Phoenix Air Group

“One of the Most Complex Medical Evacuations in History”

– U.S. Secretary of State Michael Pompeo – Press Briefing on 3/31/2020

As told by Dent Thompson, Senior Vice President and Chief Operations Officer for Phoenix Air Group, Inc. headquartered in Cartersville, GA. Article provided by CJP member Randy Davis.

U.S. Secretary of State Michael Pompeo stood before the Washington Press Corps on Tuesday morning, March 31, to brief reporters gathered in the Press Room on activities which the State Department was undertaking at the end of March. Top of his agenda was the State Department’s efforts to bring Americans home from around the world in the face of the growing COVID-19 coronavirus pandemic. Secretary Pompeo highlighted one mission by stating…

“In Bhutan, no easy place to get to, an American was critically ill from the virus, intubated on a ventilator, and frankly expected to die in a country located in one of the most remote corners of the world. But we came to the rescue. Our team arranged a biocontainment transport from Bhutan to an intensive care unit in Baltimore, Maryland, a distance of nearly 8,000 miles. To fly through Kathmandu, there’s about 12 pilots that can make that flight. It was one of the most complex medical evacuations in history, and the State Department pulled it off.”

This is a story worth telling, and telling in detail, an air ambulance mission which against all odds overcame obstacle after obstacle and kept the patient alive and delivered him into advanced medical care in the United States. For privacy reasons, few details on the patient are contained in this story, just details of how Phoenix Air Group and its cadre of highly skilled pilots, medical staff and trip planners successfully completed what is truly one of the most complex medical evacuations in aviation history.

It started midday on Tuesday, March 10, when Dr. William Walters, Deputy Chief Medical Officer at the U.S. State Department, called into Phoenix Air’s Charter Department in Cartersville, GA wanting to explore the viability of operating an air ambulance flight into Paro, Bhutan to bring out a critically ill American citizen. The patient was himself a physician, in Bhutan advising their government, when he became sick with COVID-19 and was rapidly deteriorating. He was in a local hospital intubated on a ventilator with poor vital signs. It was a Hail Mary throw…putting together a team and getting into one of the most dangerous airports in the world, then crossing European airspace which was systematically being restricted due to the growing pandemic…all this with a highly contagious patient onboard on full life support.

The Kingdom of Bhutan is also not just around the corner, it’s a small nation in the Eastern Himalayas between Tibet and India, just a bit east of Kathmandu, Nepal best known for its towering Mt. Everest.

Dr. Walters and Phoenix Air’s medical director Dr. Michael Flueckiger discussed the patient’s prognosis, not good, but let’s do this. And at that moment it was Game On.

The closest Phoenix Air medevac jet equipped with the company’s proprietary Aeromedical Biological Containment System (ABCS) capable of transporting a contagious patient was stationed in Nairobi, Kenya under contract to the State Department’s Office of Operational Medicine, which Dr. Walters manages.

Darrin Benton, Phoenix Air’s Assistant Director of Operations, looked at the pilot roster in Nairobi for that week. He and Director of Operations George Crim had studied Paro Airport in Bhutan and it was not going to be easy, in fact various sites on the internet label it as one of the five most difficult airport approaches in the world, so dangerous that aircraft must have a licensed and specially trained “Navigator” onboard talking the pilots through the procedures. The runway is deep in a Himalayan valley along a river, only 7,431-feet long at an altitude of 7,333-feet – that’s over 2,000-feet higher than Denver’s Airport and half its length. This was not going to be easy.

As Darrin looked at the crew roster, he saw that his most experienced captain in the region was Cheyenne Foote, who had completed his multi-week deployment to Nairobi and was already at Nairobi International Airport waiting to catch a commercial flight home. Darrin called Cheyenne on his cell phone, described the mission in detail, getting in and out of Paro, Bhutan with snow coming in three-days, the patient’s condition, is he interested? Cheyenne’s answer was immediate, he grabbed his suitcase back from the airline check-in desk and headed back to the local hotel to start planning the mission to Bhutan. Flight Crew One would be Capt. Cheyenne Foote and First Officer Greg McPherson.

Phoenix Air’s two medical directors, Dr. Mike Flueckiger and Dr. Doug Olson, along with manager of Phoenix Air’s medical division Vance Ferebee, RN began briefing the medical team currently assigned to the Phoenix Airbase in Nairobi. On the other end of the phone was registered nurse Rick McKinstry and paramedic Ernie DeWitt. They would be the medical team in back with the patient, who himself would be housed in full biocontainment inside the ABCS tent for the long trip to Baltimore, MD where an intensive care unit bed was waiting.

Due to FAA regulations on the length of time pilots can be in the cockpit, two more teams of pilots would have to be stationed along the long route home between Bhutan and Baltimore. So, Phoenix Air’s Charter Department staff dug in and started route planning…and most importantly…trying to locate one of only 12 elusive Paro Navigators available for this short-fuse mission. Snow was predicted for the mountain valleys in Bhutan starting Friday evening and the patient’s vital signs were continuing to deteriorate. In and out in no more than 72-hours from now, or the mission would be postponed, and the patient would likely succumb to the virus.

After a search for a licensed Navigator, a Bhutanese Navigator was located in Calcutta, India willing to go, but it would be a one-way flight into Paro Airport where he was born and wanted to stay awhile, the flight crew needed to pay close attention to his instructions and reverse their way back out on their own. This was really stacking up to be no easy day.

