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The First IRANIAN Air Medical Scort

Flight nurse medical escort service worldwide commercial airline transport cost effective alternative to air ambulance

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As a medical travel service:we specialize in commercial airline medical transports.

We advise you & your health care providers as to the safest and most cost effective plan of travel based on your medical escort on a commercial airline:or a private chartered aircraft,we will customized your travel plans to meet your medical needs.

Medical scort services offer a cost effective alternative to air ambulance services for the medically stable patient.

Our flight nurse medical travel services include:

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coordinating the details of air and ground travel from bedside to bedside.

-we provide a flight nurse escort to accompany the more acutely ill or injured patient travelin on a commercial airline or on a private aircraft.

-flying nurses assists with all phases of travel,starting from home to destination hospital bed.

Flight nurses can be your peace of mind during a difficult time.

Our scope of care includes:

  • Assisting patients with restricted ambulation
  • Orthopedic injuries
  • Behavioral health disorders
  • Neurological injuries
  • The patients who require supplemental oxygen and complex respiratory needs.many of our patients require full assist transfers frombed,to chair,to aircraft seat,IV fluids,medications,and oxygen therapy can be administrated en route.

Means of transporting patients from abroad

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Usually,people who have suffered an accident or taken seriously ill abroad have been admitted to hospital.after the physician has contacted the doctorin attendance at the foreign hospital,the patient and the patient’s next-of-kin,the further procedure is discussed.

The necessity of repatriating the patient to a hospital is assessd based on medical,social &financial criteria,and the time and means of transport are determind accordingly.

The following means of transport are possible:

Means of transport                                   prerequisite

Helicopter                                             patient is seriously ill or injured &is located in an

                                                                     Area close to the end transport by ground

                                                                      Ambulance is not a viable solution.

Ground ambulance                           patient is not in a suitable medical condition to fly

                                                                     Patient is located in an area close,need to avoid

                                                                   Frequently transferring the patient from one means

                                                                   Of transport To another.

 

Air-ambulance                                   patient is in a suitable medical condition to fly

                                                                 Transport on board a scheduled aircraft is not

                                                                   Possible.


Preparing your trip

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General:

  1. Information about the country,culture and climate
  2. Information about the medical care available locally
  3. Vaccination
  4. Details of your GP
  5. Tropical medicineor vaccination centers
  6. Insurances
  7. Health insurance
  8. In the event of existing illnesses

Travelling by plane

The oxygen supply &pressure in the aircraft is equivalent to that found at an altitude of approx.2,400 meters above sea level,which is about the same as on the top of the Gottard pass.that means that the air pressure,humidity &oxygen in the cabine are reduce.

Durina the ascent.altidute decreases at a rate of approx.90 meters a minute,while the air-conditioning systems regulate the ventilation &temperature in the cabin,they can not produce natural humidity.

These changed conditions lead to vascular dilation,an increase in the upper blood pressure value.moreover,a redistribution of the body’s blood circulation occurs:

The heart &brain are supplied with more blood,the skin,kidneys and gastro-intestinal system with considerably less

The reduce oxygen saturation of the blood goes unnoticed by a healthy person and is harmless.

The changes in air pressure are also scarcely perceivable.this only results in earache if you have a cold & the pressure is not equalized.

In this case,you should try chewing or yawing during the ascent &descent phases of the flight:nose drops,sprays or ointments can also reduce or prevent earache.

The dry air in the cabin leads to the mucous membranes drying out.sitting down for perods of several hours reduce the circulation in the legs.crossing several time zones disrupts your body clock(jet leg).

Simple preventative measures:

  • Drink plenty of fluids,preferably still water.
  • During long flights,loosen up your leg muscles from time to time,rotate your ankles &flexyour feet while sitting down.
  • Avoid putting items of luggage on the floor in front of you(restricts legroom).
  • Avoid drinking alcoholic beverages.sedation or sleeping pills should be taken with caution.

Ill people are restricted in their fitness to fly.in particular,heart or lung diseases,anemia,existing circulatory problems &vein disorders can have unpleasant consequences.

If medicaments need to be taken regularly(insulin or other antidiabetica,hormone pills,blood-thinning tablets,etc.)& you are crossing several time zones,be sure to take them at the right time.ask your GP about the possible risk of a trip by plane and when you should take your medicaments!

