Medical Evacuation Information for Mozambique and Zanzibar Mocambique: Note that Ponto do Ouro and Nacala don t have any customs available. Although it is possible to land a small aircraft at Ponto do Ouro you will have to clear customs in Maputo which will add to the flight time back to South Africa. Another option would be to drive to Manguzi Hospital and /or continue after stabilization to Hluhluwe from there the patient can be airlifted evacuated. Helicopter evacuations are not always practical or possible, they have limited range and it is impossible to state before hand whether or not a helicopter can be used as the primary means of evacuation. Inhambane has custom officers on call that are not always available. Whan the officers are available, they are not always reliable and very difficult to contact. Although it is not impossible to arrange evacuation from the Inhambane airport it s not possible to land an aircraft at night on the runway. It s possible to pick up a patient at Inhambane airport without clearing customs but the pilot will have to stop at the airport in Maputo and clear customs before entering South Africa. Nacala has the same problems as Inhamane except there you will need military clearance which can cause extensive delays. Tanzania & Zanzibar: It s possible to evacuate a patient from Tanzania but there will be an extended flight time back to South Africa. Although the airports in Dar Es Salaam and Zanzibar are in good condition you should always keep in mind that the rest of the country s infrastructure is still developing. Therefore it might be possible to evacuate a patient but the challenges of getting a patient to the airport should also be considered. The following evacuation options are available for Ponta do Ouro / Malongane:
Closest Clinic: Clinique Ponta do Ouro Brittle Star (Sandy can assist with arrangements and treatment and is also a nurse) Can initiate initial treatment and stabilisation, and treat minor injuries Closest Hospital: Manguzi Hospital, South Africa You need to cross over the border into SA, and self drive takes about 1h30 in total to get to the hospital The doctors there recently underwent training for dive related injuries with Dr Cronje earlier this year. They can manage initial treatment and stabilise patients Closest Hospital for higher care/surgery: The Bay Hospital, Richards Bay Will take 3hrs to reach from Manguzi by road ambulance or driving (Excluding the time it takes for an ambulance to reach Manguzi to collect the patient) Closest Chamber for HBO/Recompression: Sea level: Durban 500kms one way it will take about 6hrs drive in an ambulance Excluding time to reach and collect patient Only for patients requiring chamber recompression, or suspected to require HBO treatment Closest ambulance: You need to consider self driving to the facilities to save time as remote location Maputo, Mozambique: 5hours one way to arrive on scene, depends on road conditions Empangeni, SA: 4hrs one way to border post Cannot cross over into Mozambique, they can wait for patient at the border and meet patient there Excluding transport time to facility
Richards Bay, SA: 4hrs one way to border post Cannot cross over into Mozambique, they can wait for patient at the border and meet patient there Excluding transport time to facility Flights: Fixed wing flights: The flight service used depends largely on availability of the provider at the time of the incident, where the patient is being referred to for treatment (dependant on condition and injury), and flying times. There are flight services we can use are based in Durban or Johannesburg, or Maputo. Flight availability is limited to airport runway conditions, re-fuelling capability, customs officials, and airport closure times. Arrangements can be made in emergencies to keep airports open after hours, however is dependant on approval by the airport official and will only be know at the time of the incident, as well as if there are runway lights available after dark. A latest activation time is by 13h00 during the day if the flight is to reach the patient the same day. Time delays to expect: 2hrs activation time for any fixed wing flight (to file flight plans and obtain the necessary air clearances) Flying time to reach site of pick up and 2 nd leg to drop off point at medical facility (depends on aircraft type and capacity) Maputo: Flying times 2hr activation time 1hr to Ponta do Ouro to collect patient, then 1hr to clear customs in Maputo (no customs in Ponta do Ouro), Maputo is open 24hrs a day then 1h30hrs to reach Durban Total = 3h30 flying excl. activation Aircraft adequate to land on Ponta do Ouro runway conditions
