Repatriation of Stroke Patient from New Zealand Direct to Acute Inpatient Rehabilitation: Complications of International Transfers via Flight Nursing

Background and/or Objectives: An 82-year-old female with a history of hypertension presented to an acute care hospital (ACH) in New Zealand via boat-to-boat transfer after she developed right-sided weakness, facial droop, and slurred speech while eating dinner on a cruise. She was found to have an acute left thalamic hemorrhage due to hypertension. Neurosurgical intervention was not recommended. Her month-long international hospitalization was complicated by delirium and emotional lability treated with antipsychotic medications. The patient was flown to Chicago with 2 flight nurses. She was given haloperidol and lorazepam to keep her calm. She arrived directly to an inpatient rehabilitation facility (IRF) from the airport. She was somnolent on exam, with a new erythematous, tender right facial swelling. She was found to have acute parotitis, which was treated with IV antibiotics.

Design: Case Report

Setting : Inpatient Rehabilitation Facility

Participants : N/A

Interventions: N/A

Main Outcome Measures: N/A

Results: N/A

Conclusions: Most admissions to inpatient rehabilitation facilities (IRFs) come from acute care hospitals (1), though it is unclear how many patients are admitted internationally through multi-day transport. This patient’s impairments and her participation in therapies made her an appropriate IRF candidate. Flight records, however, were inadequate. The patient was sedated in order to tolerate transport. She developed acute parotitis, which was attributed to dry mouth from haloperidol use (2) and possible trauma during transport. Flight nurses are an important resource to help transport patients to their intended destinations safely. This process is not without potential harm to patients. In this case, the patient developed acute parotitis. Areas of improvement include more complete documentation and a formal handoff to the receiving physician. Though this patient did well with rehabilitation from her stroke, in retrospect, she would have benefitted from an acute care evaluation after international travel prior to her stay at an IRF. Further review of complications from international transport of stroke patients is needed.