ANNUAL IAG ACADEMY 2014

CASE PRESENTATION
(Repatriation of Mortal Remains)
INDONESIA OFFICE


O Date of Call : 14 June 2014
O Caller : Insureds colleague
O Insured : Male / 39 Years Old
O Purpose of Travel : Company Training
O Place of Death : Dsseldorf, Germany
O The insured was travelling to Germany for his company training
from 10

May 2014 to 21

June 2014
O On 13 June 2014 while went to shopping area in Dsseldorf,
the insured suddenly fainted and was brought to Marien
Hospital
O The patient was admitted in ICU Room and diagnosed with
Acute Hemorrhagic Stroke and passed away on 14 June 2014 at
1 AM
Case Summary

14 15 June 2014 (Day 1-2)
- Received first call from insureds colleague in Jakarta informing
the insured was passed away in Dsseldorf, Germany
- Family and colleague requested for repatriation of mortal
remains back to Indonesia as soon as possible
- Verified the policy and obtain the Medical Report and Death
Certificate from the hospital
- Consulted with Medical Team regarding the cause of the death
16 - 18 June 2014 (Day 3 - 5)
- Preparing the quotation for Repatriation of Mortal Remains from
Dsseldorf, Germany to Jakarta, Indonesia
- Obtained approval from the insurance company for the RMR
- Logistic arrangement:
-Removal of deceased from hospital
-Cleansing, dressing & encoffining, Embalming
-Sealing, packing & forwarding handling
-Export of remains documentation handling
-Delivery up to local cargo export terminal
-Air freight charges from Dusseldorf, Germany to
international arrival customs airport in Jakarta and
delivery up to consigned address.


19 June 2014 (Day 6) Mission Day
- The RMR was arranged with below details:
19/06/2014 : Frankfurt Istanbul (07:15 - 11:15)
20/06/2014 : Istanbul Jakarta (00:40 - 19:15)





20 June 2014 (Day 7)
- The deceaseds body arrived in Jakarta
- Insurance company was updated on the completion of RMR

Case Summary

Challenges Encountered
+ Managing family members expectation while awaiting the
Death Certificate from the hospital, as the family members
insisted the deceaseds body should be repatriated as soon as
possible
+ Due to religion consideration, the family is requesting the
deceaseds body not to be embalmed. Explaining to the family
members per the airline regulation the deceaseds body has to
be embalmed
+ Obtaining the suitable flight for the repatriation (flight charges
which is important to insurance companies, flight timings,
flight availability and also size of aircraft.)

Case Conclusion
+ The deceaseds body safely arrived in Indonesia
+ The insurance and family members were satisfied with our
services, however we need to improve our performance for
further case






THANK YOU
-TERIMA KASIH-
FROM AA INTERNATIONAL INDONESIA
International Assistance Group Academy 2014
Innsbruck, Austria
IAG Case Summary

Location: Atyrau, Kazakhstan

Case Summary

O Date of case : 06 May 2014
O Patient : Babu**
O DOB : 25 May 1960
O Location : Atyrau City, Khazakhstan
O Course of Death : Preacute Cardiovascular
Insufficiency, Coronary Atheroma,
Ischemic heart disease
O Mission : Arrange RMR from Atyrau City,
Khazakhstan to India






HR
Company
/ Family
Member
Client
Mission to repatriate the
deceaseds body back to
India
Case Summary

O We have received the request from deceaseds company requesting to do a
RMR from Atyrau, Kazakhstan to Kerala, India.
O Requested quote from our local provider
O Our provider provided us the quote in next 10 minutes
O We confirmed the case and according to our provider they can send
someone to collect the deceased body the same day.
O Our provider informed the mission will take up to 10 days
O 1
st
sector Atyrau - Almaty 2
nd
sector Almaty Amsterdam 3
rd
Amsterdam
to Mumbai 4
th
Mumbai to Kerela.
O Deceaseds body safely arrived in Kerala on 26/05/2014.



Airline
Family
Provider
AAI
CHALLENGES ENCOUNTERED
O According to our provider their Agent is from Moscow so need to follow
Moscow time for update

O There was another best route to transfer the body in India however we were
given another option

O 1
st
sector and 3
rd
sector delay causing pressure from deceaseds company and
family members.

O Too many parties involved which get a lot of miscommunication

O The advantage of our client based in Atyrau itself, they were able to obtain
information faster than us.

International Assistance Group
Academy Innsbruck, Austria 2014 by
AA International, Malaysia
+ CASE DATE : DATE OF CASE: 30/05/2012
+ PATIENT: MS. CHE*** **** ***
+ DATE OF BIRTH: 02/04/1975 | FEMALE
+ LOCATION : UPPER MUSTANG, NEPAL (APPROX. 3600
METER HIGH)
+ DIAGNOSIS: ACUTE MOUNTAIN SICKNESS
+ RECEIVING HOSPITAL : NORVIC INTERNATIONAL HOSPITAL,
KATHMANDU
+ MISSION: TO EVACUATE PATIENT TO NEAREST MEDICAL
FACILITY WHICH IS ADEQUATELY EQUIPPED TO TREAT
PATIENT
12
th
July 2014 : -
+ Received first case notification from agent. Patient was
hiking tour in Nepal and fell sick

Tour leader informed us that the patient was showing
symptoms of mountain sickness and requested to evacuate
the patient to the nearest medical facility

+ Aircraft was unable to perform the evacuation due to : -
1. It was 11pm (LT)
2. Special permit will be required to fly in that area
Followed up consistently with the tour leader to monitor the
patients condition. Patients condition started deteriorating.

Provider informed they could proceed with the helivac the
following morning and we approached the respective
insurance company for approval of coverage

The insurance company had difficulty with verifying the policy
and the local agent was not contactable.
+ Once the policy was
verified, coverage
was approved and
we arranged the
helivac to
Kathmandu, Nepal.
+ Upon the rescue teams arrival in
Upper Mustang, they advised us the
patients condition had deteriorated.
They advised that Norvic
International Hospital, Kathmandu
would be adequate to treat the
patient.
+ After the initial assessment, the treating doctor confirmed
that the patient was diagnosed with acute mountain sickness
(high altitude pulmonary edema/HACE). Patient was
catheterized, ventilated and a nasogastric tube was inserted.
Patient was admitted in an ICU. CT Scan of the head showed
subarachnoid hemorrhage
13
th
July 2014 : -
+ The hospital informed us that that the estimated cost of
treatment was approximately USD 10,000.00 and coverage
was approved by the insurance company.

