From COVID to Ebola and Monkeypox, communicable diseases threaten people and nations worldwide. Aerial Medical Evacuation (AME) may be needed for people at high risk of infection, such as pandemic travellers or outbreak responders.
AME uses medically equipped air ambulances to transport patients when local facilities cannot treat an injury or illness, or for clinical or public health reasons, such as to remove an infected patient from the community to prevent onwards transmission.
In the case of some infectious diseases, such as COVID or Ebola, a patient isolation unit (PIU), or 'pod', designed to minimise risk to aircrew and attendant medics might also be needed.
There is little research or guidance available on how to effectively communicate AME processes and procedures to patients, especially in the case of infectious diseases. A patient who needs AME, and especially a patient with a contagious illness requiring a pod, will face an unfamiliar and distressing situation, and likely without opportunity to fully understand what is happening now, nor what will happen next.
Dr Charlotte Albury, Principal Investigator on the study, Senior Researcher and Specialist in Health Communication at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, said:
“There are a number of barriers to communication between patients and clinicians at the time of an AME, making what is already likely to be a very distressing time even worse.”
Examples of barriers include personal protective equipment of crew and healthcare workers, such as masks, background aircraft noise, and patient sedation or illness.
To develop guidance and recommendations for practice, the researchers analysed twenty recorded telephone calls between clinicians and British Government employees who were about to travel internationally during the height of the COVID-19 pandemic.
Such calls are a service offered to British Government employees and their families when travelling and include pre-travel risk assessments and advice, on-going medical case management, and information on emergency medical evacuations.
Using a technique called Conversation Analysis – a well-established method for studying communication and social interaction, especially in clinical settings – the researchers systematically examined what works and what doesn’t in such calls.
They found many aspects of the AME process, including PIUs, were unfamiliar to people, and these conversations allowed them to learn about AME, ask questions, and have PIUs explained in 'lay language' they could understand.
The analysis highlighted six simple steps clinicians could use to best communicate AME contingency plans.
Those steps are:
- Explain the situation where medical evacuation may be required
E.g., “If you’re seriously unwell and the medical facilities can’t provide treatment”
- Share the quality of care usually available locally
e.g., “normally the hospitals at [place name] are of a pretty good standard”
- Describe the patient isolation pod in lay terminology to support understanding
E.g., “it’s like an adult incubator”
- Outline what will happen during travel
E.g., “it’s likely you’ll be sedated, and the medical team on board will provide treatment”
- If aerial medical evacuation will not be possible:
- State this clearly and explain why.
- Present the alternatives
- Invite questions and provide opportunity for patients to check their understanding
Wendy Lawrence, co-author and contract manager at Healix International, the organisation entrusted by the British Government to look after the medical care of its travelling and expatriate workforce, said:
“During the COVID-19 pandemic AME was frequently required to transfer patients within and between countries – and should pandemics become more common, so will demand for AME.
This underscores the need for communicating the processes and procedures of AME to patients at high risk in the future.
Doing so, will mean such individuals can better understand the risks of accessing care when traveling, make better informed decisions about international travel, and be better prepared if AME is needed.”
The researchers encourage clinicians working with at-risk patients to discuss AME as part of their travel planning or outbreak response preparation. This can help patients to make informed decisions and plan accordingly, while also allowing AME services and service providers to be better coordinated and managed.
The researchers developed training and guidance for risk communication to support foreign office clinicians to best communicate about AME.
Dr Albury finished:
“As pandemics are unfortunately on the rise, and the need for aerial medical evacuation is increasing our research can support people to be more prepared for the processes of aerial medical evacuation, so it is less distressing if or when needed.”