Medical fitness to fly:

Cardiovascular disease:

People are deemed fit to fly if they can walk 80 meteres without suffering pain.and are able to climb 10-12steps without encountering respiratory or heart problems.those who have suffered a heart attack within the last three months should not fly.people with a heart condition who rely on medication must be aware that the stress of travelling can aggravate the problem.

Lung diseases:

People suffering from lung diseases should be able to walk 80-100 metres at an altitude the same as that at the top of the Gottard pass without experiencing respiratory difficulties.the GP is responsible for deciding if the patient can tolerat an approx.10% decrease of oxygen in the blood.

Anemia:

The haemoglobin level should be over 9mg/dl(norm=12-14mg/dl)in order for a person to be fit to fly alone &without additional oxygen.

Epilepsy:

Generally speaking,people suffering from epilepsy are fit to fly if they have their illness well under control thanks to medication.it is recommended that they travel with an accompanying person.the effect of time differences,as well as possible lack of sleep,should also be taken into consideration.long flights at night should be avoided.

Pregnancy:

Flying should be avoided by women in the last 4 to6 weeks of pregnancy,as well as those at risk of miscarriage or premature birth.particular caution should be taken in the case of women who smoke heavily,who suffer from severe anaemia,a heart condition or lung disease,or who have an avid fear of flying.

Diabetes mellitus:

Hormones adapt to the time difference more quickly when flying from west to east than vice versa.when flights cross several time zones.fluctuations in the blood suger are more extreme and need to be monitored more frequently.the greatest risk of hypoglycaemia occurs during the first few nights after arrival from a long-distance flight.

Necessary waiting period after an operation:

  • In the abdominal cavity:3-10 days
  • Chest &lung:                 3-6 months
  • Heart:                             7-14 days
  • Head:                             6weeks-12months,depending on the operation

Airline restrictions on flying:

Many airlines will not allow passangers to fly with certain conditions.regulations may vary so if in doubt seek advice from the medical department of the airline concerned.

Conditions that might cause problems include:

*pregnancy beyond 36 weeks.

*new born babies during the first few days after birth.

*recent or current middle ear infections or sinusitis.

*unstable psychiatric illness or epilepsy.

*recent myocardial infarction or moderate/sever heart failure.

*recent chest,intra- cranial or abdominal surgery.

*recent pneumothorax or moderate to sever hypoxic pulmonary disease.

*the presence of a communicable disease.

*previous record of causing distruption during flights.

Economy class syndrome(deep vein thrombosis=DVT)

Much about this condition has been reported recently in the media.DVT is a condition in which a clot,or thrombus,typically forms in a deep vein in a leg.

People with a DVT may notice pain &swelling in the leg where the clot has formed,though smaller clots may not cause any symptoms.

The major problem occurs when a part of the clot breaks off &flows to the lungs.this condition,called pulmonary embolus,

can cause severe injury or even death.Sitting still for long periods of time in cramped conditions can lead to swollen ankles &occasionally DVT.this of course is not unique to air travel but the cramped conditions often found in economyclass seats especially on long haul lights has given rise to the name “economy class syndrome.

Some passengers may be flying from areas that have a hot &arid climate&may be dehydrated on boarding the plane.Others may be dehydrated as a result of contracting about of travelers diarrhea.

Other risk factors include:

age over 60 y.

-previous DVT.

-varicose vein.

-Recent surgery or injury.

-pregnancy.oral contraception,hormone replacement medication.

-cardio-respiratory disease.

-other chronic illnesses including malignancy.

Those persons with 3 or more of the above risk factors,should discuss additional protective measures with their doctors.

Preventative measures against DVT include:

  • Regular stretching &mobility exercises &if possible walking around the cabin during the flight.
  • Drinking sufficient fluids to keep the urine pale.
  • Taking a low dose aspirin tablet(75mg) for its anti adhesive effects on blood platelets.
  • The use of graded compression stocking.these are available at most pharmacies &are marketed specifically for use during long haul flights.
  • Loose- fitting clothing may be beneficial in avoiding constriction of veins.
  • Some recommend taking short nap,instead of long ones,to avoid prolonged inactivity.

Jet leg:

Nowadays it is possible to travel to distant parts of the globe in a matter of hours.this can result in the traveler ending up in a part of the world where time is out of sync.with his or her own “body clock” or circadian rhythms which regulated our sleep patterns.

If we travel east or west by more than 4time zones(hours)then we will usually be affected.

This means travelers from the UK will be affected when travelling to Asia,Australia,New Zealand,the Pacific Islands,North &South America but will not normally be affected when travelling to Europe, Africa &the middle East..