+ 2 family members travelled to Kathmandu to visit the
patient.
+ Communication was once again an issue due to bad
network coverage
+ Family was not allowed to visit the patient in the
ward.
+ We managed to speak
to the patients niece
and she informed us
that they had
activated a different
insurance company to
arrange an air
ambulance transfer
back to Kuala Lumpur.
+ We monitored the
patients discharge,
transfer and also the
arrival back in Kuala
Lumpur on 15th August
2014.



+ Patient was located in a remote area and the only
option to evacuate the patient was via helicopter.

+ Encountered difficulty communicating with the
tour leader in Upper Mustang due to network
difficulty.

+ A special permit was required for the helivac and
the approval would take approximately 24-48
hours.




+ The helivac was only able to take place on the following
morning and the patients condition was deteriorating.

+ Delay in the approval of coverage as unable to verify the
policy.

+ Not being informed that there is a different insurance
company that was also involved in the case until the very
last minute when the air ambulance transfer was already
arranged.



+ Make a list of the restricted areas for performing an
evacuation and source for alternate modes of transfer.







+ To find out if there are local clinics or hospitals in remote or
common areas that tourist visit in case of an emergency for
initial / stabilization.






THANK YOU
FROM AA INTERNATIONAL INC.
KUALA LUMPUR !


International Assistance Group Academy 2014
Innsbruck, Austria
9-Sep-2014 to 11-Sep-2014

Case Management Sharing Session
By
AA International Singapore


Patient : Mr R**
Birth Date : 07 June 1956
Age : 58 years old
Location : Papua New Guinea
Purpose of Travel : Business
Type of Policy : Corporate Policy
Symptoms : Upper and lower left limb
weakness
Diagnosis : Cerebrovascular Accident
(CVA)

Case Summary

**The above-patients name has been altered to protect the confidentiality of the case**
Mr R was sent by
his business
counterparts to a
local hospital in
PNG
Company HR
requested to have
patient evacuated
to an adequate
medical facility
Hospital does not
have adequate
medical equipment
to confirm on
patients condition

To evacuate the
patient back to the
nearest centre of
medical excellence

Mission
Afternoon:
Notification of patients admission by company HR in
Singapore.
Request to have patient evacuated to a centre of medical
excellence, Australia or back to Singapore.
Evening:
AAI sent request to client for approval of medical
expenses and for recommendation to evacuate patient.

Night:
2 options of Air Ambulance provided to client
A] Brisbane as final destination
B] Singapore as final destination

Day 1
Proposed
Ambulance
Flight Routes
(A) Brisbane as final
destination
i. SYD PNG BNE
Port Moresby
Proposed
Ambulance
Flight Routes
(A) Brisbane as final
destination
ii. SIN PNG BNE
Port Moresby
Proposed Ambulance Flight Routes
(B) Singapore as final destination

Makassar
Proposed Ambulance Flight Routes
(B) Singapore as final destination

Makassar
M
o
r
n
i
n
g

Updated client of Verbal Medical
Contact with Treating Doctor

Received approval for mission
but 5 minutes later, was asked to
hold mission

Received information that both
aircrafts are no longer available

Re-work sourcing of aircraft, re-
work quotation

Found aircraft from Darwin,
explanation had to be made to
client for difference in quote

Client decided to evacuate
patient to Singapore instead
A
f
t
e
r
n
o
o
n

Provided additional quote
for evac from PNG to
Singapore

Quote approved for evac to
Brisbane

Requested approval of
Australian Visa processing
fee and LOG to Brisbane
Hospital

Chest X-ray to be provided
to Australian authorities for
Visa approval but no
respond from local hospital

E
v
e
n
i
n
g


Approval
received for
patient to be
evacuated to
Singapore
Day 2
Darwin to PNG (3hrs)
PNG (12hrs rest) Makassar
(tech stop) to Senai (7hrs)
Map
Darwin
Port Moresby
Makassar
Senai
Morning
Notified all parties of the
mandatory 12-hr crew rest
when aircraft lands in Port
Moresby
Evening
No clearance from Singapore
authorities
Decision made for aircraft to land
at the same scheduled time in
Johor Bahru, Malaysia instead
Afternoon

Local Hospital accepted LOG placed by another assistance
company but was assured that there will be no issue upon
discharge
Received information that flight landing permit for the
aircraft will be delayed. More info about aircraft required
Day 3
Day 4 Morning
Aircraft lands in Senai, JB,
Malaysia.
Medical team received
patient on ground ambulance
Medical Team met with patients
company HR at
Singapore General Hospital
Challenges









Communication and Managing Expectations
Challenges









Obtaining Medical Information
Challenges









Availability of Air Ambulance
Confirmed Job!
Lets go!
Challenges









Availability of Air Ambulance
Confirmed Job!
Lets go!
Challenges









Medical Facilities Demands
LOG
Challenges









Statutory Requirements
PILOTS
Thank you
Case Study
IAG Academy 2014
Innsbruck, Austria



AA INTERNATIONAL Thailand
Case Details



AA INTERNATIONAL Thailand
Date of call: September 1
st
, 2013
Caller: Mr. PARINYA (Tour guide)
Patient: Mr. SINMAHAT KIATJANON
Purpose of Travel: Travelling
Place of Incident: Honolulu, Hawaii
Diagnosis: Drowned
Request: Guarantee of Payment and
Repatriation of Mortal Remains










AA INTERNATIONAL Thailand
Day 1 : Received a call from tour guide reporting
the accident of insured and asking for
guarantee of payment.

: Sent new case notification to Client.

: Attempted to obtain the insureds relative
contact details in order to get the signed
consent since the insured was unable to do so.











AA INTERNATIONAL Thailand
Day 2 : Client requested for insureds
accident circumstances.

: Obtained the relatives contact details.

: Obtained a verbal consent and sent the
official consent to be signed by family
member.











AA INTERNATIONAL Thailand
Day 3-4 : Got confirmation from relative that
they will fly to Hawaii and will hand over
the signed consent directly to hospital.











AA INTERNATIONAL Thailand
Day 5-6 : Signed consent and first medical report
were obtained by our local
correspondence in USA.

: CSU was prepared and escalated to
Client.

: Pending for police report which defined
insured accident circumstances.











AA INTERNATIONAL Thailand
Day 7 : Insured passed away

: Updated to Client

: Preparing RMR quotation to Client.











AA INTERNATIONAL Thailand
Day 8 : Police report was obtained

: Provided RMR quotation to Client.

Day 9 : Client authorized the RMR

Day 10-22 : Documentations and formalities process.