Phoenix Air captain Larry Bostrom and First Officer Kyle Houghton were also in Nairobi, Kenya that week and were sent by airlines to Dubai where they staged to take over the cockpit duties when the Gulfstream jet landed with the patient onboard. They would become Flight Crew Two. Phoenix Air captain Dan Harris and First Officer Brandon Banks along with registered nurse Kortney Yarborough scrambled to catch a commercial flight out of Atlanta to Paris where they would become Flight Crew Three.

Because none of the crewmembers would be allowed off the aircraft once it was underway with a highly contagious COVID-19 patient onboard, the jet would never stop moving except to add more pilots and refuel. Flight Crew One would move into the passenger compartment just forward of the biocontainment unit housing the patient when Flight Crew Two boarded in Dubai, then both flight crews were in the back when Flight Crew Three boarded in Paris. Things continued stacking up as their first no easy day turned into two not-so-easy days. An unknown factor was whether the patient would expire on the way home, a very real possibility based on early vital signs from the Paro hospital. The clock was ticking, it was now Tuesday night in Cartersville, GA and departure was scheduled out of Nairobi Thursday morning.

Phoenix Air’s Charter Department was deep into the planning cycle and submitting overflight and landing documents, made more complicated by the hour as different countries started closing or restricting their airspace. Being designated a humanitarian air ambulance flight helped a little, but it would still be an incredibly difficult task routing the aircraft from Paro, Bhutan to Baltimore, MD.

Then Thursday morning Nairobi time arrived – middle of the night in Cartersville – but the Charter Department was up and working. Snow was still predicted for Friday evening in Bhutan, the train needed to pull out of the station on time to land at Paro at 12 noon their time on Friday. One hour on the ground at Paro Airport was scheduled, grab some fuel and upload the patient, get out of the deep Himalayan valley alongside the river before the weather closed in, and get up to 40,000 feet where the Gulfstream jet likes to cruise.

First stop Calcutta, India to board the Bhutanese Navigator. Payment for his services had been agreed to and the flight crew was ready to cover this cost. But once the Navigator learned that this was an air ambulance mission to bring out a physician in his country helping his government, he refused payment – this became “his” duty to see through to the end.

So, he settled in a jump seat between the two Phoenix Air pilots and soon began talking them through the slow descent into the towering mountain peaks and down towards the river snaking through the deep valley below. Before long navigational instruments were shut off, this was now pure piloting skills by visual sight, stick and rudder control. Then the jet bottomed out a few hundred feet above the river and began banking along its curves. “Aim for the house’s green rooftop over there,” the Navigator can be heard telling the pilots, all captured on a Go Pro camera they sat on the dashboard aimed out the front windshield. In the background, the Ground Proximity Warning System’s mechanical voice can be heard saying over and over “Terrain ahead, pull up, pull up.”

Then around one more bend in the river and the runway appears ahead looking more like an aircraft carrier deck than a seven-thousand-foot runway. Landing gear down, full flaps, spoilers deployed and powering onto the runway, then instantaneous maximum braking and thrust reversers deployed, slowing the 70,000 lbs. aircraft to a stop just before the end of the runway.

After parking on the ramp, an ambulance from the local hospital arrives with the patient onboard. One of the Phoenix Air medical crewmembers in full personal protection equipment (PPE’s) goes out to meet the ambulance and using sign language and pantomime, he gets the patient onto a backboard carried by six Bhutanese medical attendants over to the Gulfstream and hefted up into the aircraft’s cargo-door where he is moved off the backboard and into the ABCS biocontainment tent, and transferred onto the aircraft’s life support equipment. He’s still alive, a good sign, but his vital signs are still in the tank. Snow is a few hours away so time to go.

The Navigator heads across the ramp towards home, the cargo-door is closed, and the two Rolls Royce jet engines spool up. The Angel Flight is off at max speed and soon winding down the river valley with Cheyenne and Greg as newly minted “navigators” on their own, climbing out from beneath the mountain peaks up to cruise altitude. In the back, medical teammates Rick and Ernie and busy doing final tweaking on life support equipment, fluids and medications which they hope will keep their patient alive for the long trip home.

From Paro they fly back to Calcutta to refuel, then to Dubai where pilots Larry Bostrom and Kyle Houghton are waiting. After fueling in Dubai, Cheyenne and Greg are done and move to the back, time now for Larry and Kyle to take over in the cockpit. There’s a fast refuel on the island of Crete, then on to Paris. In Paris, pilots Dan Harris and Brandon Banks board along with flight nurse Kortney Yarbrough who joins her medical colleagues taking care of the patient.

Then it’s off again headed across the Atlantic Ocean to Gander, Newfoundland in Eastern Canada for their final fuel stop before Baltimore. On the ground in Gander the med crew calls in, the patient is amazingly stable considering all. Time to press on to Baltimore.

Landing at Baltimore occurred on Saturday, March 14, at 9:00 a.m. local time. The patient remained stable and was handed off to a ground ambulance crew for the ride to his bed in a local intensive care unit.

Difficult? In the extreme. Obstacles? Almost too many. Only 72-hours to plan, needed to locate one of only 12 licensed Navigators half-way around the world, snow coming in 72-hours, needed to put two additional flight crews into Dubai and Paris, then of course navigate in and land at one of the most difficult airports in the world. Patient has falling vital signs, intubated and on full life support, and highly contagious. Then fly half-way around the world to Baltimore through highly restricted airspace.

In the end, it took 30.5 hours from departing Paro, Bhutan Friday to landing at Baltimore Saturday, the skills of six pilots and three medical crewmembers, no easy day-and-a-half for sure, but the Phoenix Air employees undertook what Secretary of State Pompeo called “One of the most complex medical evacuations in history” – and all of us at Phoenix Air Group are certainly not going to argue with that statement.