Emergency Medical Evacuation – Less Fast than You Think

Before Zac broke his arm, I’d assumed that emergency medical evacuation was, well, a fast process. You know. Just look at those three words: “emergency medical evacuation”.

It sounds like something out of one of those Vietnam War memoirs, built guys hanging by one arm from a helicopter’s skids, firing a submachine gun with one arm while performing CPR with the other, Tropic Thunder style.

Yeah. ‘Bout that.

I was wrong.

Oh boy, was I wrong.

My own emergency medical evacuation began with an oxcart, proceeded to a donkey, then a motorbike, car, ambulance, and, finally, plane.

Morning dawns, our laundry arrives, and, with the patient sitting up in bed anticipating a bacon-led breakfast followed by a busy day of Cheezburger, Cyanide & Happiness, Armor Games and YouTube, we put in Skype calls to concerned relatives in various timezones.

I’m not surprised my parents are cool with the broken arm. When I was 19, a friend and I went from Morocco to… well, it was supposed to be Ivory Coast, but the journey ended in Mali, with an emergency medical evac for a selection of noxious tummy bugs that left me incapable of meeting our flight out of the Ivory Coast.

This was in the days before mobile phones, or internet. Or, at least in Mali, helicopters. My emergency medical evacuation began with an oxcart, descended to a donkey up the cliffs, then ascended the transportation evolutionary scale to a motorbike – the vehicle that got us to the nearest phone – a car, an ambulance, and, finally, a plane.

I AM surprised how cool Zac’s dad is – even by Brisbanian standards, he’s laidback, but STILL… – particularly once he’s established that Zac thought the horse riding adventure was worth it.

He floats the idea of meeting us in Hong Kong. It’s one hell of an easier (and cheaper) flight from Oz than Europe, where we are headed next, and he’s probably got a place to stay. That will need to wait, of course, until we’ve established whether we’re headed to Hong Kong or Seoul.

Now I need to go to war?! Apparently so. I gird my loins, and Skype call OneAssist. “Our medical team are looking at all the options…” the girl begins.

Anywise. My next port of call is poor OneAssist, our travel insurer’s emergency assistance company. They’re looking at scheduled flights to either Hong Kong or Seoul.

Fair ’nuff. I rather fancy Seoul, in fact. So does Zac. Ever since he watched and read Cloud Atlas, he’s had Seoul on the brain. Neither of us have been, it’s an easy flight from Oz and… Well, Seoul really sounds rather more exciting than Hong Kong, which we’ve visited a couple of times before.

I wander through to Shirley’s office, grab one of her excellent coffees and update her.

“He can’t fly scheduled,” she says.

“WHAT?” I say. “But when I got evac-ed from Mali they just laid me down across some seats.”

“Most airlines won’t take stretchers now,” she says. “And it can take ten days or a week to get clearance for stretcher transport. Zac’s arm can’t wait that long, and he can’t fly four hours sitting upright, let alone clear passport control, even with a wheelchair. I’m putting together prices for an air ambulance. You need to lean on them.”

Oh. I’d rather thought that everything was out of my hands now, and I could start wellying through the 500-odd emails that have accumulated over the last couple of weeks, and, ya know, actually make some money.

Now I need to go to war?!

Apparently so.

I gird my loins, and Skype call OneAssist. “Our medical team are looking at all the options…” the girl begins.

“That’s not good enough,” I say. “The medical director at the best clinic in Mongolia has recommended evacuation as an emergency. Zac can’t fly scheduled.”

By the end of the call, I am under the impression that when I call them back at 6pm, there’ll be an air ambulance with crew and flight plan in place.

As someone who can be reduced to a gibbering idiot by a couple of deadlines, I have no idea how everyone involved in this logistical clusterfuck stays so calm. Well, Zac’s calm, obv. He gets it from his father.

