Repatriations and 28-day mortality of ill and injured travellers: 12 years of experience in a Swiss emergency department
QUESTIONS UNDER STUDY: Many persons are travelling all over the world; the elderly with pre-existing diseases also travel to places with less developed health systems. Reportedly, fewer than 0.5% of all travellers need repatriation. We aimed to analyse and examine people who are injured or ill while abroad, where they travelled to and by what means they were repatriated.
METHODS: Retrospective cross-sectional study with adult patients repatriated to a single level 1 trauma centre in Switzerland (2000–2011).
RESULTS: A total of 372 patients were repatriated, with an increasing trend per year. Of these, 67% were male; the median age was 56 years. Forty-nine percent sustained an injury, and 13% had surgical and 38% medical pathologies. Patients with medical conditions were older than those with injuries or surgical emergencies (p <0.001). Seventy-three percent were repatriated from Europe.
For repatriation from Africa trauma was slightly more frequent (53%, n = 17) than illnesses, whereas for most other countries illnesses and trauma were equally distributed. Injured patients had a median Injury Severity Score of 8. The majority of illnesses involved the nervous system (38%), mainly stroke.
Forty-five percent were repatriated by Swiss Air Ambulance, 26% by ground ambulance, 18% by scheduled flights with or without medical assistance and two patients injured near the Swiss boarder by helicopter. The 28-day mortality was 4%.
CONCLUSIONS: The numbers of travellers repatriated increased from 2000 to 2011. About half were due to illnesses and half due to injuries. The largest group were elderly Swiss nationals repatriated from European countries. As mortality is relatively high, special consideration to this group of patients is warranted.
- WHO.int [homepage on the Internet] World Health Organization: International travel and health. World Health Organization, 2012. [updated 2015; cited 2015 Aug 15]. Available from: http://www.who.int/ith/en/
- Wilde H, Roselieb M, Hanvesakul R, Phaosavasdi S, Pruksapong C. Expatriate clinics and medical evacuation companies are a growth industry worldwide. J Travel Med. 2003;10(6):315–7.
- Kramer W, Domres B, Dürner P, Stockert K. Evaluation of repatriation parameters: an analysis of patient data of the German Air Rescue. Aviat Space Environ Med. 1996;67(9):885–9.
- Patel D, Easmon CJ, Dow C, Snashall DC, Seed PT. Medical repatriation of British diplomats resident overseas. J Travel Med. 2000;7(2):64–9.
- Duchateu FX, Verner L, Cha O, Corder B. Decision criteria of immediate aeromedical evacuation. J Travel Med. 2009;16(6):391–4.
- Rega.ch [homepage on the Internet] Zuerich/Switzerland: Rega, Operations abroad [cited 2015 Aug 15]. Available from: http://www.rega.ch/de/einsatz/einsatz-ausland/einsatzarten.aspx
- Teichman PG, Donchin Y, Kot RJ. International aeromedical evacuation. N Engl J Med. 2007;18;356(3):262–70.
- Committee on Injury Scaling. Association for the advancement of automotive medicine (AAAM). The abbreviated injury scale 2008 revision. Des Plaines, Chicago: AAAM; 2008.
- Schweizerische Herzstiftung, 3th ed. Bern; Oct 2008. German.
- bfs.admin.ch [homepage on the Internet] Bern/Switzerland, Swiss Confederation, Reisen der Schweizer Wohnbevoelkerung [cited 2015 Aug 15]. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/themen/10/04.html
- Hasler RM, Srivastava D, Aghayev E, Keel MJ, Exadaktylos AK, Schnüriger B. First results from a Swiss level I trauma centre participating in the UK Trauma Audit and Research Network (TARN): prospective cohort study. Swiss Med Wkly. 2014;144:w13910
- Ecdc.europa.eu [homepage on the Internet]. Solna/Sweden: European Centre for Disease Prevention and Control (ECDC) [updated 2015 Aug 15; cited 2015 Aug 15]. Available from: ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/map_reports.aspx
- WHO.int [homepage on the Internet] World Health Organization: Guidelines on public health pesticide management policy for the WHO African Region. World Health Organization, 2011. [updated 2011; cited 2015 Aug 15]. Available from: whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf
- Josseaume J1, Verner L, Brady WJ, Duchateau FX. Multidrug-resistant bacteria among patients treated in foreign hospitals: management considerations during medical repatriation. J Travel Med. 2013;20(1):22–8.
- Duchateau FX1, Verner L, Gauss T, Brady WJ. Air medical repatriation: compassionate and palliative care consideration during transport. Air Med J. 2012;31(5):238–41.