Mon, Oct 2, 2017
A cloud of rising smoke could be seen from the helicopter, identifying the location of the accident. Photos courtesy Sanjaya Karki
It's the middle of the day and the Grande International Hospital (GIH) EMS hotline receives a call from a group of travelers who had been out trekking in a remote jungle near Pokhara, Nepal, and had overturned their vehicle.
The GIH-based helicopter EMS (HEMS) air ambulance team is activated. With three sets of jump bags always ready to go, responders go through their checklist as a call back is made to the patient party for additional details: two French citizens were injured after a brake failure overturned their vehicle. Once the team is fully prepared to tackle their condition, responders quickly make their way from the ED on the first floor to the helipad deck on the 14th floor.
The patient is carried to the waiting helicopter for transfer to Grande International Hospital in Kathmandu, Nepal.
The helicopter carries the team toward Tanchowk, a lush forested area located in the Lumle Village Development Committee in the Kaski District, about 5,600 feet (1,700 meters) above sea level and 28 miles (45 km) northwest of Pokhara, where the Annapurna base camp-a popular site for tourists who want to trek in the Himalayas-is located.
The helicopter's pilot, Captain Suraj Thapa from Heli Everest (a private helicopter tour company), is familiar with the area, and rescuers on board are in constant touch with the patients via satellite phone.
After flying for 42 minutes, however, rescuers can't pinpoint the exact location of the patients, who report hearing the helicopter hovering above them, but can't see it. They tell the crew they're waving a red bandana-but rescuers can't see them, either.
Unable to locate the patients after circling above the vicinity of the scene, Thapa lands in the village near Lumle and the team asks for the precise location of Tanchowk.
Rescuers get in touch with the patients via satellite phone and ask them to burn a fire which they hope will reveal the accident site. In a few minutes, the crew sees a cloud of rising smoke signaling the exact location of the injured tourists; however, it's a very difficult place to land the helicopter.
Captain Thapa finds a place to land as close as possible-about a mile (1.5 km) away from the accident site.
The Grande International Hospital ED team, Sanjaya Karki, MD, and Staff Nurse Saru Shrestha, assess the patient and prepare her for transport.
Emergency medicine physician Sanjaya Karki, MD, and staff nurse Saru Shrestha head toward the accident site. Uninjured members of the stranded tourist group help carry their lifesaving equipment and drugs to the scene.
As Karki and Shrestha arrive on scene, they see a 15-year-old boy lying on the ground shivering next to a vehicle that's overturned. He complains of back pain. Nearby, a 51-year-old female reports severe pain over the right scapula and clavicle.
Following protocol, the patient is immobilized, an IV is established, and she's put on a cardiac monitor.
Villagers help carry the patient during the 1.5-hour walk back to helicopter. Despite heavy rain, the crew loads the patient into the helicopter and heads back to Kathmandu.
Before 2013, coordinated prehospital care didn't exist in Nepal, a landlocked country in South Asia that boasts a diverse, often harsh geography, including plains, densely forested hills and some of the tallest mountains in the Himalayas.
Although efforts have progressed in developing a ground ambulance service in the capital and largest city of Kathmandu, it delivers only the most basic emergency care. People living in remote regions of the country and the thousands of trekkers and mountaineers who visit trails and camps in the Himalayas are all vulnerable to preventable deaths that occur due to altitude-related illness or traumatic injuries.
Although private companies do provide air rescue and transport of patients, they do so without the ability to provide medical care.
The EMS team at GIH is changing all of this. They've set up a system of integrated prehospital emergency care built on evidence-based practices, including dispatch, assessment, treatment and communication protocols.
The ED team from Grande International Hospital finally reach the patient after trekking through dense forest.
At GIH, a team of physicians and other healthcare providers are ready to be deployed on helicopters, armed with the right medical equipment for the patient, without any delay.
Private companies continue to operate the helicopters used by the team, and in the future they hope to have a dedicated HEMS aircraft.
Following communication protocol, the ED Department Head, Ajay Singh Thapa, DM, is briefed on the patient's details and the ED staff greets the HEMS crew at the helicopter deck.
In the ED, the patient is fully assessed and treated. A few days later, the patient is discharged and able to head back to France in good health.