In the past when people travelled by sea there was ample time for the body to adjust to the local time but with the advent of modern high speed aircraft the body does not have time to adjust.

The effectsof jet lag are usually 1- tiredness&insomnia but can also include:2-Poor concentration-3-nausea4-vomitting5-constipation &general malaise.

The effects are made worse by alcohol &hangover.

Sleeping whilst flying may help to reduce the symptoms of jet lag but long period of immobility abroad the aircraft can make the traveler more susceptible to DVT.

Some travellers find taking melatonin helpful.it may help the body to adjust its circadian rhythms but its effects are scientifically unproven.

  • A relaxed flight is important.
  • Avoid travelling when you are already tired &take rest before departure.
  • Remember the actual travelling time will usually be at least twice the actual time spent in the air since it will include travelling to and from &hanging around in airport.
  • Avoid heavy commitments on the first day.be prepared for tiredness in the evening and early waking which can last up to 5 or more days.
  • Sleeping tablets will help you to sleep &be correspondingly alert during the next day but they do not speed up adjustment to the new time zone.

Respiratory infection:

There is no evidence that re- circulation of the air in aircraft cabins increases the risk of spreading infections amongst the passengers since very effective filters are used to remove bacteria &viruses.

However,sitting for long periods in close proximity to passengers who are suffering from common colds or influenza may increase the chances of another passenger becoming infected.this is why most airlines discourage passengers with infectious conditions from flying.

Tuberculosis is increasing world-wide &there is a small but real risk of catching the disease during the air flights.transmission has only been recorded in flights lasting over 8 hours.the risk is greater when many of the passengers on board are from countries with a high incidence of the disease.

The risk of transmition of TB on a commercial aircdaft islow & there is no reason to suspect that the risk of transmission on aircraft is greater than in any other confined space including other forms of public transmission if the duration is the same.

Parasite infection:

Occasionally head lice &other skin parasites may be passed on through contact with aircraft seats where previous passengers have been infested. it must be stated though,that most airlines carry out throrough cleaning of the cabin &other facilities between flights.

International flights to some countries(including the UK)require the spraying of the aircraftpassenger compartment with insecticide when departing from certain locations while the passengers are present,or require periodic applications of a residual insecticide.this practice called disinsection,that is used to prevent the importation of insect such as mosquitoes but this will also have an effect on any other insect parasites present.

Altitude sickness on arrival:

Most healthy people who trave rapidly to 3500m above sea level may develop symptoms of acute mountain sickness (AMS)after arrival.people with respiratory or cardiac problems may experience symptoms at even lower levels.a few airports in the Andes &Himalayas are actually sited above this altitude which can result in symptoms occurring soon after disembarking.

An awareness of the symptoms of AMS would be helpful.

Dehydration exacerbated by the dry aircraft cabin atmodphere may worsen symptoms.

Acclimatisation & rest after arrival is recommended since strenuous activity may worsen symptoms.

Further ascent should be avoided until any symptoms have disappeared.

Those people with pre-existing hypoxic respiratory disease should seek medical advice prior to departure.

Fear of flying:

An stimated 9 million people in the UK suffer anxiety about flying &may miss out on professional & personal opportunities as a result.

Fear may develop from a bad experience-a rough flight,or after a news report of a high jacking or crash.

Panic attacks are common &the sensation is often so frightening that the sufferer may refuse to fly from then on.

Advice for travelers who are afraid of flying:

  • Emphasis that flying is safer than road or rail travel in most developed countries.
  • Try distraction by talking with other passengers,watching in-flight films,eating or reading.
  • Tell the cabin crew.reassurance about strange sounds etc.can help.
  • Visit your doctor prior to travel to assess your general fitness for air travel.
  • Consider taking a tranquilliser before flying but remember,these drugs do not mix well with alcohol.

Air rage:

This term describes the psychological or physical violence occurring within an aircraft during flight.

It is of particular concern because of the cramped conditions inside an aircraft &the inevitable involvement of cabin crew & other passengers.these have been several instances where aircraft have had to land prematurely to offload disruptive passengers &taken legal action against those involved.

Air rage may be caused by a combination of events,including delayed flights,exhaustion due to lack of sleep,excessive use of alcohol &the behavior of fellow passengers.

It has recently been recognized that a common cause of air rage is nicotin withdrawel in heavy smokers on long-distance ‘no smoking’ flights which have now been introduced by many airlines.