Day 23 : Remains was successfully repatriated back
to Thailand.











AA INTERNATIONAL Thailand
Challenges Faced

- Time zone different between Hawaii and Thailand

- Many parties involved

- Custom clearance difficulty

- Time consuming

The Inverse Swiss Cheese Model of
Success
IAG Academy Case Study



Sean Culligan
Chief Operations Officer







The Swiss Cheese Model of Disaster
The Inverse Swiss Cheese Model of
Success
Africa
Size of Western Europe
Case details

27 yr old male Malaria/ jaundice / sepsis
Location- Lalibela, Ethiopia
In a small clinic with limited facilities
Call came in at 1300 local

Considerations
Confirmation from the insurance
How to get there
Operational constraints
Landing permission / Opening hours
Lalibela- Daylight ops only;
No Customs/ Immigration
Routing via Addis Ababa

Operational calculations

2 hours from Nairobi to Addis
30 minutes on the ground in Addis
45 minutes to Lalibela which closes at 1800
Need to be airborne by 1430
If we miss that time, the flight will be tomorrow.
The patient was unlikely to survive until the next day



Take off and en route issues
Clearance obtained at 1410
Insurance company advised
Pts travel documents found
Take off!
Airport officials can behave like Rheopectic Liquids
i.e. Become slower and thicker over time when shaken, agitated
or otherwise stressed.



Patient status on pick up

A lot worse than reported
Only 30 minutes ground time allowed- maximum!
IV lines / ventilator / pumps / drips / machines
Take off just as light was fading



Patient status in flight and arrival in Nairobi

Improved in flight
Even began breathing for himself
Handed over at the hospital much improved
Some days later was reported stable and positive
prognosis



Moral of the story!

Contact us as early as possible
Ensure all travel documents, visas, contact details are
available and accurate.
Hospital discharge is arranged and confirmed.
Accept the fact that we cannot always work miracles


Questions?
Bupa Private and Confidential Date
if required
80
IAG Academy
Case Scenario
Presenters names Merete Mortensen & Alio Viera
Bupa Global Assistance
9-11 September 2014
Bupa Private and Confidential 9-11 September 81
Case Summary
Incident: 44 years old member has an accident on a ship sailing to
Singapore.
Missed step on stairs and fell down on his back

Initial symptoms: Severe pain in spine and left leg

Main challenges:
Lack of medical personnel on board
Limited choice of medical supplies
Location of the ship (several days from shore)
Bad phone line
Administrative complications in Singapore

Bupa Private and Confidential Date if required 82
Case Resolution
Ship on route to Singapore:
Direct contact between the captain and our Clinical Team
Our Drs. Evaluated patient condition based on pictures and information from
the Captain
No immediate evacuation was required
Our Drs. Adviced on medication and patient care (daily monitoring)
Our Ops. Department managed to control the communication with the ship
and update the different stakeholders
Ship in Singapore waters:
AAI was contacted to assist and their response was excellent
Doctor and nurse was sent on boat (3 hours route) to pick up the patient and
bring him on shore



Bupa Private and Confidential 9-11 September 83
Learnings

Due to a proper assessment of the situation, the patient was not evacuated
on open sea
24hr Doctors on call were vital to monitor the patient and update the Captain
AAI was invaluable for us assisting on the Dr. to patient connection in
Singapore



working with
We are Capita Global Assistance (formerly FirstAssist) the medical
assistance company working on behalf of many insurers.
We provide medical and repatriation assistance to our clients
worldwide
We appoint local agents within the IAG network to assist us with
various medical and sometimes challenging scenarios


Our Role
Call received on 28
th
July 2014 at 19:00 from a company called
Pamir Peaks requesting a medical evacuation for a British
Mountaineering Council (BMC) policyholder
The client is 4,500 metres above sea level at the International Base
Camp Moskvina in Tajikistan, situated between glacier Moskvina
and glacier Valter
The client has altitude sickness High Altitude Cerebral Odema -
and is at risk of lung and brain failure due to the severe cold weather
conditions
The Tajikistan Ministry of Defence need to evacuate the client and
the cost will be approximately $30,000

Case Scenario
Remote location
Time limits
Limited facilities
Contacting insurers out of hours
Discussing case with Tajikistan military
Language barrier
Shuttle helicopter for the treks are
limited to trip start and end dates
Only 2 helicopters can access location
Severe weather conditions
Barriers
No medical facilities in location
Tour guide with patient is limited in treatment can provide due to
the medical condition
Pamir Peaks advised transfer can only be undertaken by helicopter
due to location of base camp
The base camp is usually only accessible via helicopter shuttle on
pre-determined dates to coincide with expeditions
Location
Our in-house nurse called our on-call Doctor to evaluate situation;
Patient contacted us via satellite and is concerned for his health
Risk of lung and brain failure due to cold
Twice daily doses of Diamox at 250mgs to be administered by tour
guide / medic in the interim
Case discussed further with our Chief Medical Officer
Patient not in a place of safety and urgent medical evacuation is
required

Medical evaluation
Due to our financial limits we need to call the insurers to authorise
the transfer
Verify the insurance policy is valid
Activate agent to speak with ministry of defence to send helicopter
to evacuate the patient
Arrange for the patient to be assessed at a medical centre in
Dushanbe
Cover the costs of the helicopter transfer
Obtain medical reports after the patient has been assessed

Plan of action
Advised insurers we need to send a guarantee with $30,000 as
amount to be covered
Insurers were reluctant to cover $30,000 for the transfer as this is
unusually high
Explained this is not confirmed amount and is generic due to
time / location / potential hourly rate for transfer
Only way down the mountain is via a helicopter, no safe route to
walk
Re-iterated urgency of evacuation due to patients condition
Insurer discussed with accounts manager and agreed we can send a
guarantee of payment to proceed
Invoice to be reviewed by insurers before settling costs
Insurers evaluation
GVA contacted to see if they have links to any other helicopter
company that could assist in evacuating the patient in bad weather
conditions

Due to location only the Ministry of Defence could assist
Weather delayed transfer
Helicopter located 2 hours away from Tajikistan

Evacuation went ahead on 30
th
July when the weather cleared and
the patient was taken to Dushanbe
Medical evacuation
Our patient went to a hotel on arrival to Dushanbe as felt much
better
Arranged for patient to attend a medical facility for assessment
Russian medical reports sent to GVA for translation
Patient recovered quickly from the altitude sickness and required no
further medical intervention
Medical assessment
Patient was unable to return to the mountain
Patient spent time in Dushanbe then returned to the UK
Invoice was received for evacuation totalling $14,440 and has been
processed for payment to the Ministry of Defence via the rescue
company

Outcome
Any Questions
Case Scenario
On 07/04/2014 We received an email request from Insurance
Company at 11:23 AM that a client on board Nile Cruise on the
way from Edfu City to Aswan City via Kom Ombo city.
IC needed urgent doctor visit on board & can be at Kom Ombo City
when floating hotel docked near Kom Ombo City.

