UKC

Hi, I'm sorry if this is not the best forum for this, but I'm sure that climbers have found themselves broken, uninsured and needing repatriation before. I'm after some advice for my sister who has broken both of her legs in the Canaries without insurance. I don't know all the details, but this is the outline.

She doesn't have insurance. She's been told she needs to go back to the UK for surgery, so that needs to happen ASAP. The only option that we've found involves chartering an air ambulance to fly her all the way to the UK for £37 000. This includes a doctor on the flight, which we believe is unnecessary and we're also not sure it's not a scam. I think she's been told by the hospital that she's "fit" to fly, so I think what she really needs is a stretcher onto and off some kind of a commercial flight covered in cast which appears to be possible, we're just not seeming to be able to make it happen. 

Many thanks for anything relevant.

In reply to Cake:

Does the card that replaced the EHIC not entitle to her to the surgery over there? My partner recently thought she was in labour in Spain and they said she was entitled to the same care as a local person and could have the baby there. She wasn’t in the end. 
 

edit: you can even get one temp issued if she doesn’t have one: https://www.nhsbsa.nhs.uk/get-healthcare-cover-travelling-abroad/get-tempor...

In reply to Cake:

My experience of repatriations with single lower limb injuries (arranged by the insurance company) is that they:

- book 3 seats on the flight so you can sit along the length

- book assistance at the airport to get you on & off the flight

- arrange transport to and from the airport at both ends

I would suggest that she has someone to accompany her (friend/family) even if that increases the costs, because it's quite stressful being a lone traveller in a wheelchair in a foreign airport.

Given that she's bust both legs, she won't be able to use crutches so will need a wheelchair with two elevated leg rests and will need extra assistance onto the seats. That may be why the repatriation company is talking about an air ambulance (so she can just be on a stretcher the whole way rather than manoeuvring around).  It's probably worth buying one at the outset and using it for her whole recovery process.

I have absolutely no connection to them, but this company came up on a web search and their website seems to be sensible, with mention of various options for repatriation. Probably worth a phone call to them.  https://www.medical-repatriation.uk/

Good luck!

In reply to Cake:

If she's been deemed 'fit to fly' you can just book a normal commercial flight. Make sure you have a note from the doctor stating so, and contact details for hospital and doctor as the airport/airline will want to phone to confirm.

One caveat, for this to be viable, she must be able to sit normally for take off and landing. Otherwise you are now looking at medical flights so as to have a stretcher on board.

Possible workaround could be booking business class or something with a big reclining sofa bed type thing, which can be put upright for take off and landing, and reclined back for the flight itself.

You'll need to provide a wheelchair to get her to the airport at least. In the airport they will provide assistance in the form of a wheelchair if needed and a porter-type person to wheel her around, including as a bonus fast track through customs/border control via a back corridor. This is free of charge but it's advisable to notify in advance. (often a tickbox when buying ticket that says 'need assistance', but phoning a bit before also advised. When i needed it i just rocked up to the airport and was fine as well).

If she must have the legs elevated, she might have to book a full row of seats. If winging it and not booking it saying "i'll be fine" chances are they will make their best efforts to provide them anyway, but it's a risky move.

Good luck, that situation really sucks

In reply to Cake:

Have you contacted the British consulate in Santa Cruz, Tenerife?

https://www.gov.uk/world/organisations/british-consulate-santa-cruz-de-tene...

I've no experience of them but this kind of situation must crop up a lot over there. Good luck!

In reply to Lankyman:

Consulates don't help with repatriations

Medical repatriation or evacuation

If you are ill abroad, you may need to return home:

while still receiving care (medical repatriation)

because specialist care isn’t available locally (medical evacuation or medevac)

Your insurance company should arrange your medical repatriation or evacuation. If your insurance does not cover this, you’ll have to arrange and pay for it yourself. You can check the list of medical repatriation companies to get the support you need.

The British embassy or consulate cannot arrange medical repatriation or pay for it.