Passengers should avoid excessive alcohol consumption &discourage their travellng companions from heavy drinking.airlines have the right to refuseto carry those who are intoxicated or who have previously caused disruption on a flight.

Children:

Parents should take special care when travelling with young children &being prepared in advance is important.

Vaccinationare important &schedules can differ for children so seek advice from your doctor or nurse.doses of malaria tablets are usually less than for adults.special seating arrangements in planes can often be arranged if advance notice is given.prepare for possible travel sickness.boredom during travel can be relieved by books or toys.

Remember to avoid contaminated food &water.if your child has vomiting or diarrhea lost fluid &salts must be replaced.it may be helpful to take rehydration tablets or powders for reconstituting with boiled water.you can usually buy these at your local chemist.Dehydration develops quickly in children so offer frequent cool drinks when it is hot.

Infections such as tuberculosis &diphtheria. Spread from close personal contact with those infected,can be more serious in young children.

Children’ skin burns easily in the sun.take sensible clothing,high factor sun screens &avoid exposure to ‘mid day’ sun.

Keep children well away from stray or sick animals &seek medical advice without delay if any illness persists.

With small children,the balance of pressure between the pharynx and the middle ear is insufficient.consequently,small children often suffer from earache during take off and, above all,landing.you can alleviate discomfort by giving your baby a dummy or something to drink during the descent phase of flight.

Pregnant women:

Travellingduring pregnancy is usually possible but there are important things to keep in mind:

Always seek a medical check-up befor planning your trip &again shortly before departure.it is important to get the ‘all clear’ from your own doctor or obstetrician befor departure.

Most airlines will not accept a pregnant traveler after 28-32 weeks gestation &long air flights in the later stages can be very uncomfortable.the most risky times for travel are during the first 12-15 weeks of pregnancy when miscarriage is more likely.

Ante-natal facilities vary greatly between countries &you should think carefully before travelling to a country with poor medical facilities or where there are major cultural &language differences from home. This could be important if you have health problems such as threatening to miscarry or going into early labour.

Illness during pregnancy can be more sever so take special care to avoid contaminated food &water &insect &animal bites.avoid partially cooked meat,unpasteurized milk products &soft cheeses.in some countries infections such as tuberculosis or meningitis can be spread from close personal contact with locals&these can be serious during pregnancy both to yourself &your unborn child.

Appropriate immunization &malaria prevention is sometimes different during pregnancy so seek advice.some vaccines are best avoided during pregnancy.for example/:those that contain live organisms.however vaccination may be safer than travelling to some high risk areas without protection.discuss this carefully with your doctore or nurse.

Ensure your insurance policy covers pregnancy but remember insurance policies are only as good as the facilities available.

Erderly travelers:

More&more elderly people are now travelling abroad for holidaysand to visit relative.special holidays can be arranged but age does not give natural protection against disease.

.take adequate personl medication.these must be clearly labeled and carried in hand luggage for easy access in case of delays or loss of luggage.while abroad store your medicines in a cool dry place.if you are crossing time zones,do not miss out does specially if you are diabetic or have a heart condition.

If you suffer from any recurrent illness or are on regular medication check with your general practitioner.you may find a check-up helpful to ensure that you are fit to travel.a referral letter can be useful in case you need treatment while abroad.

Immunizations are important at all ages.having have disease previously.such as polio or diphtheria,does not always mean you are immune.if you are prescribed anti malaria tablets,be sure to mention if you are on any other medication.

Read the small print of your insurance policy which should include repatriation in case of illness and ensure there are no important exclusion clauses.

Remember to take care to with food &water hygiene &to avoid insect &animal bites

Disabled travelers:

Travelling with a disability is now commonplace &there is no reason why this should pose serious problems if good preparations are made.

Adapting to unexpected situations is a part of the challenge of travelling but advance knowledge of facilities available.during travel and at your destination,can be yery important.some organizations &tour companies arrange trips for the disabled when mobility problems,are taken into account.

Airlines are usually helpful &provide assistance at airports and offer special facilities on aircraft if advised in advance.however this may not be the case with some airlines and at small airports especially in African,Asian &South American countries.

When selecting accommodation check good lifts are available,the condition of staircases &bathroom equipment,ask in advance if special food requirements are necessary.

Make sure that you have comprehensive health insurance with no important exclusion clauses which affect disability &which includes repatriation if necessary.

In case of emergency:

What should you take ill or suffer an accident while abroad?