We contacted with Nile Cruise mentioned on
the request to know when the Floating hotel
will arrive to Kom Ombo city.

Receptionist advised that estimated time can be at 13:20.
We asked him what was the patient suffers from?
He reported that patient suffered from chest pain, dizziness, weakness
Dyspnea & left shoulder pain.

Our medical director advised to send a doctor with portable ECG
Case Scenario
Doctor were on time at the dock waiting for the floating hotel

Nile Cruise arrived 10 minutes late & doctor went to examine the
patient on his cabin.

By examination, blood pressure was 160/90 & ECG showed acute ST
changes with possible inferior MI (Myocardial Infarction).

Doctor asked for immediate transfer to an appropriate hospital to
Perform Cardiac Catheterization.

Our medical director asked to transfer patient urgently to Aswan
But according to our experience, there are no hospital can provide the
necessary intervention efficiently.
Case Scenario
So we advised the IC at 14.00 that patient might need
to be transferred to Cairo by Air Ambulance to save
his life.

We received confirmation shortly at 14.30 & we started on Air
Ambulance procedures which took approx. 30 min. & the plane
took off from Cairo to Aswan with 1:30 hr duration.

During that time we ordered a ground ambulance to
transfer patient from Kom Ombo city to Aswan Intl.
Airport 75 KM far (duration about 1.15 minutes).

All permits were ready to allow for the ground ambulance to
meet the plane on the tarmac.

Plane flew within 15 minutes back to Cairo.
Case Scenario
Air Ambulance arrived approx. at 18:20 & ICU ambulance
were ready at the tarmac to transfer patient to hospital
which we already arranged near to the Airport 12 min.
max. to save time.

Catheter was performed & installed 2 stents.

1 Week later IC asked to offer a flight ticket from Cairo
to home country on board a regular flight in a business
class seat & provide a local doctor escort to join patient.

We sent our offer & IC accepted it.

Hospital medex were covered & transferred patient &
doctor escort by ground ambulance to Cairo Intl. Airport.
Case Scenario
We already asked previously for wheel chair & vehicle
wheelchair lift for a comfortable transfer into the aircraft .

Challenge
Find a free local doctor with available ECG
monitor to be available in another city from
Aswan to Kom Ombo in the shortest time.

Arrange an Air Ambulance & finish all
permits procedures in a no time (30 min).

Specialized hospital ready & near
to the airport.

A local doctor with Schengen
Visa to join the patient back to home
country.

The End
Part of Our Team
Thank you...
www.egyptassistance.com
EMA CASE SCENARIO
IAG ACADEMY INNSBRUCK
9 11.9.2014
105
Case begins 25.9.2013
46 year old CEO on business trip in Salekhard, Siberia
Got chest pain 25.9., was admitted to local hospital
EMA alerted at 11:45 by representative of company
Travel companions returning to Finland 25.9.
Phone contacts to destination difficult
Preliminary information received through embassy
Patient diagnosed with myocardial infarction
Patient in ICU, according to treating doctor
hospitalization needed at least for one week
Angiography not possible in local hospital

106
Action 25.9.2014
EMA gathers information from all parties

Patient was reached at 15:30
Medical report & ECG was obtained by 16:00
Diagnosis: acute myocardial infarction with ST-elevation
(STEMI)
Company authorized air ambulance evacuation
Flight operator alerted immediately (flight permits etc)
Ambulance flight arrangements started (medical team etc)
Flight scheduled to depart 26.9. afternoon
Problems with local airport opening times?
GVA alerted to arrange ambulance transportation to
airport

107
Action 26.9.2013
Continue ambulance flight arrangements
Ambulance flight departs from Helsinki at 17:00 LT
Stop-over in St. Petersburg needed (authorities)
Flight time to destination with stop-over approx. 5 h
Arrival in destination at night 27.9. 00:50 LT
Salekhard airport not open 24H (domestic airport)
=> airport opening needed special arrangements
GVA agreed to transport patient from hospital to airport

108
Action 27.9.2014
Patient brought to airport in a van, had IV-cannula
without line, no oxygen, no monitorization
Patient examined by our ICU team, had some chest
pain, ECG with anterior ST-elevation
Started with instant nitro-infusion, MO, betabloc,
oxygen
Ambulance flight departs from Salekhard 01:30 LT
Onboard i-STAT analyses, treatment adjusted, stable
in monitor / EGC
Ambulance flight arrives in Helsinki 04:30 LT
Patient transported by ambulance to Helsinki
University Hospital
Immediate angiography and PCI on arrival to hospital

109
Summary
Patient repatriated and in receiving hospital
42 hours from the first alert
Adequate treatment started by EMA in 36
hours
Cost of ambulance flight reasonable, 34.000
euros (not including ICU medical team &
equipment)
Cost of opening of Salekhard airport for few
hours not reasonable, almost 20.000 euros !!!

110
Conclusions
Case was quite challenging, due to location
and patients medical situation
Decision of repatriation was done very quickly
Good co-operation with partners
Patient very satisfied, recovered and returned
to work quickly
111
IAG ACADEMY
INNSBRUCK 2014

GARANTIE ASSISTANCE
CASE SCENARIO
MOTORBIKE ACCIDENT ON KABRI ISLAND / TH : BRAIN TRAUMA
CASE DETAILS

E Date of call : January 30th 2014, late afternoon
E Caller : Patient + mother in France
E Injured : Subscriber, 30 Y.O
E Country of origin : France
E Currently in: Thailand, on Kabri Island
E Contracts nature : Health care insurance including
worldwide medical assistance and repatriation but with no
direct financial coverage

114
FACTS/SITUATION
E Further to motorbike accident, subscriber received medical
care as outpatient in local medical center.

E CT Scan and X-Ray were performed; patient was discharged
with short medical report: brain trauma diagnosed.

E Subscriber is worried: he is still having nausea, headache
and hyperthermia; he carries Von Willebrand disease.