If you are returning to the UK on a scheduled flight, you may need to provide the airline with advance confirmation from your treating doctors that you are fit to fly.

https://www.gov.uk/guidance/in-hospital-abroad?utm_source=Hospital&utm_...

In reply to Lankyman:

That's a great point, thank you.

In reply to Mr Lopez:

This is very useful, thanks. I think she will need a stretcher/special wheelchair onto the plane so I don't think the three seats arrangement will work. 

In reply to snoop6060:

Yes, I'm sure she is entitled to the same treatment as a Spaniard. Of course, she would still  need both legs in a special wheelchair for weeks afterwards, I suppose

In reply to Cake:

It'd be highly dependant on the 'details'. If she's got casts below the knees or similar she'd get away with it if going for the business class option, which might even be cheaper than 3 standard seats. Full leg immobilisation or similar then yes, totally different ball of game unfortunately.

Given the plane does not have to be medically equipped, a private jet share could be a viable option and a lot cheaper even when booking for 2 people or even 3 ro provide assistance. Something like this https://www.londonjetcharter.com/jet-sharing/ 

I believe most of these companies are brokers, so they should be able to advise or tailor for the needs

In reply to Cake:

Sorry to hear about your sister. With a much less serious injury the insurance company I had considered a repatriation flight (+ doctor - I think that's the norm). I actually got my scheduled return flight home (I could sit in a normal seat and the flight was short) but the airline very nearly didn't let me on even though I had a fit to fly note. It's up to the airline. I'd be very wary of thinking the note will get your sister on the plane given she has much more serious injuries. Definitely check in advance.  When I got back the NHS were horrified they'd let me fly.... Got away with it (thrombosis was the concern).  

In reply to Cake:

I flew to Prague last week. The person in front of me (they had a second row seat) only had use of one arm, to the extent that they had to have a chest strap to hold them in the seat. His friend next to him helped him with stuff, he had a carer who sat a long way back, and a second friend in the same row plus two porters who helped him from his wheelchair into the seat.  It all seemed routine.
However, if her legs don’t bend I can see that being a lot more difficult to accommodate in a regular aircraft

In reply to Cake:

Hi Cake, I've no relevant advice to offer, but reading the threads, it occurred to me that a doctor's 'fit to fly' note may not work with the airline. I could imagine that the doctor says that yes, she can fly in her condition ie her lungs/heart etc are up to it, but the airline may still say 'no' as in the event of an evacuation from the plane, your sister may prove unable to do so. So perhaps a phone call to the airline before arrival at the airport? 

Hope everything works out well for her.

In reply to hang_about:

The doctor discharging/clearing for travel to the UK is the one making the call on that, as he/she's the one with the relevant info.

In my case, i was given a load of Heparin pens and directions for use.

Funnily enough, it was the NHS people when i made it here that told me not to bother with the injections. "We do things differently here" was their response when i mentioned how much emphasis the discharging Doctor put in how important it was that i used the pens religiously at the given intervals.

In reply to Cake:

In most circumstances advice to an injured Brit that they need to return to the UK for treatment is probably helpful. It makes the flight medically necessary and helps to justify an insurance claim.  Obviously that doesn't help your sister.

However she should be entitled to the same treatment as a local. Presumably the hospital wouldn't advise a local to go to the UK for treatment, and Spain has good hospitals.  If that particular hospital cannot treat an injury of this nature, where would they send a local? If that were to mean evacuation to the Spanish mainland, would the health service pay for that?

The consulate won't help with repatriation, but they might he able to help her gain access to the appropriate local health care.

