Mere hours after the category 5-hurricane Irma struck the windward islands Sint Maarten, Saba and Sint Eustatius on Wednesday, September 6th, 2017, the Fundashon Mariadal on Bonaire set up a medical airlift. This upon request by the Sint Maarten Medical Center (SMMC) for the transfer of its patients.

Kees Klarenbeek of the Board of Directors (BoD) of the SMMC asked Fundashon Mariadal to take care of the evacuation and also the coordination of care for both dialysis and other critical patients. Soon the Saba and Sint Eustatius Health Care Foundations too requested air transportation for their pregnant women with increased risk, to Aruba, Bonaire or Curaçao.

Cooperation
This resulted in a cooperation never seen before between the hospitals of the six Caribbean islands of the Dutch Kingdom: the ones of the three afflicted Windward Islands and those of the Leeward Islands.

The axe in this operation is the medical airlift which gained in importance when it became clear that another threat was lurking: hurricane José with the windward islands on its projected path. This medical airlift is to be distinguished from the evacuation airlift that the Dutch army guides out of Curaçao. Despite the approval of VWS in the Hague, it was the intervention of the Representative of the Kingdom BES, mr. Gilbert Isabela that was needed to bring the dialysis patients over to Aruba through the Defense Ministery.

Learjets on standby
The Fundashon Mariadal integrated its departments of Emergency Room, Ambulance and Air Ambulance into one department around the year 2000. Thanks to a contract with Medic Air, the Fundashon Mariadal disposes of a fully equipped Learjet 35 that is 24/7 on standby, exclusively for air ambulance flights. A Learjet 55 will become available in the near future, as backup.

Medic Air supplies the pilots and the Fundashon Mariadal delivers the medical crew. Additionally, the Fundashon Mariadal has access to a wide network of other air ambulance providers in the region. These factors enabled the very quick setup of the requested medical airlift service.

Operation base Bonaire International Airport
Eventually, an operation was designed for this medical airlift containing three air ambulances, ten pilots and the needed medical crews, formed with Fundashon Mariadal personnel. The base of the operations is the Bonaire International Airport.

After delivering patients on Curaçao or on Aruba, Bonaire is revisited for fueling purposes and, if needed, to change pilots after which the plane flies to the windward islands. This relief operation is ongoing since Thursday, September 7th and will continue daily as long as the windward islands need it.

Curaçao and Aruba join in
A few hours after the medical airlift was operational, the Sint Elisabeth Hospital (Sehos) on Curaçao contacted the SMMC to offer help. After learning that the Fundashon Mariadal was coordinating the relief work, Medical Director Franke Scheper, who was abroad, instructed his deputy Medical Director Lysandra Berenos-Riley to make the contact with the Fundashon Mariadal.

From Aruba, Ezzard Cilié, from the BoD of the Horacio Oduber Hospitaal (HOH) approached the Fundashon Mariadal, stating: “just let us know how we can help and we ‘ll do it.”

Fly over
The SMMC indicated, in the meantime, that it was necessary to relocate all its 62 dialysis patients by air transport. Within one hour, after consultation between the actors concerned with ZVK and VWS The Hague, the decision was made to fly the dialysis patients from Sint Maarten to Aruba. Another decision made, was to airlift all critical patients by air ambulance planes to Curaçao and to Bonaire.

On Tuesday, September 5th, before hurricane Irma had reached the windward islands, Ton Wassenaar, the deputy Head of the Zorgverzekeringskantoor BES (ZVK), that resorts under the ministry of Public Health, Wellbeing and Sports (‘VWS’) in The Hague, already contacted Fundashon Mariadal to notify that the ZVK and the VWS had made communication lines available to handle an eventual airlift of patients with the Army. Wednesday evening, September 6^th, Giovanni Frans of Fundashon Mariada’s BoD, informed Wassenaar about the local cooperation in order to make further arrangements.

Guarantee letters
Up to two Saturdays ago, the medical airlift served 83 windward patients needing leeward hospitalization. The ZVK on Bonaire is handing out guarantee letters for all the patients transported, including those of the country of St. Maarten, in order to facilitate their internalization and medical treatments on the ABC-islands. The ZVK is also taking care of all the logistics concerning the travel of accompanying persons and also for the patients who don’t require hospitalization.

Bonaire itself received five patients – among them three French speaking persons – during the first days of the airlift operation. The medical indications were: pregnancy, hip fractures, dialysis and epilepsy. There was also a patient from Sint Maarten, with an eye injury, headed to Curaçao.

Birth
Aruba had sheltered up to then, in the HOH, 62 dialysis patients (34 on Friday and 28 on Saturday) and also two pregnant women, of which one gave birth in the meantime.
A group of the dialysis patients are being treated in The Instituto Médico San Nicolas (InSam). Meanwhile, ten of the above-mentioned dialysis patients were relocated to Bonaire on Wednesday.

All the dialysis centers are performing an additional shift to accomodate the patients from Sint Maarten, Saba and Sint Eustatius. The SMMC sent dialysis nurses to Aruba to reinforce the dialysis team there. Four dialysis nurses are on their way to Bonaire to assist the dialysis team there. These nurses are available due to the collaboration between Fundashon Mariadal, the Academic Medical Center and the VU University Medical Center in Amsterdam.

Intensive Care
Curaçao took in fourteen acute patients during the first days of the medical airlift. One was placed immediately in intensive care and two were placed on nursing departments after their operations.

There is a child from Sint Eustatius among these patients, who suffered a neurotrauma. This child was flown by helicopter from Sint Eustatius to the airport on the island of Sint Kitts where a ‘wing-to-wing’transfer brought this patient to an air ambulance plane from Bonaire that executed the transportation to get the child in Sehos.