E He is can only be reached by email or on his girlfriends
cellphone for a couple of days.
115
1st issue :
DIFFICULTY TO OBTAIN MEDICAL INFORMATION
E Poor discharge summary; local medical centre not reachable.
E Upon conversation with the Client our regulating doctor
advises to transfer him to a hospital in BKK for further
investigation.
E We contact our correspondent (AAI) to try obtain a detailed
medical report which is not compulsory for PHs transfer.
E AAI promptly informs that an agent will have to be sent to
obtain medical report directly from the medical facility(cost
and delay).
E We decide to transfer PH to BKK asap.



116
2
nd
issue
LOGISTIC & CONTRACTUAL LIMITATIONS
E No availability on commercial flights due to high season.
+Our doctor agrees on transferring client by air ambulance,
which AAI confirms to be possible within 4 hours.

E BKK hospital requests a guarantee of payment for the
admission.
E The contract does not cover medical expenses; exceptionally
+GA agrees to place GOP for medical costs at BKK Hospital
via AAI

117
OUTCOME

E Transfer and admission to BKK is achieved within 24 hours
after case opening.

E Medical update from Feb 1st confirms that patient is fit to fly
under normal condition; he will be discharged within 48
hours.

E Upon mother's request (she is a doctor) we ask hospital to
postpone discharge for a couple o days.

E On Feb 4th, PH flies back to France in Business Class.


118
CONCLUSION
PROBLEMS FACED
E Difficulty in obtaining medical information from public
facilities.

E Difficulty to reach patient by phone.

E Difficulty to find available seats on commercial flights (peak
season).

E BKK Hospital demanded GOP for medical expenses to
confirm availability for admission while patients transfer for
accurate medical assessment was considered urgent.


120
WHAT WENT WELL

E AAI promptly organized air ambulance to BKK and placed
GOP to ease patients admission.

E AAI was a great help liaising communication with the client
before he was transferred, as the facility where he was
accommodated was reluctant to allow phone calls.

E Patient was well assisted at BKK hospital and medical
reports were easily provided.



121
MANY THANKS TO
123
www.garantieassistance.fr
Hirondina CAVACO/Senior Coordinator
hirondina.cavaco@garantieassistance.fr

David ADAMANTIDES/Assistance Coordinator
david.adamantides@garantieassistance.fr

Tl. +33 9 77 40 70 70
Garantie Assistance
108 Bureaux de la Colline
92210 Saint-Cloud
FRANCE
IAG ACADEMY
Innsbruck, Austria 2014
Case Scenario Presentation
by
Initial information
Date of event: 01/01/2010
Gender: Male
Date of birth: 09/09/1974 (35 y/o)
Purpose of travel: Tourism
Place of accident: Punta Arenas, Chile
Medical diagnosis after doctors
examination: Colon invagination, bowel
obstruction, peritonitis



First call


Patient hospitalized with acute abdominal
pain.
Diagnosis: Colon invagination, bowel
obstruction, peritonitis.
Treatment: Resection of the colon.



Problems faced

Maximum coverage for medical and evacuation expenses
EUR 100,000. Approximate cost for the treatment on
12.01.2010 is 39 881 259 Chilean Peso (~ EUR 53 867,77).
EUR 250,000 estimated medical costs heavily
overcharged (45 day-hospitalization).
UK Honorary Consul in Punta Arenas interference with
pressure on GVA to pay bill in full. The UK Honorary
Consul is the employee of the hospital.
Restrictions by hospital to discharge patient without
payment.
Patient not fit for quick discharge.
Fitness to fly on stretcher or Business / First Class.
No stretcher or Business / First Class from Punta-Arenas
to Santiago.

Solutions

3-day full time cost containment work by
GVA, line by line of the invoice.
Letter to the Embassy of the UK in Chile.
Contained invoice finally accepted by the
hospital, GOP issued and accepted.
Domestic airline agreed to secure two
extra seats for the patient on the route
Punta Arenas Santiago.

Actions performed &
Medical Evacuation

Getting MR&FTF.
Getting official paper from
the clinic that patient can
legitimately leave Chile.
On 26.02.2010 GVA arranged
patients medical evacuation
to RF by regular flight in
First Class with doctor and
nurse escort on the route
Punta Arenas-Santiago-
Paris-Moscow.




Problems we faced
during evacuation


27.02.2010 flight from Paris to Moscow was
delayed for 4 hours due to the strike of
airport services employees and Air France
employees




When the patient was
transported to Russia


On 27.02.2010 earthquake measuring
8.8 began in Chile.




Questions ?
Wir helfen
Menschen.
Repatriation by Air
Ambulance from Turkey

Patient Marco T.
135
Wir helfen
Menschen.
Evening of 18.07.2012
Announcement of case on the 18.07.2012 by the hospital
Calling hospital for case opening with parents
Coverage request to headquarters of insurance
Calling father CM for 19.07.2012
136
Wir helfen
Menschen.
9 am: father inquires about repatriation procedure
Coverage confirmation for hospital fees
11 am: CM doctor calls, immediate repatriation by air ambulance
Quotes from 5 providers, several contacts for same day repatriation
with pediatrician

Morning 19.07.2012
137
Wir helfen
Menschen.
Midday 19.07.2012
Coverage request to insurance for repatriation
Contact with mother for repatriation approval fails
CM doctor confirms approval of mother
AA-providers request feedback
Repatriation coverage confirmed by insurance
Cost guarantee to hospital (direct)
138
Wir helfen
Menschen.
Afternoon 19.07.2012
Order for repatriation to chosen provider
Organization of bed in ICU at pediatric hospital in CH
Confirmation of TT by AA-provider
Info mother about TT
Info hospitals (T/CH) about TT
CH-pediatrician and CM-doctor discuss case

139
Wir helfen
Menschen.
Evening 19.07.2012
Decision about transport from air ambulance base to
hospital in CH (ambulance vs. Helicopter)
Landing 23.40 at Airport Friedrichshafen D
Arrival at Childrens Hospital KS St. Gallen at 1 am 20.07.
Wir helfen
Menschen.
Medicall
we are here for you
always and everywhere
Bernadette Andrey
Edy Hofmann
Marlen Krakowitzer
Miriam Pasini




Please Note: *

Names used in this case scenario are
fictitious to protect identity.
Case received 01May 2014
32 year old Yasmin*
Name of caller Kim* from the medical
department. Followed by email request
Member originally admitted on 16 April
2014
Country of Residence Canada
Insured by a Canadian Insurance
Travelling in Nigeria

Admitted to University College Hospital
Ibadan, Ibadan Nigeria
Diagnosis of Poly trauma with mild head
injury, C-spine Injury and multiple long
bone fractures
Motor Vehicle Accident
Coverage of medical expenses by
Insurance: Yes
Situated in Ibadan Nigeria:

