On May 31, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu received an emergency call from Samtse. A buffalo had gored a 47-year-old woman’s chest. The village is nine hours walk from the nearest road point. She had to be immediately evacuated.
With poor weather condition, she was evacuated on helicopter the next day with severe respiratory distress and in shock. Her heart rate had dropped. The emergency team and a health assistant resuscitated her and was flown to Thimphu.
She was treated at JDWNRH and went home after a week.
This would not have been possible without the help of a team called Bhutan Emergency Aeromedical Retrieval Team (BEAR), which comprises of three members – Doctor Charlie Haviland Mize, a resuscitation specialist, and two Bhutanese veteran emergency nurses with JDWNRH, Lhab Dorji and Kiran Diyali.
The team BEAR aims to supplement Bhutan’s ability to save lives and deliver cutting-edge resuscitation and critical care to patients in remote parts of Bhutan before ensuring their safe transport to definitive medical care.
The team was founded in May in collaboration with health ministry, JDWNRH and Royal Bhutan Helicopter Services Ltd (RBHSL) with the mission to save lives by providing intensive-care medicine wherever needed. The BEAR responds to any life-threatening emergencies with the Health Help Centre 112 to ensure that it is able to reach the patients in real need.
The idea of BEAR took shape in the fall of 2016 when a 14-year-old boy from Trashigang died after falling from a roof even after the medical team tried to save him. The boy died after his lungs collapsed although he was brought to JDWNRH.
Doctor Charlie said the team was heartbroken because the boy’s death could have been prevented with the right treatment at the right time.
“That was when it struck the three of us ‘what if we could find a means to deliver ICU-level emergency care anywhere in the country within an hour with a helicopter-based emergency/resuscitation team?’” Charlie said. “After months of works and training, the team BEAR was born.”
BEAR provides elite trauma and medical resuscitation to patients and undertake life-saving surgical procedures in BHUs or district hospitals or in an open field besides providing other medical attention.
A flight is staffed with two BEAR members, two resuscitation experts, a pilot-in-command pilot and a co-pilot from RBHSL. The JDWNRH keeps equipment dedicated for the BEAR team, like ventilators designed to use on board helicopter, surgical equipment, anesthetics, monitors for oxygen, carbon dioxide and oximetry, among others.
Team so far has saved 10 Bhutanese through the actions of BEAR since its establishment, Dr Charlie.
“The majority of cases the BEAR attends to are related to trauma, severe injury and its consequences,” he said, adding that the team also responds to severe medical and obstetric cases.
He said that to ensure the sustainability of BEAR, the team is currently training Bhutanese physicians to join the team both academically and physically to ensure their readiness. BEAR will charge the insurance of foreign tourists whenever they require medical evacuation, which would cover the cost to care for five Bhutanese.
To improve emergency services, Bhutan Foundation is in the process of campaigning to support and fund the BEAR by collecting donations from abroad.
Program Director, Tashi Tshering Dukpa, said the funds would be used to buy the different equipment required by the BEAR and to enhance capacity building.
Meanwhile, officials from the emergency medical service division with the health ministry, said that earlier, when the emergency evacuation was performed, a health official would fly with the patient but had to return via road, which was a problem.
“But today it is different. we’ve a team that goes to the spot, treat on board, and fly back,” an official said. “We’re also planning to train a team in Paro so that a team would be ready in Paro to fly directly instead of first flying to Thimphu to collect the team and then go back to the spot.”
The ministry has so far evacuated 193 patients on emergency at the cost of Nu 178,000 per hour for the helicopter.
BEAR recently treated a woman from Zhemgang, who suffered from florid cardiopulmonary failure. The team took ‘high-risk’ anesthesia induction.
Yangchen C Rinzin