Lying in little Emilia’s bed in Fribourg is not a teddy bear, but a Rega jet soft toy. It reminds the baby girl of her very first flight, from Cairo to Zurich. Her mother tells Emilia the story of this journey every evening before she goes to sleep. It goes something like this: Emilia wanted to explore the world much earlier than planned, so she made an appearance well before the expected birth date. She weighed just 1,500 grams and so spent her first days in Cairo in a lovely and warm little house made of glass, and waited until she was strong enough to be flown to Switzerland, accompanied by her parents and her cuddly ambulance jet toy.

Many specialists for little Emilia

Emilia is one of 235 premature and newborn babies that were transported by Rega’s ambulance jets and rescue helicopters in 2018. An undertaking that brings with it very special challenges, for the professional care of premature and newborn babies with medical problems cannot be compared with those of an adult – the demands made on the attending physician and nurse are quite different. Consequently, these flights are also accompanied by a team specialised in neonatal medicine. Therefore, on the flight from Cairo to Zurich, Emilia does not only have a jet soft toy at her side. She is also cared for by three medical specialists: besides Rega’s flight physician and paediatrician André Keisker and Rega intensive care nurse Kathrin Oegerli, Nicole Grieder, a neonatal nurse from the children’s hospital in Aarau, is on board. It is also Nicole Grieder who, together with André Keisker, examines Emilia at the hospital in Cairo and attaches her to the mobile machines that continually monitor the preterm baby’s bodily functions during transport. “The handover of the patient by the local doctors at the hospital is an important moment,” André Keisker explains. “From then on, we assume responsibility for the patient and need to be fully informed about everything that has happened since he or she was admitted to hospital.”

In Emilia’s case, not only her low birth weight is giving cause for concern, but also a burn on her foot, which occurred during treatment in hospital and the extent of which is only revealed to the Swiss medics when they examine her at the hospital in Cairo. Just as prior to every repatriation, the medical consultant on duty at the Rega Operations Centre clarifies whether Emilia’s medical condition allows her to be transported in the first place. He speaks with the doctors on location and tries to obtain as accurate a picture of the situation as possible based on the available medical documents, such as laboratory reports and x-rays. However, even despite these clarifications, it can happen that on location the Rega crew are confronted with a different situation than originally assumed. As is the case with Emilia. When the Rega crew examine her in Cairo, they find that Emilia is more seriously ill than they had thought. André Keisker suspects the onset of an infection, and the burn is worse than expected. Even before Emilia is taken by ambulance to the Rega jet at the airport, the team immediately start her on a course of antibiotics to get the infection under control.

Ready for takeoff

At the international airport in Cairo, the crew secures the transport incubator in its designated place in the Rega jet and Emilia is now ready for the several-hour flight to Switzerland. Back at the hospital, Nicole Grieder had already covered the baby’s ears with a tiny set of ear protectors to prevent the noise in the ambulance jet from straining them as little as possible. Emilia’s parents are allowed to accompany her in the Rega jet. “During the flight, we explain to the parents everything that we are doing. If they want to touch their baby in the transport incubator, they can put their hand through a narrow opening and have physical contact that way”, says André Keisker. The crew also handle Emilia gently and lovingly. Small gestures and touches are intended to make the tiny baby aware that everything that is happening to her is for her own good. Emilia spends most of the flight fast asleep. Nevertheless, the transport still represents a medical challenge. Babies that are born preterm often have difficulty breathing because their lungs are not yet fully functional. Rega’s mobile incubator ensures that, among other things, ventilation does not need to be interrupted while transferring the newborn baby between hospitals and that the top-quality treatment can continue seamlessly throughout the entire journey. “With premature babies, many organs are still not fully developed”, explains André Keisker. “For example, they are not able to maintain their body temperature themselves, or the fine blood vessels in the brain are still developing and are extremely susceptible to bleeding. This is why gentle transport and precise monitoring are so important for our tiny patient.”

Safe arrival in Switzerland

Accompanied by her jet soft toy, Emilia lands safely in Zurich and is taken by ambulance to a hospital with a specialised neonatal unit. Here, her own personal “bedtime story” continues. Emilia is given her own room at the children’s hospital. She drinks plenty of breast milk, and so rapidly grows and puts on weight. Her parents visit her every day and spend many hours with her. Ointment is regularly applied to her injured foot and the wound is freshly bandaged. In addition, a specialist often comes by to check Emilia’s foot. Thanks to effective treatment, the burn heals better than expected. But despite all the care, the front part of her big toe and some of her heel do not heal completely. But this does not bother the baby girl. Several weeks later, she is finally allowed to go home. Emilia fought for her recovery and it was worth it: now, she is almost one year old, attends nursery and enjoys baby swimming classes – and her parents are extremely proud of their little heroine.

Karin Zahner