Please obtain medical information as
well as cost till date
Please advise if the facility are suitable
to treat the member
If facility not suitable, please advise
where member should be moved and
advise on method of transport

Member was admitted to the hospital on 16
April 2014 as a referral from State Hospital
Ijebu Ode, Ogun State Nigeria
She was an unbelted middle seat passenger
in a Toyota Sienna van.
Was involved in a head-on collision with a
trailer.
She had immediate loss of consciousness
which was partially regained after 5 Hours

On examination the clinical diagnosis was
polytrauma with mild head injury, Frankel E
c-spine injury and fractures of bilateral
radio-ulnar,left femoral and left tibio-fibular
fractures
She had surgery done on 18 April 2014
which included Open Reduction and Internal
fixation of the fractures as well as an
external fixation of left tibia
On 21 April she had Gardener-Wells tongs
application and traction for reduction and
immobilization of the unstable c-spine
fracture and is awaiting procurement of a
Halo Brace
Halo brace not available in Nigeria or
surrounding countries
This was the first challenge we had for this
case.

Halo Brace not available not even in South Africa
trying to source this brace
Neurosurgery not available at the University
College Hospital Ibadan
Member requires transfer to Lagoon Hospital,Lagos
via Air Ambulance. MSO Nigeria provided quote.
Cost of air ambulance USD22,000.00
Halo Brace could not be sourced,neurosurgeon at
Lagoon hospital will be able to do a posterior
stabilisation if member is transferred.
Insurance wants to repatriate member back to
Canada and not transfer member to another
hospital.
Insurer wants to know why the university
hospital are unable to help in getting a halo
brace is it due to lack of resources?
Not due to lack of resources but due to halo
braces being unavailable in Africa at that
time.
Costs till date for hospitalisation
USD2,800.00 and awaiting for fit to fly from
treating doctor
Road works between Lagos and Ibadan,
therefore road transfer never an option.
Halo brace could not be sourced in Nigeria
Hospital not within MSOs network having
difficulty in guaranteeing expenses. The
hospital have forwarded the invoice to the
insurer costs for hospitalization CAD3,028.45.
Our medical director in Nigeria went to the
hospital to settle the invoice as they did not
want to except a credit card payment.
Member to be evacuated on 22 May 2014 to
Lagoon Hospital in Lagos Nigeria without the
halo brace as she is currently on traction.
Situated in Apapa, Lagos Nigeria.


08h30 10h30: Doctors in UCH will be
dressing patients wound in preparation for
evacuation.
11h00 11h30: Departure of patient,
spouse and crew to airport in Ibadan
12h00 12h30: Departure from Ibadan
Airport
13h00 13h30: Arrival at Murtala
Mohammed International Airport II Lagos
and onward transfer to Lagoon Hospital
Apapa Lagos.
Patient admitted to the hospital in the
afternoon on 22 May 2014
Medical report on the 23 May 2014 Patient
had been on skull traction for over 5 weeks
now and fractures have been fixed both
internally and some externally.
Her C2 fracture seen on CT is minimally
displaced. The plan is to review her cervical
spine x-ray at six weeks and hopefully if the
fracture is healed as I expected, she may not
need further surgical intervention but to
continue on a Philadelphia collar.
C2 Fracture has healed well, Philadelphia
collar insitu as per CT scan done on 31 May
2014.
Skin graft of left leg as well as manipulation
of left knee was done. Wound well healed.
Patient having regular physiotherapy as well
as neurosurgical and orthopaedic review.
Her clinical condition is stable.
27/05/2014 Husband very worried about wife as
he was under the impression that she would be
operated on for her c-spine fracture.
Medical Director MSO Nigeria commented the
following:
I think Lagoon hospital is one of the best private
hospitals in Nigeria and the only one with a JCI
accreditation. We have been in contact with the
patient and the treating team on a daily basis.
No surgery advised as there are positive healing.

Once member are deemed fit to fly she will be
repatriated back to Canada
Insurance and husband updated on her
progress as well as treatment plan.
Comprehensive medical report to follow
with recommendations for repatriation and
future treatment.
Member will be fit to fly on 13 June 2014.
Awaiting instructions from insurer
Member being escorted back to Canada.
A team of nurses will come and pick up the
patient and her husband at the hospital at
around 16h30.
The insurer has made the request that
there should not be any issues with regards
to a guarantee of payment.
A letter of guarantee was issued to the
hospital on admission on 22 June 2014.

This case had a lot of challenges due to
costs as well as the unavailability of the
Halo Brace.
The outcome was the safe repatriation of
the patient back to her country of origin
Canada.
Limited Air Ambulance providers on the
African Continent.
Time difference between insurer, MSO
South Africa and MSO Nigeria.

IAG Case Study
IAG Academy 2014 Innsbruck, Austria
Presented by On Call International

Jayme ONeil
Operations Supervisor
On Call at a Glance
24/7 global emergency response center and nurse helpline

U.S. trained and licensed in-house Medical Director and Consulting Staff
Physicians available 24/7
On Call has added U.S trained and licensed nurse case management
staff that has helped to enhance our medical team.
On July 14, 2014 On Call International acquired an exciting nurse escort
company and now has access to over 30 U.S. trained and licensed
nurses for commercial transport.

Health Insurance Portability and Accountability Act (HIPAA) compliant

On Call is a member and the U.S. affiliate of the International Assistance
Group (IAG)

On Call specializes in assisting leisure, academic, and business travelers.

Case Vitals
Date of Call: December 10, 2013

Caller: Travel Companion

Patient: 35 year old female, 42 year old female & 27 year old female.

DOB: March 7, 1978; October 30, 1971 & December 13, 1985

Residence & Country of Origin: United States

Purpose of Travel: Missionary Group

Country of Incident: Niger

Insurance: Berkely

Client request: Patients currently in remote location without adequate
diagnostic/treatment capabilities. Client requests evacuation to adequate
hospital as well as repatriation of the remains to the U.S.


Diagnosis
Motor vehicle accident resulting in two patients being seriously injured
and one fatality.

1
st
patient: Contusion of spleen and comminute fracture of the
sacroiliac

2
nd
patient: Spinal Fracture from D8 to D12

3
rd
patient: passed away due to injuries before reaching the hospital.
Scenario Management
A member of the patients missionary group notified On Call
of the vehicle accident involving 6 travelers in Niamey,
Niger. Assistance was requested to transport the patients,
travel companions, and the deceased home.