In reply to Cake:

Hi. I’m sorry to hear about your sister’s situation.  I broke my lower leg in Kalymnos last Oct, thankfully I had travel insurance.  
Although the break was to the tib&fib (lower leg) the splint was full leg length to keep it stable and thus the knee could not be bent.  Sitting was not possible and transportation was by wheeled stretcher, not wheelchair.  My understanding is that this precluded repatriation on scheduled flights.  
The insurance company flew me home to the UK for surgery.  They used a medical repatriation flight with doctor on it.  Given my considerable discomfort, inability to sit, trauma and need for pain relief I was glad of it.  I had a ‘fit to fly’ certificate from the hospital and my understanding is that this did not necessarily mean I was ‘fit to fly’ on a commercial flight, it is simply a doctor’s assessment that my condition allowed me to fly in a pressurised airliner for the required number of hours.  I was told that I couldn’t go on a commercial flight as I couldn’t sit and couldn’t walk to get to a toilet     
Given this recent experience I would be very surprised if a standard commercial flight would take your sister with 2 broken legs (presumably with full length splints).  It may well be that a medical repatriation flight is the only option if surgery cannot take place over there.  
I’m not an expert, just quoting recent experience.  All the best and hoping you (and her) get a successful outcome, both logistical and medical.  

In reply to Neil McA:

Thanks Neil. 

So a flight was chartered just for you, is that correct? A repatriation company has advised us that a few air lines (eg Lufthansa) will take a stretcher on board, but whether any of these companies go to Fuerteventura is a different matter! If we take this option, then they will get her out with a medical professional on board. 

On the other hand, I suppose that getting the treatment in the Canaries will mean that she is still in full-leg casts for weeks, needing similar requirements for travel.

In reply to Mr Lopez:

That was my experience.  I was very very sick in India with little money and no insurance. I am British. I went to the UK embassy in Delhi and asked for help. They were TOTALLY unsympathetic and said "We can send your family a request for money. Hope they send you some". Their attitude was so uncaring and unhelpful, honestly they couldn't have cared less. Put me right off.

In reply to Cake:

The reasons for the return to the UK for surgery could be that they're not equipped to do the surgery on island and would send locals to Spain. They're probably not advising this for your sister as 2 extra hours on a flight and you're back in the UK is a better option for everyone (apart from a bank balance)

Medical flights are mentally expensive as you're finding out. They have to ensure the aircraft is fit for the patient, have a suitability qualified doctor, all the medical equipment and medicine. Then they will need to return the aircraft and people to their home location. This adds up really quickly and I know I've missed off a lot from this list.

A fit to fly just means they are medically stable - there is no apparent reason that she'll need immediate medical assistance. It doesn't mean she can jump on an easyJet flight home.

Speak to all the airlines that fly to there and explain the situation to them before booking a flight. If one is happy for you to book, brilliant, but understand that the captain of the flight will have the final say if she is allowed on the flight.

Otherwise is a charted medical flight.

Travel insurance is expensive, no travel insurance is more expensive.

In reply to Howard J:

You aren't covered for non-urgent care that can be delayed until you return to your home country, the lady has been signed off as medically fit to travel so end of story.

In reply to Cake:   Yes it was a dedicated medical repatriation flight just for me    A very small Learjet with 2 pilots and 2 medics   This is standard practice, there are loads of them constantly on action repatriating injured people for insurance companies   I think your assumption is probably correct in that you will either need to use one of these and have the surgery in the uk (preferable in my view) or somehow have the surgery over there but then be left with the situation of a long stay there or a repatriation flight post surgery   Again I’m not an expert but that is how I would assess the situation   

In reply to Cake:

I broke my leg in France in 2016. I came back on a standard flight occupying a 3 seat row on my own. When i reached UK a normal ambulance met me at Arrivals with a wheelchair and took me home. 

I had insurance but i guess the company saved money by using an NHS conveyance for the last 120 miles rather than a private ambulance. I felt bad tying up an ambulance but it was out of my hands. 

In reply to Cake:

A few years ago I was climbing with some young British lads in Siurana. One of them broke both ankles and was in a similar clusterschnitzl. The local hospital set both his ankles in plaster for a minimal fee, he caught his flight back home the next day and went direct to NHS central to get the casts cut off and the damage fixed. He got a helping hand to get into the car to the airport from friends and at the other end the airline was able to wheelchair him to the plane... I guess he got help from friends or staff to get into his seat. Then same thing at the other end. I don't think there was any extra cost involved. Airlines are set up to wheel around elderly people, fat people, disabled people, etc.