The day passes pleasantly enough – I honestly can’t speak highly enough of the staff at SOS Medica. If you’re going to be stuck in Ulaanbaatar waiting on an air ambulance, I couldn’t think of a better place to be. They’re all so lovely, it’s like a bleeding rest cure.

“You just need to keep chasing,” says Shirley, repeatedly. “You need to lean on them.”

I have no idea what she’s on about. There’s an air ambulance available in reasonable flying time from here tomorrow, apparently, and 6pm is the deadline to confirm we need it. Why would they not take that air ambulance? It’s in Beijing. That’s no distance, relatively, and the next available one is currently in Shanghai, which is MUCH further.

For, believe you me, it’s a hell of a lot more complicated getting someone on an air ambulance than a land ambulance.

There need to be pilots and a plane in a feasible place – the travel insurance underwriters have to pay for the plane’s journey into Mongolia as well as out of Mongolia – as well as qualified medical escorts, who’ll often need to fly in to meet the plane.

Both pilots and escorts need the relevant clearances and visas for the countries they’re starting in and the ones they’re going through. And, given the direction we’re headed in, we’re going to need to clear a flight plan coming in and out through either Chinese or Russian airspace. All of which needs to be signed off by the faceless folk at our travel insurance underwriters.

As someone who can be reduced to a gibbering idiot by a couple of deadlines, I have no idea how everyone involved in this logistical clusterfuck stays so calm. Well, Zac’s calm, obv. He gets it from his father.

My mother was a headmistress, and I, too, am an Olympic-grade yeller. I shout at her louder than I have ever shouted at anyone other than my child. “Don’t talk to ME about neurovascular damage,” I bellow.

6pm rolls around. I ring OneAssist. Perhaps unsurprisingly, given the air ambulance will cost our insurers some way north of $100,000, their medical team are STILL considering all the options, including scheduled.

“But he can’t fly sitting up!” I wail. “And Shirley says it’ll take at least a week to get permissions for a scheduled flight, and his arm can’t wait that long.”

“Are you happy with the care Zachary’s receiving?”

“Well, yes,” I say, and wander through to Shirley’s office, feeling in my water that it might be time we were all aligned, as they say in corpspeak. “Except we’re now more than 50 hours out from injury and the only treatment Zac’s had for his broken arm is painkillers and a splint.”

“Our medical team are concerned about the possibility of neurovascular damage for Zachary,” she begins, fake-caringly. “If we can reduce his shoulder in Ulaanbaatar…”

At this, I lose the plot. My mother was a headmistress, and I, too, am an Olympic-grade yeller. I shout at her louder than I have ever shouted at anyone other than my child.

“Don’t talk to ME about neurovascular damage,” I bellow. “We’re almost 60 hours out from injury and there’s no transportation in place. NOTHING. Any delays in treatment are coming from your underwriters, and if YOUR medical team are talking about neurovascular damage while ignoring the advice of the medical director of the best clinic in Mongolia, a doctor who has actually EXAMINED him, I WILL hold you liable if that develops…”

Shirley and Doctor Nicolas nod approvingly as blood spirals lazily in the metaphorical water.

“There IS no neurovascular damage,” says Doctor Nicolas, after the call has reached its gory conclusion. “We’re checking every few hours.”

“Yeah,” I say. “I know that. Fuckers.”

I ring poor OneAssist again, and get confirmation that someone will call me back by midnight with concrete answers to the questions-that-no-sane-person-would-ever-answer-but-will-help-me-get-what-I-want.

I pop out for a calming fag, then follow up with a carefully crafted email headlined “Zachary Sutcliffe – Neurovascular Damage” using terms like “concerned” and including a series of the sort of questions that no one wants to answer in any format that could be held up in a court of law, EVAH.

Then I ring the British consulate’s out-of-hours number for the nth time. (I’ve been using them as an alternative to an international phone card, which apparently you’re not supposed to do, but, hey, how often does a child break his arm horse riding in Mongolia?)