MSO was immediately contacted with a request for
assistance. We asked that MSO help with hospital and
funeral home communications.

On Calls medical team was connected with the treating physician to
consult about the patients conditions.

MSO sent a member of their team to the hospital to assist with obtaining
medical records, a medical release, and all other subsequent information
necessary for an emergent evacuation.

On Calls medical team determined that the current facility was
inadequate as the hospital was only providing pain management
treatment for severe injuries. It was recommended that the patients be
evacuated to the closest tertiary care facility or to their home hospital in
the United States for further treatment.

Scenario Management
On Call presented the options provided by our medical team along with quotes
for the proposed services. It was decided that arrangements would be made for
the patients to fly home via air ambulance.

On Call arranged for both patients to fly in the same air ambulance from Niger to
their home hospital in Texas, USA for further treatment. Upon arrival, the patients
were reunited with their families.

With the assistance of the local embassy, On Call was able to arrange and pay
for the repatriation of the deceased remains.

The three remaining travel companions that were
in the accident flew home on their original
arrangements.

The patients, families, and church group were very
grateful for the assistance provided to get everyone
involved in the accident back home.
Challenges
Patients were located at an inadequate hospital within a country
that had limited resources.

Limited evacuation benefit. On Call was able to contribute $30,000
USD for the double air ambulance. The remaining funds came from
fund raisers, family, and the church group.

Limited communications within Niger.

The repatriation of the deceased necessitated the
use of several different organizations. Within Niger,
there is no single company that can facilitate the
preparation and transportation of remains.

Multiple travelers involved in the same accident.


A Note of Appreciation
On Call International would like to express our thanks to MSO for their
assistance with this case.

MSO made it possible for On Call to arrange the evacuation home for
these patients by helping to establish communication with the hospital
and by sending one of their team members to the hospital to acquire
the documentation we needed.
Questions?
Case Scenario for INNSBRUCK,2014

Cost Containment
mit freundlichen Gren

Cost containment in 2014
Date Of Caller : 02.07.2014

Patient : Meydin KASAP
Date Of Birth :19.04.1926
Residence :Belgium
Hospital :Private Reyap Hospital,Corlu
Country of Origin:Turkey

Incident :After falling down in bathroom due to cardiac rhythm
disturbance,the patient was admitted to Intensive Care Unit.

Med. Diagnoses : Anemia,Acute Myocardial infraction ,Pertrochanteric hip
fracture

Client's request : Medical assistance and Cost containment.



Total claims before cost containment and deduction: 63.000

Savings : 44.000 (app. 70%)

Total payments done by Remed after discounts and ruling out
ineligible expenses : 19.000
Cost containment in 2014
Type Inv Discount Deduction Payment Savings
In Patient 63.000 6.000 38,000 19,000 44.000
Cost containment in 2014
The patient was admitted to Private Reyap Hospital due to Pertrochanteric hip
fracture.When we received new case notification,we have contacted urgently
with the hospital and we learnt not only patient's medical condition but also
found out a deposit payment by son of patient approximately 4,000

We requested refund of depoist and hospital did it immediately once they
learnt we are in charge of the case.We learnt that the patient had a valid
Turkish citizenship number and he is insured from Belgium.
To cover expenses through Turkish Social Security Institution,we requested
necessary BT8 form from Belgium.

After completing patient's medical assistance,we reverted to hospital BT8
form to cover expenses.At first the hospital was reluctant to use Social
Security and sent us the patient's detailed medical expenses as 63,000
We get legal consultancy and forced the hospital by legal consequences to
use Social Security and travel insurance as complementary.We settled with
the hospital at the final amount of 19,000 that is more than % 70 discount.
Vielen Dank-Thank You
Case Scenario for INNSBRUCK,2014

AA ORGANIZATION

mit freundlichen Gren
Date Of Caller : 08.08.2014

Patient : Stephan BUTLER
Date Of Birth :20.04.1959
Residence :Adelaide,Australia
Hospital :Medical Park Fatih,Istanbul

Incident :After 15 hours of trip by plane,inability to
move extremities and falling down.

Med. Diagnoses: Cerebrovascular diease ,kidney failure
Client's request: ICU-equipped AA organisation
Distance : 13978.87 km.

AA Organisation from Turkey to Australia
Contained Costs in 2011 AA Organization from Turkey to Australia
The patient fell down in his hotel room after a 15 hour plane
trip.Remed were asked to find a hospital for the insured and he was
hospitalized in Medical Park Fatih Hospital.He stayed in Intensive
Care Unit for 6 days and in normal ward for 9 days.We received an AA
organization request on 8 August.

We contacted a local provider and provide our customer with date and
expense information however, afterwards they informed us that the
date will be furthered and the expenses will increase since there is no
too many AA provider which can make such a long distance flight.

Hence we contact an international provider and arrange the AA for the
date and budget that was specified in the beginning.
1.Experienced medical and technic teams for best service.

2. Checking all local and international providers

3. Giving the best price and making the fastest organization.

4. High quaility of service and communication with customer.
We managed 5 AA organizations in last 6 months
We care the people
Vielen dank-Thank you
IAG 2014
Case Scenario
Medical Assistance
Academy, IAG
INNSBRUCK 2014
Ingrid van de Grint
IAG 2014
Case: Paraglide accident in
Nepal




Paragliding in
Nepal
AG 2014
IAG 2014
Main details of the
case
Date of call: 06 November 2013
Caller: Patient
Patient: Mrs. Ingrid van de Grint
Date of birth: 13-09-1970
Residence: Netherlands
Country origin: Netherlands
Incident: Patient had a paragliding accident in
Pokhara/Nepal
Diagnosis: Multiple trauma: femur fracture L/R, skull
fracture, double eye vission
Insurance: Health insurance and a Travel insurance
Situation: Patient needs to be evacuated by
helicopter from Pokhara to
Kathmandu for inmediate surgery. Later she needs to be
repatriated to Holland.
Request: Arrange guarantee of payment for
helicopter and hospital. When the patient is
Fit to Fly organize repatriation to
Holland.
Note: Patient herself works at SOS International
Amsterdam



Medical status
06/11/13
Patient evacuated with helicopter from Pokhara, where the accident
happened, to hospital in Kathmandu for urgent surgery. There is no good
hospital in Pokhara and a guarantee of payment needs to be arranged asap for
the helicopter and the private hospital in Kathmandu. Operation was done
directly after arriving in hospital.

06/11 until 15/11/13
After surgery patients stays first on the ICU and is then transferred to a private
room. She needs to stay in the hospital in Kathmandu until she is fit to fly.
After a couple of days she starts with physiotherapy for mobilisation so she can
sit in a wheelchair.

