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Repatriating patients from abroad

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As the popularity of long-haul travel grows, so does the need for nurses who can repatriate those taken ill or injured abroad.

As the popularity of long-haul travel grows, so does the need for nurses who can repatriate those taken ill or injured abroad.

Being asked to fly halfway around the world at a moment’s notice is not an every day occurrence for most nurses. But for Lucy Dunning, flight nurse and operations manager for Healix International Ltd, an independent organisation who provide medical case management and evacuation services to the travel industry, it is all in a day’s work.

‘You have to be flexible because you can be called in at very short notice,’ says Lucy. ‘A call in the morning can mean you’re on your way to Australia that same afternoon.’

With a background in general surgery and ICU, Lucy became interested in flight nursing after seeing an advert for the RCN in-flight nursing course. ‘After completing the course I originally intended to continue working in ITU part time and fly on my days off,’ she says. ‘But then I saw the advert for the in-house job at Healix and I’ve now been here for seven years.’

As a flight nurse, Lucy is responsible for the safe repatriation of patients who have been taken ill abroad. It is her job to do a head-to-toe assessment of the patient, including a social assessment, get a full handover from the medical staff and liaise with staff back at the Healix offices. She also has to prepare the patient for the flight and make sure things like passports and seating are organised, and that oxygen is arranged. ‘My job is not to diagnose but to be there should anything go wrong,’ she stresses.

Patient details are provided to Healix by an assistance company, one of a number of independent companies contracted out by travel insurance companies to help people who experience difficulties while abroad. The medical team at Healix then undertake the medical and nursing decisions.

‘It is important to have as much information as possible about the patient beforehand,’ says Lucy. ‘We have to be very specific when sending an escort because they have to have the right clinical background and experience. The escort can make or break a repatriation.’

In her role as operations manager, Lucy is responsible for the management of the repatriation and the medical case management of the patient. She liaises with overseas doctors to assess what kind of escort or team is needed, whether the patient can travel by seat or stretcher on a commercial aircraft or whether an air ambulance is needed, and contacts the patient’s GP or starts arrangements for hospital admission.

‘Repatriations can take various different forms, often based on the patient’s oxygen requirements,’ says Lucy. ‘The maximum a patient can have on a scheduled flight is four litres, and this is not enough for an ITU patient so they would have to travel by air ambulance. These are the kinds of things that have to be picked up on in the office.’

Most of the patients Lucy repatriates are holidaymakers. This can include young people who have been involved in drink and drug related incidents, diving and road traffic accidents. When there was a bus crash in Egypt six months ago, Healix were contacted by assistance companies and several medical teams were sent out to triage, assess and repatriate the patients. But the majority of patients Lucy sees are elderly. ‘Trends in the travel industry have changed, with low cost airlines and more flights meaning more travellers. Cheap and available flights mean more of the older generation are going on long haul flights, especially to Australia or New Zealand.’

And although what happened on 9/11 has not impacted directly on Lucy’s role, changes such as British Airways no longer allowing stretchers on most of their flights have had an effect. ‘We now have to look to other airlines if a stretcher is needed, and the use of more air ambulances can be very costly.'

Since starting in her role, Lucy has seen the number of applications to become a flight nurse increase dramatically. ‘Although it is still a little known role, as it is becoming more renowned we have been inundated with CVs.

‘It is a rare role within nursing and is not really recognised as a speciality, even though you have to have certain qualifications to do it. But the RCN In-flight Nurses Association is pushing to try and change this.’

Being able to work autonomously is very important in Lucy’s job because the majority of repatriations she undertakes are solo ventures. ‘You have to be good at working on your own and can’t be too regimented in your outlook. Language barriers mean that breakdowns in communication do occur and sometimes the patient is not what you expect when you arrive.

‘You have to be flexible in your thinking and proactive in dealing with different cultures. People see it as a glamorous lifestyle but it can be very exhausting at times.’

Although the job may sometimes be stressful, it is all worth it for Lucy when she meets the patients. ‘I love the patients because they are always thrilled to see you. They’ve had a lot to deal with and are so grateful to you for being there to take over their care and explain to them exactly what they’ve had done and what is going to happen.’

And even when she has repatriated a patient, Lucy is never off duty. ‘I was on the return leg having dropped a patient off in the United States and was looking forward to my first class meal and getting some rest,’ she laughs. ‘But the call went out for someone with medical experience to help a woman who had collapsed. It turned out that she had a heart rhythm problem and I ended up looking after her for the whole flight home!’

‘How do I become……. a flight nurse?

This could be for you if: you have a love of flying, are interested in working with patients with a variety of conditions and can be available to fly at short notice.

You need to be good at: working autonomously, keeping a cool head under pressure, be flexible and have a certain level of personal fitness because the job can be physically demanding.

You need to have: a sound nursing knowledge base with at least four years post registration experience, preferably in an acute or critical area such as A&E or ITU.

You don’t need to have: an in-flight nursing qualification already because companies like Healix provide an orientation to and introduction to flying course.

Other similar jobs you could consider: jobs in the travel industry such as medical centres at airports or travel clinics, or medical case management within an assistance company setting.

Where to find more information: To find out more about Healix International Ltd you can visit their website at Or for more information about flight nursing and the RCN in-flight nursing course you can go to

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