I have a lovely chat with a chick who thinks that’s just how insurers are and that they’ll probably come round, but, yes, since I’m thinking about it, a chat with a lawyer could do no harm, and, hell, no, she’s been stationed in Mongolia, and painkillers and splinting is the absolute limit for medical treatment there.

Then I Google and Skype call until I find a no-win/no-fee travel insurance litigation guy in the UK. I establish how fast he can move, what down-payment he requires and who to contact outside UK working hours just so that I’ve got all my bases covered and a nuclear-level threat if the underwriters either insist on scheduled or pull their ex gratia cover, a possibility that is causing me quite heart-pounding anxiety.

Then I ring poor OneAssist again, and get confirmation that someone will call me back by midnight with concrete answers to the questions-that-no-sane-person-would-ever-answer-but-will-help-me-get-what-I-want.

“I sent you an email,” I hiss. Even to myself I sound like a cross between Sauron, Gollum and Voldemort when he’s just starting to materialise at the end of the Philosopher’s Stone.

On the dot of midnight, I call OneAssist, and am handed straight through to the duty officer. I may be wrong on this, but I picture our case number coming up on their phone system with a large flashing red alert reading “Psycho, please escalate to a manager immediately. Preferably Sally. She’s good with her.”

“I sent you an email,” I hiss. Even to myself I sound like a cross between Sauron, Gollum and Voldemort when he’s just starting to materialise at the end of Harry Potter and the Philosopher’s Stone. God only knows what I sound like to her. “I need answers. I need answers NOW.”

“Yes,” says the poor girl. “Sally was about to call you back. The underwriters have agreed to cover the cost of an air ambulance to Hong Kong. The one we’re looking at would arrive around 9pm tomorrow, but that could change. We were hoping to have a solid confirmation for you, that’s why we’re a little late…”

I switch, schizophrenically, from psychotically hissing bitch-from-hell to nice mum who totes understands how difficult your job is, fellow female and comrade in arms! “Thank you!” I say. “That’s brilliant!”

Well, ya know, by the time your travel insurance is funding a helicopter and an air ambulance, they might as well chuck in a professor of surgery too, no?

Over to Sally. Having little to think about but Zac’s arm, I’d got rather hung up on a professor of surgery, and specialist paediatric shoulder surgeon with a list of publications suggestive of minimal family time, who Nicolas had recommended. (Well, ya know, by the time your travel insurance is funding a helicopter and an air ambulance, they might as well chuck in a professor of surgery too, no?)

And so I’m a bit disappointed we’re only getting a doctor. I’m also in compulsive checking mode, so request the surgeon’s CV.

To my amazement, dear Sally agrees to provide this. He’s a Doctor Ian Wong of the Union, Hong Kong, who is not only Cantonese, and therefore possessed of minimum three languages and a brain the size of a planet, but also rather better qualified than anyone Zac could hope to get on the NHS.

I email Zac’s uncle, who lived in Hong Kong.

Yes, it’s a good hospital. The best in Hong Kong. It’s a private emergency hospital where all the CEOs go when the pork and Cognac finally coalesce and their hearts go kaboom over private dining, KTV or a mistress.

Cool! I begin to think about the best places to have a Negroni in Hong Kong, and confirm to Zac’s dad that we’ll be arriving either tomorrow or the day after, and he should go ahead and book flights. It’s all starting to feel rather serendipitous.

“I’ve never known one of these things come in on time,” remarks Doctor Nicolas, sanguinely. “But what if he had HEAD INJURIES?” I say. “Then we just have to ship them to the public trauma hospital and hope they can stabilise them till they’re fit to fly.”

Morning dawns. I pack up our stuff. I don’t even bother to ring OneAssist, because, well, there’s totally an air ambulance arriving at 9pm, right? And I’ve got the loveliest schedule for all the personnel involved (Sally really does know how to handle neurotic, hissing control freaks, god bless her).

By around lunchtime, as we select our options yet again from UB’s finest takeout services and wish the French place actually did lunch, I’m beginning to wonder whether the air ambulance will show.

