer and medical services providers ("chain of survival"),

• The medical assistance provider must be a very strong link of this chain and a full member of the team.

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