If the lady in question can fit in a normal seat with legs in casts (or maybe pay for an extra legroom upgrade and try and get the seat with the max possible space), this might be your best bet. But it might also depend on how bad the damage is - if it's too bad to risk this kind of thing you are going to be stuck with big expenses. Only a doctor who has examined her is going to be able to offer an informed view on the chances of bone fragments starting an arterial bleed or any other number of life-threatening horrors that could happen mid-flight.

If you do decide to chance it, I strongly recommend against giving the airline any information about risky complications. A simple "got my leg in plaster, all sorted by the doctors, but need to get home, plz extra legroom seat and wheelchair at airport" explanation is the best policy - if they start to think her body might be in danger of causing an emergency destination change mid-flight, I would imagine they'd refuse to carry her.

Edit: Oh, missed the bit about doctor saying she is fit to fly. That's good news and should make it all easier.

In reply to Cake:

Thank you everyone, 

All your replies have been useful. As things stand, we are waiting to hear back just one repatriation company as to whether she could get in a standard flight. All the others have said it won't work. I think she would not be able to sit in a normal seat, so it is the stretcher, and airlines which cater for that, which is the problem. 

So, we're likely back to the air ambulance, but will know today.

They could still do that if she turned up at the gate unannounced.

In reply to Neil McA:

Who was your insurance with out of interest? Sounds like they looked after you. 

In reply to snoop6060:

As the accident was falling off a scooter rather than claim on my climbing insurance I claimed instead on the free travel insurance that comes with my HSBC premier bank account, and yes they were pretty good.  One thing everyone should be aware of is that Greek hospitals only provide medical care. They do not provide personal care, this is supposed to be provided by your family.  Personal care includes drinking water, most food, washing, bed changing, emptying pee bottles, opening curtains etc etc.  Without personal care, and being immobile in bed, life can become pretty grim pretty quickly in hospital!

In reply to Cake:

Of course there's always getting treatment in a private hospital there, might be cheaper? Or of course just returning home overland, private ambulance transport is a thing

In reply to Cake:

Can your sister get surgery in the Canaries? Then 8 weeks recovery in a hotel. That's got to be much cheaper than medical flight home.

In reply to jimtitt:

A ferry to Cadiz followed by private ambulance to Bilbao/Santander then a ferry to the UK may be an option.

In reply to Cake:

I've seen many of the replies here. You are now sitting in the world of aviation, medicine and liability. 

One thing that I suggest you keep uppermost in your mind is that the Captain of the aircraft is the ultimate decision maker as to 'fitness to travel'. You can produce any certificate you like but if he/she says 'no' at the point of boarding, that's it. Booking seats and hoping for the best is (I would suggest) very risky. 

There is advice (on the thread) here for those who have been repatriated with an insurance company (IC)). Your situation is completely different in that the IC is bearing liability, possibly even signing certificates that they would pay in the event of enforced landing in case of emergency. I suspect that you would have to would have to use a  CAA/ EUAA approved medical re-pat operator for the airline to allow the passage.

See here below the CAA guidance on flying with surgery. The cabin is pressurised at 8000 ft and 2 hours looks to be the limit with plaster casts. This is a 4 hour flight. That's (probably) the reason for the doctor on board, swelling in the cast.

https://www.caa.co.uk/passengers-and-public/passenger-guidance/health-guida... 

I wish you luck.

In reply to Cake:

It's looking hopeful that the repatriation agency that we have found will get her on commercial flights on a stretcher, via Brussels and it will cost less then £20k but will involve a paramedic on the flights. The day is not yet set and there are forms that still need to be signed, but it's looking hopeful. It seems that we won't be able to relax until she's actually on as plane. 

My sister is understandably getting anxious the through all this time her bones are setting in the wrong place and will need to be broken again in England, but I think that's what we've got to settle for.

