On April 8th 2019, a rhinoceros charged into a group of 3 tourists and 2 guides in Chitwan National Park, injuring a young Australian tourist. It quickly became evident that surgery would be needed to deal with the injuries, but the remote location (the national park is located 150km southwest of Kathmandu, capital of Nepal), meant that providing medical care would be tricky.
Luckily, a rapidly evolving HEMS team was able to provide assistance and ensure the effective treatment of those involved.
This is the story, as told by Dr Sanjaya Karki:
The rhinoceros injured an 18-year-old Australian male, biting his right thigh and striking him several times over his chest, abdomen and left leg. One of the guides, a 51-year-old male, intervened and he too was struck on his chest by the agitated rhino.
The rhino fled after the intervention, and the guides called local security personnel and local health workers. The injured were carried to safety inside the forest itself and the wounds were tended to. They called Simrik Air, a helicopter operator active in rescue services in Nepal, to request the evacuation of the injured. In light of the severity of injuries, the operator requested that the helicopter emergency medical service team of Nepal Mediciti Hospital assist with the rescue and provide necessary medical help. Nepal Mediciti Hospital and Simrik Air have collaborated for multiple successful medevac and rescue missions throughout the years.
The craft used for this mission was Bell 407GXP, call sign 9N-ALT, piloted by Captain Siddhartha Jung Gurung.
Soon after the information was collected from the dispatch centre, the medical doctor at the pre-hospital care department started to gather the best possible information from the ground. Within just a few minutes, the message was sent to the respected departments and with all the required equipment and gear, the team went up in the helipad.
The helicopter reached the exact location of the injured 25 minuted later. The team got to work immediately, with onboard medics from the HEMS team of Nepal Mediciti Hospital, Dr Abhijit Adhikary and Paramedic Ekadev Neupane stabilising the patients on-site before bringing them safely back to the hospital. The patients needed splinting of injured limbs, pain management and fluid resuscitation. One patient was placed on a mattress and the next was on a scope, and both patients were fitted with a monitor looking for vital signs throughout the journey.
On arrival at the ER, further lab investigations and imaging were completed. The young Australian tourist was diagnosed with a comminuted fracture of shaft of the right femur with multiple deep lacerations. He was admitted and surgeries were carried out in multiple settings. The Nepalese guide was diagnosed with left-sided minimal hemopneumothorax, and was conservatively managed. Both the patients are recovering well in the hospital.
Collaborations between helicopter operators and Hospitals, like in this instance, have contributed to better patient outcomes in recent years. In Nepal, the first helicopter was introduced in 1964. Today, the HEMS team in Nepal now have more than 10 helicopter operators and over 30 helicopters. These helicopters are an essential part of pre-hospital care in Nepal as many areas are inaccessible via road and the vast majority of the terrain is mountainous or hilly.
Dr Karki stated that the medical evacuation was a “glowing example of how HEMS has advanced in Nepal”.
Sequence of events:
11:31 am – Call received from the Helicopter operator Simrik Air.
11:36 am – Call back made to Simrik Air confirming our preparedness.
12:26 pm – Helicopter landed in Nepal Mediciti Helipad and HEMS team dispatched.
12:50 pm – First contact made with the injured on-site.
13:22 pm – Take off after initial stabilisation, pain management, splinting and fluid resuscitation of the patients.
13:55 pm – Patients brought into the ER.
This incredible tale was highlighted by Dr Sanjaya Karki, former winner of the David Weil Extreme Medicine Award.
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