Before we are allowed to lift off with a patient, we have to make contact with the MD's in our regional office to discuss the patients condition and discuss treatment en-route seeing as they have loads more flying hours than we do. After conference calling with the MD, the patient was transferred to our stretcher the Aggrastet placed on the syringe pump at 17ml/hr with the ECG and Stats connected to the patient. As per my discussion with the MD, the patient was placed on a 60% re-breather mask at 6L/min. Where after we transported the patient to the awaiting air plane.

Upon arrival at the airport, we started packing the King Air  and transferred the patient to the stretcher provided on the plane. We removed the stretcher from the plane, and transferred the patient (weighing +/- 145+ kg’s) to it. With the help of my crew and the Pilot’s we loaded the patient in the plane. While trying to secure the stretcher to the lifeport / Aerosled it was noticed that the left hand bracket at the head of the stretcher was bent and therefore made it impossible to secure the stretcher to the Lifeport / Aerosled. It took me and my crew approximately 10min to convince the maintenance dude that the bracket is bent preventing the stretcher from being secured.

We again removed the stretcher from the plane while the maintenance dude went to fetch another stretcher. It was at this point that I noticed the first stretcher supplied is a normal camping stretcher that has had the brackets welded onto the aluminium bars to enable it to fit the locking mechanisms of the Lifeport / Aerosled. I decided to cover my ass and phoned the my office and explained to them that the stretcher bracket was bent. They again told me that they will phone me back as the MD at the regional office would like to know why the delay in taking off was so long. I explained to the MD what the situation was as well as my thoughts on the stretcher having been “modified” to fit the Lifeport / Aerosled.

Once the maintenance dude arrived with the replacement stretcher. We strapped the patient in and prepared for takeoff. At this point we were approximately 2 hours behind schedule with the patient’s condition remaining unchanged since we started the transport from ICU.

The flight itself remained uneventful with the patients vitals, fluid intake, fluid output as well as pain score being monitored and documented. Approximately 20min prior to landing the patients started de-saturating to 89% while on the oxygen flow and I felt my ears “popping”. At this point I increased the flow of the Oxygen to 10L/min. The pilot told me to “strap in”, after ensuring we were strapped in, they performed an emergency decent and received priority landing authorization from CPT air traffic control.

I noticed the patients PVC’s (Pre-Ventricular Contractions) increased in frequency although still irregular in nature as a result of hypoxia due to the sudden decrease in cabin pressure (3000ft/min according to the Pilot). This made me decide to get my shit sorted and ready the Atropine should it be needed since the increase in PVC’s also resulted in the patients heartbeat slowing to 55b/min. As soon as the plane levelled out, the patient’s heartbeat increased again to 90b/min with the frequency of the PVC's slowing down slowly.  

The landing went smooth as per normal ops however approximately 10 – 20sec after touchdown, the aircraft started shaking violently. I recognised the feeling as that of a flat tyre. We continued taxing for another 8 meters to clear the runway where the pilot stopped the plane and proceeded with the shut down procedure. The pilot exited the plane and returned to confirm that the wheel on the nose gear had in fact deflated.

Again I had to phone my office in Windhoek and tell them this. My managers first reaction "You are joking!" Sadly I wasn't joking nor will I ever joke about this type of thing. Needless to say, at that time of night (18:30) there was nothing to be done and we had to spend the night in Cape Town.