In reply to john arran:

In my world of motorcyle racing moving bashed up guys is kinda normal and when they have extensive damage (especially head injuries) flying often isn't an option, flying in a specialist orthopaedic surgeon to a local clinic is pretty normal (and Spain has some of the best, the guys from the UK go there). Shunting them around Europe by ambulance is usual, they must be moving people from the Canaries to the mainland as routine.

In reply to Cake:

That sounds like possible progress and I hope it works out for you both.  As aostaman says the issue they are always concerned about in a pressurised cabin is swelling within the cast.  I would be surprised if she is in a solid plaster cast.  Mine was a rigid hard plastic back but a soft topping to allow for expansion/swelling.  My fit to fly certificate was issued on the basis that there was no signs of pressure blisters or swelling and that I had this kind of splint on.  I don’t know how long it is now since your sisters accident but I had 9 days from accident to surgery and this did not cause the bones to set incorrectly and need to be broken again.  
mall the best for a successful outcome.  

In reply to snoop6060:

It's the GHIC card and should get you treatment at the same rate as a local.

However, it's possible the island doesn't have the facilities for the surgery she requires.

In reply to jimtitt:

Not so. 

My wife had surgery in France earlier this year for a broken arm. The doctor said she could wait until we returned home, but advised treatment ASAP would be better for healing and more comfortable on the flight, as it would be better stabilized.

We used the GHIC card at a private hosptial we were referred to, no problem - still had to pay some, but was about 1/4 of the bill we saw.

In reply to LastBoyScout:

They have a population of 2.25m and two university hospitals, you'd imagine there isn't a lot they can't do.

In reply to Cake:

That sounds like possible progress and I hope it works out for you both.  As aostaman says the issue they are always concerned about in a pressurised cabin is swelling within the cast.  I would be surprised if she is in a solid plaster cast.  Mine was a rigid hard plastic back but a soft topping to allow for expansion/swelling.  My fit to fly certificate was issued on the basis that there was no signs of pressure blisters or swelling and that I had this kind of splint on.  I don’t know how long it is now since your sisters accident but I had 9 days from accident to surgery and this did not cause the bones to set incorrectly and need to be broken again.  
All the best for a successful outcome.  

In reply to Neil McA:

Similarly impressed and for a freebie policy it's quite comprehensive, covering winter sports, mtb (to a certain level) etc. It also covers the whole family so probably saves us £350 a year.

In reply to Cake:

Book on a cruise ship going back to the UK with a companion/nurse going with her?

In reply to Cake:

Well, the cheapest possibilities have all fallen through and she's going to be an a super expensive air ambulance tomorrow or the next day, after four or five days of her bones healing in the wrong place. Well, we tried. 

Getting treatment there sounds all good, but she'd either have to have a long recovery time there, or she'd still have to get on one of the expensive air ambulances a little later. 

As it is, we've wasted some time and her legs will take longer to heal, but never mind. Hopefully she'll make a great recovery in the end.

In reply to Cake:

I would not be overtly concerned about bones healing in the wrong place, etc. The standard time to surgery is 'up to' 21 days, and often the doctors will wait that long if there's soft tissue damage to let it heal before cutting through it. 

The initial phase of healing for bones is for up to a couple of weeks, and it's just blood clotting, cleaning up the area and getting ready for repairs, that then turns into a jelly like substance that slowly hardens over the following weeks. The 21 days yardstick is at the point that the callous is still jelly enough that bones can be moved around into position if needed without negatively affecting whatever has been happening.

Granted, the timescales for milestones after surgery won't be adjusted to account for the previous healing, so she's still losing some time so to speak, but thought it worth mentioning as the situation is probably stressful enough without having to stress about things you don't ought to stress about.

Best of luck

In reply to Mr Lopez:

Thanks, that's good to learn

In reply to Cake:

If the amount of money involved is not feasible for you all, consider starting a crowdfunder. I'd chuck something in.

Good luck with everything, and best wishes to your sister.

In reply to abcdefg:

Thank you very much. We are fortunate enough to be able to get her back ourselves and she's got to England now.