15/11/13
A nurse escort from Holland flies to Kathmandu to accompany the patient
during the repatriation by stretcher flight. The ambulance from the hospital
brings them to the airport of Kathmandu. The stretcher flight was performed
by Turkisch Airlines. The ambulance in Holland brought her to a Dutch hospital.

15/06/13 until 21/11/13
Because the patient came from a foreign hospital, she has to stay in a
quarantine room in the hospital in Holland, where she will be tested for the
MRSA bacterie. She will stay in the hospital until a rehabilitation clinic has
been found for her.

21/11/13
Patient is transferred to a rehabilitation clinic.
IAG 2014
Insurance limitations

Maximum coverage on Healthinsurance: 100 % coverage
on the helicopter transport to the hospital, admission,
doctors fee, treatments, medicines etc.

There is normaly no coverage for a private room in the
hospital. In Nepal normaly the family take care of the
patient. But she is traveling alone and the people of
the paraglide center need to stay with her to take care
of her. Therefore she gets special permission out of
good-will for a private room. (it probably also helps
that she is working herself at SOS-International)

Full Coverage on Travel insurance for repatriation.

Paragliding is a dangerous sport and can therefore
be excluded from the Travel insurance. Because
paragliding was not the purpose of the holliday, the
Travel insurance is still valid in this case.

Help from assistance centre is fully covered






IAG 2014
Admission in the hospital in Kathmandu: ICU +
private room
IAG 2014
Actions taken by SOS-
International
IAG 2014

Admission:
- Organize a Guarantee of payment the evacuation by helicopter
- Organize a Guarantee of payment for the admission in the hospital in
Kathmandu
- Request a medical report from the hospital for a clear diagnosis.
- Keeping in touch and updating the patients mother in Holland on a
regular basis.
- After the surgery, keep in touch with the patient and the treating
doctor for evaluation of repatriation.


Repatriation:
- Organizing admission in a dutch hospital, to continue her treatment
after repatriation.
- Organizing a nurse escort to accompagny patient during the
repatriation
- Via our travel agency looking for flight options for strecher flights
from Kathmandu to Amsterdam.
- Once flight has been conformed and consulted with patient; organize
ambulance transport from the hospital to the airport in Kathmandu
and from Amsterdam airport to the dutch hospital.

Repatriation by stretcher-flight
IAG 2014
Problems encountered



Is paragliding (dangerous sport) covered in the travel insurance?
Can patient stay in a private room after leaving the ICU, so the
paraglide-school people can take care of her as she is traveling alone
?
Can we find a dutch hospital who has a quarantine room avialable
(MRSA infection problem)?
How can we inform her mother in Holland in a way she will stay calm
and convident (she has a bad medical condition herself)





IAG 2014
What is important
It proved to be important to have also an IAG-contact organization
in Nepal to be able to check the quality of the hospital in
Kathmandu that was unknown to us.
SOS International made sure that the patient was repatriated
under SOSs conditions and made a clear cost-breakdown.
SOS International decided to repatriate the patient, so she can
continue her rehabilitation proces in Holland.




IAG 2014
Greetings from SOS International Amsterdam
IAG 2014
IAG ACADEMY | CASE SCENARIO
Presented By: Andrea Bobby
THE INCIDENT
Date of Incident: July 27, 2014
Notification: July 27, 2014 by the Employer
Location: Kandahar, Afghanistan
Sex of Patient: Male
Age of Patient: 62 years

Nature of Injury: The patient, a contractor for the U.S. military and a U.S.
citizen, was walking around a mine roller attempting to unhook certain
chains. As he was walking toward the front of the mine roller, he slipped and
fell approximately 6 feet striking the ground headfirst.
MEDICAL SUMMARY
The patient regained consciousness and was awake, alert and oriented. He
was admitted to an ICU at Role 3 Hospital in Kandahar where a CT scan of
the head was performed. The patient was hemodynamically stable, not
vented and saturating adequately.

He sustained a left 3rd rib fracture, grade III spleen lacerations, a finger
fracture which had been reduced, a zygomatic fracture which may require
surgery and a C1 fracture which did not require surgery. He was stabilized
with a neck brace.
ASSISTANCE REQUIRED
Kandahar, Afghanistan Dubai, UAE

Medical Evacuation
by Air Ambulance
with ACLS
RN/Paramedic and
immediate hospital
re-admission with
assessment by an
oral maxillofacial
surgeon.
SPECIFIC CHALLENGES
Last-minute Cancellation: Air Ambulance Provider A cancelled on the day of
pick-up due to technical difficulties with their aircraft. Air Ambulance Provider B
was then hired, delaying the evacuation by one day.
Ground transport in Kandahar: Difficult to arrange due to entry restrictions
into the military base (ISAF call sign/PPR/SQUAK code needed). At the end, the
employer arranged this themselves, which is not the ideal solution.
Uncooperative Patient: Once admitted in Dubai, the patient refused to be treated
and at one point, left against medical advice. We had to contact the patient and
convince him to cooperate so that his subsequent return to the U.S. can arranged.
CASE ANALYSIS
S
t
r
e
n
g
t
h
s

Knowledge of what
documentation is to
be requested (e.g.
CAC card, LS-202
form, etc.) right at
the get-go
24-hour availability
of our assistance
agents and medical
case managers to
work on cases in
other time zones
Established
relationships with
medical facilities
and hotels in the
region (e.g. CSC,
Dubai Grand, etc.)
Consistently
providing updates
W
e
a
k
n
e
s
s
e
s

Maintaining
consistency in case
management
among different
shifts
O
p
p
o
r
t
u
n
i
t
i
e
s

Each case is a
learning
experience and
increases the
departments
expertise through
audits and reviews
Sourcing out new
providers and
contacts in the
region
T
h
r
e
a
t
s

Limited number of
air ambulance
providers who are
able to enter the
region and obtain
the necessary
permits.
The military directly
evacuates the
patient to
Landstuhl Regional
Medical Centre,
Germany while we
are in the process
of arranging a
medical
evacuation.
Urgency / working
with a time limit
CASE CLOSURE
After receiving treatment in the hospital in Dubai, the patient returned
to the United States via commercial repatriation on August 2, 2014.
Total costs were $63,000 (Canadian) which includes the following:
Air Ambulance from Kandahar to Dubai
GOP for hospital in Dubai
Ground transfers
Miscellaneous expenses for the patient while in Dubai
Commercial flights from Dubai to the USA.



Thank You