Johannesburg: 2hr activation time 1hr to Maputo to clear customs 45min to Ponta do Ouro to collect patient, then 45min to clear customs in Maputo (no customs in Ponta do Ouro), Maputo is open 24hrs a day then 1h30 to reach Durban Total = 4hrs flying excl. activation Durban: 2hr activation time 1hr to Manguzi to collect patient, then 1hr to Durban to drop off patient Total 2hrs flying excl. activation This service has a Pilates that can land at Manguzi runway Airports: Ponta do Ouro: Airport hours: daylight hours only sunrise to sunset No customs officials are available, all flights need to route via Maputo Tar runway unconfirmed condition 750m long runway is too short for jet aircraft land on we cannot land there unless. A King Air aircraft is available to use, and that is not guaranteed. Manguzi: Airport hours: daylight hours only sunrise to sunset No customs officials are available Grass runway with no lights Jet aircraft cannot land on grass, we cannot land there unless. A King Air aircraft or Pilates is available to use, and that is not guaranteed. Rotor wing flights: Patients that are considered for heli flights, need to fit within certain medical criteria, normally these patients need to be intubated, ventilated, unconscious or sedated. Conscious sitting patients and accompanying family are not permitted, due to space
limitations. Certain medical conditions could be worsened by flying in a heli due to the rotor wash effects, anxiety of a patient and if the patient is claustrophobic, and air sickness. A patient needs to be haemo-dynamically stable, as if a patient worsens in the heli, and goes into cardiac arrest, there is no space to initiate CPR and the heli will need to make an emergency landing. A patient cannot sit up in a heli, and might only visible from the chest up depending on the heli design; most stretchers are in the tail of the heli. Maputo Military Heli s from Maputo may assist on occasions, however this is not guaranteed, and needs to be investigated at the time of incident. Richards Bay 1h05min flying time to Manguzi to collect the patient, then 1h05min flying time to Richards Bay where the heli will need to re-fuel The heli has a maximum fuel capacity for a 2hr flight. Then a further 1h45min flying from Richards bay to Durban Service is daylight operations only as heli is single engine, and flights need to be activated before 14h00-15h00 to adhere to CAA regulations. Largely the injured party will be reliant on your first aid skills. You will need to medically manage the condition/injury and the DAN Hotline doctor on call will advise on how to assist the patient with medical advice, and the Hotline will make all the necessary flight arrangements and stay in contact with you to co-ordinate the evacuation. You will need to get the patient to the airport to meet the flight by your own means, unless an ambulance is available in the immediate area at the time. You can call the DAN Hotline on: +27 10 209 8112 For all Diving related queries in terms of: General medical advice Fitness to dive queries Emergencies / Evacuations Diver presents with any symptoms post dive
Advice on DCI and related management The DAN service is available to the general diving public and any DAN members. If a diver is not a member you can still call the DAN Hotline on their behalf. DAN will assist where possible, and where non-members will still receive the service and advice, they won t have cover through DAN and will need to note that any service providers used will be for their own account or any other travel insurance they might have. Active DAN members will receive the benefits of cover as approved by the DAN Doctor on call and the services, as per policy rules. I hope the information is useful to you and you can incorporate it into your emergency plans. These are only evacuation options, and play a small role in your emergency plan; you need to think of how to manage the patient before any medical service arrives on scene, and what time it will take to get the patient to the closest airstrip in terms of driving EMERGENCY FIRST AID FOR INJURED DIVERS CALL DAN 24-HOUR HOTLINE 0800 020 111 (RSA) +27 10 209 8112 (INTERNATIONALLY) or +27 828 10 60 10 Assess: Airway, Breathing, Circulation 1. Place diver in left lateral (recovery) position & keep warm 2. 100% O2: Breathing patient via demand valve or non-rebreather mask @15Lpm. Non-breathing patient administer artificial respiration using a pocket mask @15Lpm. Call DAN: 0800 020111 or +27 10 209 8112 (INTERNATIONALLY) or +27 828 10 60 10 3. Check consciousness, memory, muscle strength, skin sensation, balance and coordination 4. Give conscious divers non-alcoholic, non-caffeinated liquids 5. If trained give 1000 ml Saline / Ringers Lactate over 60 minutes 6. Record all data: Diver s Name; ID & DAN Membership No (if applicable)
Location of the emergency Events leading to the diving emergency Signs & Symptoms plus onset times Treatment given Dive Profiles 7. Keep diver s gear intact; turn air off; send gear with diver 8. Ensure no other divers are missing or injured Please Note: Although DAN offers free, 24-hour advice and assistance to all divers, evacuation and treatment are provided by regional private companies who require a guarantee of payment for their services by means of validated emergency medical insurance or a financial guarantee from the injured diver or their next of Kin. DAN members automatically enjoy full cover for evacuation and treatment of diving related medical emergencies as well as medical evacuation for non-diving-related medical emergencies while away from home. This saves valuable time in an emergency. For peace of mind, join DAN today: International admin numbers: - Telephone +27 11 312 0512 - Fax +27 11 312 0054 mail@dansa.org www.dansa.org If a scuba diver presents with unusual signs and symptoms, call DIVERS ALERT NETWORK (DAN): Inside SA 0800 020 111 or +27 10 209 8112 (INTERNATIONALLY) or +27 828 10 60 10