Medical evacuation to Morocco: in which situations is it necessary, and how is it organised?

What is a medical evacuation?

A medical evacuation (EVASAN) is the organised transfer of a patient to a place able to provide the necessary level of care. It may be by road or by air, and may concern a stable patient needing a treatment unavailable locally as well as a critically ill patient requiring continuous monitoring. An EVASAN is not automatically an “air ambulance”: the means of transport is chosen after assessing the risk, the distance, the degree of urgency and the needs for oxygen, ventilation, infusion or monitoring.

The first step: stabilise before transporting

Transport must not replace initial stabilisation when it is possible. Before departure, the team assesses in particular the airway, breathing, circulation, neurological status, pain, infusions, drains, availability of medicines and oxygen supply. For a ventilated or unstable patient, transport must allow a level of monitoring and treatment as close as possible to that provided on the ground.

Air transfers involve specific constraints. In a pressurised cabin, the ambient pressure generally remains lower than at sea level; this can affect oxygenation and the volume of trapped gases. Lung diseases, certain recent surgical procedures, undrained pneumothoraces or certain devices therefore require a specific assessment. The literature on aeromedical transport stresses the importance of clinical, operational and logistical preparation before the flight.

How is the means of transport chosen?

The decision depends on several factors: urgency, distance, airport access, the patient’s stability, the need for a stretcher, oxygen, ventilation, suction, syringe pumps, medicines, the presence of a doctor or nurse, and the capacity of the receiving facility. An accompanied commercial flight may be possible for some stable patients; a dedicated air ambulance may be needed for others. There is no universal solution.

A heavier set-up is not necessarily better if it is not needed: the right means of transport is the one that matches the patient’s risk and ensures continuity of care.

What the transfer file should contain

The file must state the diagnosis or suspected diagnosis, the current clinical condition, vital signs, treatments given, allergies, recent tests, imaging, devices in place and the reason for the transfer. Ideally, the receiving facility should be informed before departure and confirm that it can admit the patient. Coordinating the transport and coordinating with the hospital are therefore two inseparable steps.

In a critical situation, the receiving team needs up-to-date information, not just an old file. Before departure, the receiving department, the referring doctor, the admission arrangements and transport from the airport or point of arrival must all be organised.

When is a situation urgent?

Respiratory distress, shock, an acute change in consciousness, major bleeding or rapid deterioration first require local emergency care. In these situations, the priority is to stabilise the patient and then decide, with the doctors, whether and how a transfer can be carried out safely.

Useful questions for the family

• What is the precise medical objective of the transfer?
• Has the receiving facility accepted the patient?
• Does the patient need oxygen, ventilation or continuous monitoring?
• Who will accompany the patient during the journey?
• How will the file be handed over between the teams?

Frequently asked questions