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This evening I sat back to write my blog update while tracking another flight back into the US. A Humanitarian Aid worker in South America was placed under sedation and needed secure transport back to the United States. Watching the hours tick away on the clock until wheels down and following the live tracking from the plane I couldn't help but think back to a few of our previous flights, thankful that this one was as routine as it comes for Castle. We have an office joke that by the time everyone else has said an evacuation isn't possible they call us, it's part of the humbling experience that is our organization, accomplishing the impossible on a daily basis. Talking with the team in the office the invariable conversation of "that one flight" always comes up.


For our team "that one flight" was an extraction of an injured Aid Worker from Central Africa. To say that mission had everything stacked against it from the start is a monumental understatement. I had recently returned to a consultant position in Europe, only a few days before speaking with a member of the team here at Castle about any possible opportunities to come on board more officially, when I was contacted with an opportunity. Sitting in my truck at 2am I still remember my excitement when my phone lit up with a "hey can you help. us out on a handholding" text. Information was developing from a family that their mother had been placed into a medically induced coma following medical complications at her mission in Africa. She thankfully had recovered to the point that she was capable of traveling back home for recovery and a medical escort was requested. Clearing enough time off for travel and return I sent an enthusiastic "let's do it" and found myself on a series of rushed gate changes and near missed flights racing at breakneck speed to her bedside. 
 

The ambulance we secured for the transport races us to the hospital in the middle of the night. 

The ambulance we secured for the transport races us to the hospital in the middle of the night. 

Landing in country I immediately knew everything had gone wrong. My official liaison met me at the airport and asked me where my medical kit was and how I intended to transport the sedated and ventilated, patient out of the country. As far as curve balls go I like to think I handled it fairly well, translating to the hospital with my liaison I immediately went into "work mode." Sizing up the traffic conditions, normal crowd size, infrastructure level, and most importantly time to transit to the hospital I began running mental calculations on if this patient was even capable of being transported on time for my next flight. Upon reaching the hospital and examining the patient I vividly remember walking back into the office I had my equipment set up in, sitting down, and making the one phone call I have always dreaded would come.

"Curve ball" were the first words I spoke, alerting the team to get ready for my status update. "Patient is sedated, ventilated, and non responsive." I could hear the words not spoken on the other end of the line as my team contact obviously had to sort through most five letter adjectives before finally sighing and requesting a full workup and a planning session to update logistics. Sitting down at the hotel the entire team brought their A-game to a sandbox planning session for the company books, in 20 minutes we had the plan, identified the hurdles to overcome, and began breaking down the problems one by one. 

A week later I was finally boarding a plane with my patient. The days in between read like a spy novel, but truth it seems is always stranger than fiction. In the time between sandboxing the plan around the table at the hotel and boarding the plane every hurdle turned into a mountain. We used personal contacts and favors with the CEO's of 2 international banking institutions to wire an extraordinary sum of money to the region to buy plane tickets, gained approval from one of the largest commercial air carriers to conduct a first for their company endurance medical evacuation on two of their largest airframes, lost communications due to civil instability, and finally suffered critical equipment failure upon boarding the plane. 

Hand ventilating while monitoring oxygen levels. 

Hand ventilating while monitoring oxygen levels. 

As I settled into my seat next to my patient's head to monitor her vital signs and the settings on the only portable ventilator available for purchase in the country I remember having a sense of serenity fall over me, relief that as a team we had reached the point that movement was happening. Immediately after takeoff, 30 minutes into the flight, the ventilator failed. 21 hours away from my next medical handoff I was only capable of having the captain of the plane radio ahead to our layover destination and request a ventilator be prepared and waiting for us as I hooked oxygen up to an ambu bag and began manual ventilations. 

There was no ventilator at our layover though. Constant monitoring of our patients pulse oxygenation levels though had shown that we had managed to keep her perfused properly the entire trip to this point and her condition was not in danger of destabilizing any more, so we continued on. Landing in New York and transferring care to our domestic teams the exhaustion kicked in and I slumped over in the back seat of the Lear 35 and passed out until landing at our final destination. I accompanied our patient to the hospital where a smooth but awkward handoff occurred, the doctors and nurses in the ICU were asking the flight paramedics for an update while I ate every snack left unattended on the nurses station ignored until one question was asked, "who hand ventilated for 21 hours?"

Our final handoff at the stateside intensive care unit. 

Our final handoff at the stateside intensive care unit. 

"I did," was the only response I could muster.

I was tired, my clothes were filthy from a week in Africa, and I had worked up quite a bit of sweat on the endurance flights out managing the patient. I was not the image they were expecting to see when I spoke up. The chief of neurosurgery walked up to me, shook my hand, and asked for a photo for his collection.

The team at Castle had accomplished our most difficult operation to date, and we had definitely impressed our medical partners in the process. It's through our accomplishments that recovering another sedated aid worker this evening was made into a seemingly easy task. As the flight landed and we received confirmation of the team transferring the patient to the stateside hospital I sat back and smiled knowing that another family was going to be able to hold their loved one again, thinking of the hugs and tears that dampened my own shoulder. 

Transport on our domestic plane.

Transport on our domestic plane.


The Veterans at Castle International have had a drive to save lives that comes from life experiences few others will ever understand. Our victories, and our defeats, have taught us the value of all life and drive us to continually improve our ability to care for our patients. If you are ever in need of a medical transport please do not hesitate to contact our team 24/7 at 1-(480)-477-7750

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