MoH spends over Nu 2B for the evacuations 

Younten Tshedup 

In the past five years, 646 patients, mostly from the remote parts of the country, were airlifted to the national referral hospital with the helicopters evacuating an average of 11 individuals every month.

Of that, 129 succumbed to their injuries and illnesses, the most recent casualty being a young man fatally hit by an arrow on the head in Chukha.

Helicopter service for patient evacuation was introduced in November 2015 and since the start, the initiative has helped to save lives and minimise the challenges of distance, terrain, and crucial time for the most critical patients.

The most common emergency cases that have been airlifted so far were paediatric cases followed by trauma surgery emergencies and obstetric gynaecological cases.

A group of teams from the health ministry and the Royal Bhutan Helicopter Service Ltd (RBHSL) called the Bhutan Emergency Aeromedical Retrieval (BEAR) team carry out the evacuation.

The BEAR team, emergency physicians and nurses from the national referral hospital working with the pilots, was formed in June 2017 to evacuate critical patients. It has grown from a three-member group to a vibrant 16-member team today. 

Air evacuation is one of the most expensive services that the health ministry provides today. The ministry has so far spent more than Nu 2 billion (B) for air evacuation since operations began.

Chief programme officer with the ministry’s emergency medical services division, Kinley Dorji, said that every evacuation (per hour) costs Nu 150,000. For a single evacuation, on average it takes about two hours depending on the weather condition.

He said that on average 129 patients were airlifted from various parts of the country every year between 2015 and last year. However, the cases dropped drastically to about 36 cases until November this year. Although unconfirmed, officials said that the pandemic could have played a role, as movements were restricted thereby, avoiding cases like accidents.  

Kinley Dorji said that an emergency physician on duty decides if a patient requires helicopter service or not based on his or her medical conditions. “There is a wrong notion that the service is provided only to those with higher social status and better connections.”

As per the guidelines for the use of helicopters for medical emergencies, patients falling under the criteria such as severe trauma, surgical, paediatric, obstetric gynaecological, and medical emergencies including other life-threatening medical conditions as decided by health professionals, could avail the helicopter service.

“The air evacuation service has come at a right time whereby we could save many lives through timely interventions,” he said. “However, there are many limitations such as weather and the loading capacity.”

Since the helicopters are not air ambulances, Kinley Dorji said that only a limited number of health staff and equipment were allowed to fly. He added that there were fewer evacuations in summer due to bad weather.

“With the number of emergency cases increasing, Bhutan, in the long run, needs a fully equipped air ambulance to provide better services,” he said.

Kinley Dorji said that precious time was wasted in picking the team from Thimphu after the helicopter left from Paro. “We are in the process to build a BEAR team in Paro so that we can effectively deliver our services.”

The BEAR team responds to any life-threatening emergencies in collaboration with the Health Help Centre 112.

The idea of forming the team took shape in the fall of 2016 when a 14-year-old boy from Trashigang died after falling from a roof. The boy died after his lungs collapsed although he was brought to the national referral hospital.