ITV #2 - Dr Achraf Sokari - Medical Director

The fundamentals of medical evacuation according to C3Medical
Doctor Achraf Sokari - medical director of C3Medical - shares with us the three essential components of a successful medical evacuation.
Can you remind us what the basics of an EVASAN are? 

Firstly, I would say responsiveness and the ability to provide a quick and appropriate solution, because we know very well when we are contacted that it is for an emergency that must be managed. Thus, we must be able to provide a first solution within four hours of receiving the request. Secondly, I would say rigor and expertise:  for every evacuation, we must bring together the best fitted teams for that type of medical evacuation. It should be noted that there are different kinds of evacuation: those which require the patient to be intubated or ventilated, those which require a nurse, a resuscitator or an emergency doctor, those which can be done by a commercial airliner, or those which require the chartering of a medical plane. All have different prerequisites throughout their duration (from taking on the patient at their place of departure to their arrival at the destination hospital) that must be addressed before launching the mission. This is why, before organizing an EVASAN, the teams must systematically verify more than fifteen elements of a specific “checklist”. The third point is the quality / price ratio: today, we are in competition with other companies. What is therefore important, beyond mastering the profession, is to have access to qualified and competitive service providers and to be able to optimize the various stages.  Therefore, the three important elements for a medical evacuation are: speed, rigor and know-how, and the quality / price ratio.      
During a medical evacuation what are the points on which you are the most vigilant? 

There are three people in our EVASAN team: the medical director, that is to say myself - I am an emergency doctor specializing in air travel medicine - and two people who manage the calls and the collecting of information.
The key to a successful medical evacuation is to receive a detailed, high-quality, up-to- date medical report prior to the evacuation. When the request is received, we follow a precise process, which is mainly composed of forms to be completed by local doctors, who are treating the patient. This information is intended to help us identify the patient's state of health and allow us to define the equipment we will need (for example, the type and amount of oxygen expected to be necessary or the need for intubation), the adapted flight plan (with or without a layover), anticipated transportation (specifically to the outbound airport and from the inbound airport to the destination hospital) and to identify and obtain admission to the most suitable structures for the patient in regards to his pathology . This preliminary preparation and the data provided by the patient or his family and by the local doctor allow us to respond quickly and, above all, in a means that is fully adapted to the needs of the situation. As soon as we have constructed the end-to-end solution and it is validated with the local teams and the ordering party (insurance, institution, etc.) we trigger the medical repatriation.
Has the current situation - COVID, border closures - caused any changes , if so which ones ? 

Usually, medical evacuations by medical plane or " air ambulance " is reserved for vital emergency situations requiring a stretcher and the delivery of oxygen during the flight, which is not possible during commercial flights.    
However, there are currently very few commercial flights, so we are solicited for medical conditions that, strictly speaking, are not life-threatening emergencies.
At this time, we are conducting evacuations mainly from all countries in Africa, the Middle and the Near East, to Moroccan, Turkish, and European medical. We’ve also been organizing Evasans to and from other areas of the world (US, Latin America) but this is not as common.
Administratively, the border police now require a certain number of papers. Thus, we ensure that the patient already has, or does not need a visa for their destination, otherwise we help him to obtain an emergency visa if this is a possibility. We also make sure that the local authorities in his country have given the green light for him to travel, and that we have all flight and take-off authorizations.
Lastly, we are currently also evacuating a great number of COVID cases. During the flight we set up an “isolation bubble” that allows us to travel with a person suffering from COVID in optimal safety conditions for both the crew of the aircraft and for the medical staff. In such cases of evacuations, we are also subject, on departure and arrival, to specific protocols developed by local administration and care structures.  
Can you share a recent medical evacuation with us? 
We recently organized an evacuation from Algiers to Nice. The patient was an immunocompromised individual who had undergone a kidney transplant. However, the patient caught COVID, and the slightest infection could have been life- threatening , thus motivating his emergency evacuation.
As we did not have a fly-over authorization request to make, in less than four hours we were able to mobilize the team and find an ambulance with access to the tarmac. The flight lasted one hour and forty minutes, the patient was transported in an isolation bubble and the repatriation took place in optimal conditions with oxygen therapy and appropriate treatment during the flight.