I talk to Shirley. “You need to keep chasing them,” she reiterates.

I ring OneAssist. The air ambulance has slipped. It’s now coming in tomorrow, and the team should be at the clinic around 11am. Bad weather’s expected over UB tonight, and the pilots don’t want to fly at night.

Bugger!

They send me a new flight plan and evac schedule, which proves pacifying, even though it’s clearly the same schedule with the hours moved forward by 14, and hell, they probably gave it to an intern.

“I’ve never known one of these things come in on time,” remarks Doctor Nicolas, sanguinely.

“But what if he had HEAD INJURIES?” I say.

“Then we just have to ship them to the public trauma hospital and hope they can stabilise them till they’re fit to fly,” says Doctor Nicolas. “We don’t have life support facilities here. No surgeons…”

Jesus.

Public service announcement: when horse riding ANYWHERE wear a helmet. But especially when horse riding in Outer Mongolia. Because if you get serious head injuries in Outer Mongolia, your best outcome is a lifelong disability.

This portion of Zac’s journey from breaking his arm to surgery has cost our travel insurance around $6000 so far, in addition to the $30,000+ they spent on helicopter evac.

Morning rolls around yet again. We’re still in SOS Medica’s emergency room.

I pack up all our stuff, yet again, and make a bundle for Baatar and Ganbaa, and go through it with Shirley, who’ll look after it for me until either Ganbaa or an emissary make it from Khatgal to UB.

I return Bue’s phrasebook to Baatar, and leave Ganbaa the sleeping bags we bought for Everest Base Camp and have been using on the trek on the basis that he can rent them out once he’s washed the sharty feet smell out, plus all my Mongolian tögrög which, at around £320, presumably covers the remainder of what I owe him.

I sign off our bill at SOS Medica. This portion of Zac’s journey from breaking his arm to surgery has cost our travel insurance around $6000 so far, in addition to the $30,000+ they spent on helicopter evac.

A call from Sally at OneAssist. The air ambulance is running late.

“Held up at the airport, probably,” says Doctor Nicolas.

“What?” I say. “But I thought you’d go through fast on an air ambulance.”

“No,” he says. “They get held up all the time. It takes longer to clear customs on an air ambulance than it does as a private citizen.”

The medical escort will arrive at 11am… At 12.30pm… At 2pm…

Zac has an unusually high pain threshold. I’m the only person I’ve come across who ended up with a natural childbirth because I didn’t ask for the epidural soon enough because I was waiting until it got painful.

Around 1.30pm, the guys shoot Zac full of Stemetil, an anti-emetic, against the painkillers he’ll be shot up with for the flight.

At 2.15pm, Doctor Rama, Zac’s medical escort, arrives at the clinic, and looks disapprovingly at my spawn, who’s gaming with his good arm, sunny as a daisy, freshly washed, off all pain relief and generally not looking remotely in need of emergency medical evacuation.

Zac, I should add, has an unusually high pain threshold. I’m the only person I’ve come across who ended up with a natural childbirth because I didn’t ask for the epidural soon enough since I was waiting until it got painful (despite having “every drug I want when I ask for it and an epidural asap” as my entire birth plan); Zac’s father, as a toddler, was found cutting himself with a Stanley knife and inspecting the pretty red patterns with amiable curiosity.

“Is this the patient?” Doctor Rama enquires, sceptically.

We load Zac onto a gurney, make our farewells to the lovely folk, clamber back into the ambulance, and head to the airport. More than four days after Zac broke his arm, he’s finally on his way to someone who can fix it. On a private jet, no less!

I’m gunning for a LearJet.

I’ve made precisely two claims for travel insurance over a lifetime of travelling with insurance. Both were for emergency medical evacuation, and both cost substantially more than I could have funded myself. If you’re planning travel, and ESPECIALLY if you’re travelling already, you might want to check out World Nomads: they’re one of fairly few providers that will cover you after you’ve left your country of origin.