A race against time

A race against

time

AMREF Flying Doctors’ mission to save a gunshot victim involved intricate planning and complicated logistics.

In the field of aeromedical transport, where challenges are abundant and decisions are often time-critical and complex, AMREF Flying Doctors (AFD) stands on the forefront of commitment to safe and excellent emergency care. With a well-known and rich history spanning over six decades, AFD has mastered the art of conducting intricate medical evacuations in challenging environments within and outside of Africa, across all borders and into the rest of the world.
One remarkable case that showcased AFD’s prowess was the evacuation of a 38-year-old Somali national who had suffered a traumatic brain injury from an accidental gunshot in Garowe, Northern Somalia, to Nairobi, Kenya.
The incident unfolded at a security checkpoint in Garowe, where the victim became collateral damage in a targeted shooting by an armed officer. Struck just above the left eye socket, the bullet created a compound skull fracture with an exit wound at the mid parietal area, exposing the patient’s brain matter. The gravity of the injury and the patient’s remote location made immediate medical attention imperative for any chance of survival.
Difficult logistics
The first hurdle AMREF Flying Doctors faced was the intricate logistics involved in obtaining permits and executing the evacuation within a limited timeframe.
Complicating matters, the airport operated only during daylight hours, and armed insurgents loomed in the area, adding an extra layer of complexity to the mission. Thankfully, AFD’s extensive experience to perform missions even in the remotest and most complex situations allowed for a swift planning and safe evacuation plan.

The victim was initially rushed to a local facility in Garowe, which was unfortunately lacking neurosurgical capabilities. Despite their limitations, the medical staff at the facility managed to secure the airway and perform basic wound care, utilising bulky dressings to shield the exposed brain matter. Recognising the urgency of the situation, the local facility urgently sought an emergency medical evacuation to Nairobi.
Throughout the patient’s treatment, AMREF Flying Doctors’ medical team in Nairobi provided continuous online support to the local facility. At a critical juncture, the patient went into cardiac arrest but was successfully resuscitated. The clock was ticking, and the window of opportunity for evacuation was closing rapidly.
The response from AMREF Flying Doctors was swift and coordinated. AMREF Flying Doctors’ Pilatus PC-12 aircraft – ideally adapted for such a time-sensitive and complex medical evacuation – was airborne within minutes of receiving clearance from Somali authorities. Prior to takeoff, the organisation’s safety team meticulously assessed operational safety and security on the ground, ensuring a seamless execution of the mission.
Upon arrival at the airfield in Garowe, the medical crew was met with a deteriorating patient displaying alarming vital signs. With only 30 minutes to assess, intervene, and safely load the patient onto the aircraft, the team faced a race against time. Failure to meet this deadline would leave them stranded in a highly volatile environment as the airport closed immediately at sunset.
Undeterred, AFD’s medical team rose to the occasion. Employing their expertise, they stabilised the patient, secured him safely onboard, and managed to take off within the narrow timeframe. The aircraft soared towards Nairobi, where a tertiary hospital awaited the arrival of the critical patient with a neurosurgical team on standby.
A journey to recovery
The successful evacuation marked the beginning of an arduous yet triumphant journey to recovery. The patient, against all odds, underwent extensive treatment in Nairobi. Two months later, the resilient survivor was discharged, having made a remarkable recovery thanks to the collaborative efforts of AMREF Flying Doctors’ skilled medical professionals alongside local doctors. The race against time successfully won with the best possible outcome.
In yet another remarkable mission, AMREF Flying Doctors’ team not only demonstrated their technical expertise in executing intricate medical evacuations but also illustrated an unyielding dedication to delivering lifesaving care amid challenging circumstances. The successful resolution of this traumatic incident highlights the organisation’s overarching mission to maintain the highest standards of emergency medical care, surpassing geographical boundaries, and instilling hope in individuals facing dire circumstances. AFD’s teams are already ready to take on the next one!

This article originally appeared in
Air Ambulance Review | March 2024

Shortly after the first contact, AFD was able to confirm that the patient held valid insurance and coverage and started making arrangements for the patient to be transported in a more adequate facility. It was determined that a transport to Nairobi, Kenya, was the best option for better medical access, as well as for organising the patient’s repatriation home. Quotes for the evacuation to Nairobi via Air Ambulance were obtained and the flight done by the AFD Team was confirmed for the following day at first light, as Arusha Airstrip is a daylight operation only.

Whilst AMREF Flying Doctor’s aircraft was on the way to Arusha, the hospital bill was settled, and the patient was prepared for transport. Upon arrival, AFD’s team picked up the patient from the hospital as per AFD’s policy of bed-to-bed-service, to assure seamless treatment and monitoring throughout the transfer.

As Nairobi had not been a planned destination for the patient or his wife, AMREF Flying Doctor’s team assisted with several services, such as placing a payment guarantee at the hospital, obtaining a phone SIM card for the patient’s wife, and arranging a hotel for her near to her husband’s hospital.

The patient remained in hospital for 24 days, during which he underwent various tests and investigations, had a surgical intervention for the fractures, and underwent physiotherapy. AFD’s medical team continued to monitor his progress, and when the patient was eventually declared fit to fly on a commercial airline with medical escort, AFD was tasked to arrange the same.

Being well versed in arranging commercial escorts worldwide, AFD’s team started the process by obtaining medical clearance from the commercial carrier that would take the patient, his wife and AFD’smedical escort back to Canada. AFD also purchased the tickets, arranged for ground ambulance and wheelchair assistance throughout the trip, and coordinated his arrival back home.

An in-person pre-flight assessment was performed by AFD’s medical escort prior to the flight to assure that the patient was sufficiently stable and well informed about all steps of the trip.

The repatriation went very well, the patient remained stable and was comfortable at all times. Upon arrival in Ottawa, the AMREF Flying Doctor’s team escorted the patient and his wife to his residence and returned to Nairobi the day after.

Another successful case and mission done by AMREF Flying Doctors – who are equipped for all kind of assistance and aero-medical needs in Africa. Due to AFD’s deep understanding of the circumstances and longstanding experience in providing medical services and assistance in Africa, AFD’s team could support the client on every step of the way. From the first medical information, followed by the initial aeromedical transport to the nearest centre of excellence, covering the costs in all hospitals, to the commercial medical escort that brought the patient home AMREF Flying Doctors was always there for the patient, while helping the insurer to fulfil the obligations towards his client in the best way possible.