  • Go to the hospital or consult a doctor.
  • Call your insurance.
  • You will need to provide the following information:
    • Name of the patient
    • Address &telephone number of the hospital
    • Name &telephone number of the attending physician and the ward
    • Reason for hospitalization
    • Name of the next-of-kin or other contact persons
    • Name of the patient’s GP

Offers:

  • Medical advice over the phone
  • Information on suitable hospitals
  • Local patient transfers
  • Medically justified repatriations to a elective hospital

What happens next?

  • The physicians contact the local doctor in attendance &decide whether the patient is fit to travel.
  • Decision as to the mode & time of travel.
  • Transport from one hospital to another
  • Medical care if necessary.
  • Where possible, combined transports with other patients.

Travellers diarrhea(td);is a condition characterized by a marked increase in the frequency of unformed bowel movements & is commonly accompanied by abdominal cramp,urgency,nausea,bloating,vomiting,fever and malaise.

It occurs in up to a half of European travelers who spend 2 or more weeks in developing parts of the world and should therefore be taken seriously.

Episodes of TD usually begin abruptly,occur during travel or soon after returning home,and are generally self –limiting.the onset TD is usually within the first week of travel,but can occur at any time during the visit and even after returning home.

The most important determinant factor is the destination of the traveler.high-risk destinations include most of Latin America,Africa,The middle East,and Asia,where attack rates of up to 50% have been reported.

TD is slightly more common in young adults than in older people but attack rates are similar in men and women.it is possible for travelers to experience more than one episode of TD during a single trip but rarely is it life threatening.

TD is usually acquiredby ingestion of faecally contaminated food or water,or both.both cooked and uncooked foods may be implicated if thay have been impropertly handled.the place in which food is prepared appears to be an important variable,with private homes.hotels,restaurants,and street vendors are listed in order increasing risk.

Particularly risky foods include raw or undercookedmeat,poultry,seafood,raw fruits and vegetables.tap water,ice,unpasteurized milk and dairy products are also associated with increased risk of TD.in the UK,we drink water straight from the tap and rarely consider that the water may be the source of disease but when the cleanliness of a water supply is in doubt,only adequately purified water should be drunk.

Worldwide,unsafe drinking water is a major problem.however,international travelers should not become hysterical about avoiding all water whilst travelling abroad.most of the general information sites for travelers recommend to avoid drinking water anywhere abroad.but to avoid water where it is safe,could be as annoying,as dangerous to drink it where is not safe.

Safe water for international travelers(swit)-is an independent organization that provides the best available information about water safety around the world.information is gathered from the most important and trustworthy sources.

Safe beverages include;bottled carbonated beverages(specially beverages like coke and fanta),bear, wine,hot coffee or tea.water boiled and appropriately treated with iodine.

TD typically results in 4 to 5 (somtimesmore)loose or watery stools per day.the average duration of diarrhea is 3 or 4 days but about 10% of the cases persist longer than a week and approximately 15%of cases experience vomiting and up to 10%have diarrhea accompanied by fever or bloody stools,or both.

Most food related illness is due either to a change in the amount or type of food,oran infection caused by eating contaminated food.infectious agents(bacteria, viruses,protozoans)are the primary cause and people travelling from developing countries frequently experience a rapid and dramatic change in the type of organisms in their gastrointestinal tract.

These new organisms often include potential enteric pathogens and those who develop diarrhea have usually ingested sufficient virulent to overcome defence mechanisms,resulting in symptoms.

The organisms most commonly associated with traveler’s diarrhea are:E.coli,Salmonella,campylobacter,shigella,Rotavirus and Giardia.                  

pre vention of travelers diarrhea:

no vaccines are available and none are expected to be available in the near future that are effective against TD.

The use of prophylactic antibiotics is not recommeneded for travelers since there evidence to show that they are widely effective in preventing TD and there are potential drawbacks which include allergic and otherside effects and the possibility of developing resistance.

A new product has been developed and is currently being launched in Australlia that has been clinically proven to reduce the risk of E.coli caused TD(current TGA regulation prohibit the use of the words prevents or protects).the product is called travelan.

However,most evidence shows that meticulous to hygiene during food and beverage consumption can greatly decrease the likelihood of developing TD.many travelers,however encounter difficulty in observing these restrictions.

Collected &arrange by:

Zahra-eghbalpoor(managing director)

Flight nurse of iranian civil aviation

 

12/12/1388=02/03/2010

About Zahra Eghbalpoor

Zahra Eghbalpoor
Managing Member, Board of Directors

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