MS 264: Medical Evacuation

Table of Contents

1.0  Authority

2.0  Purpose

3.0  General Policies

3.1  It is the policy of the Peace Corps to evacuate Volunteers and Trainees (V/Ts) and their dependents from the country of assignment to the United States or third countries when an illness, injury, or other medical necessity requires evaluation and/or treatment beyond the scope of care available in-country.  Under no circumstances should a Peace Corps Medical Officer (PCMO) hesitate to evacuate an individual, if that is the medically sound course of action.

 

3.2  Medical evacuation shall not be used in lieu of administratively separating a V/T for inappropriate behavior related, for example, to alcoholism, drug abuse, failure to follow medical advice or to take required immunizations or prophylaxes, or behavior that risks the transmission of sexual diseases.  See MS 284.

 

3.3  Emergency evacuations shall be funded even when other expenditures must be curtailed during a period of lapsed federal appropriations. 

4.0  Procedures

4.1  Medevac Approvals

 

Medical judgments concerning whether and how to medevac a V/T are made by the PCMO after consultation with the Office of Medical Services (OMS).  If the V/T is being medevaced to the United States, the written authorization of OMS is required.  Non-medical judgments may be made by the Country Director (CD).  Thus, in any situation where, in the judgment of the PCMO, medical considerations require that certain actions be taken, it is the responsibility of the CD to implement those actions and ensure that all necessary administrative and logistical support is provided.  In situations where the PCMO determines that medical considerations can be equally satisfied by more than one option, the CD may decide how to proceed. 

 

If the CD disagrees with a decision made by the PCMO and OMS, and the PCMO determines that a delay will not materially endanger the health of the V/T, the CD may request review of the evacuation decision by the Director of the Office of Medical Services.  If, at any point, the PCMO determines that the delay will endanger the health of the V/T, the CD shall immediately implement the decision of the PCMO.  Questions on disagreements may always be raised with OMS after an evacuation.

4.2  Travel

4.2.1  Travel Options

 

V/Ts may be evacuated via commercial flights, medical or other private charter flights, military air craft, or overland transportation, as defined in the post's medical evacuation plan. Most V/Ts are medically evacuated on regular commercial airline flights.  In a life-threatening emergency requiring evacuation, where suitable commercial transportation is not available or adequate, the assistance of the Department of Defense's aeromedical evacuation units may be sought. It must be recognized, however, that decisions concerning such flights are the ultimate responsibility of an appropriate DOD authority.  The PCMO or Country Director should contact the American embassy to coordinate emergency evacuation by the DOD.   

 

4.2.2  Medevac Locations

 

Peace Corps generally evacuates V/Ts either to the United States or a regional medevac location.  

 

4.2.3  Medevac to the United States 

 

Medical evacuees to the United States mainland shall go directly to Washington, D.C., or to another point in the United States, as determined jointly by the PCMO and OMS.  For the Africa region, the PCMO shall also consult with the Area Peace Corps Medical Officer (APCMO).  The selection of an evacuation point shall be based on the V/T's medical condition and needs, and the proximity of a medically appropriate facility.  Evacuation to the United States is required for:

(a)  Difficult diagnostic problems;

 

(b)  Cases requiring difficult treatment, especially if the treatment is lengthy or possibly controversial;

 

(c)  All psychiatric problems, when they are the primary reason for evacuation or when they threaten to complicate the medical management of the case;

 

(d)  Cases involving a long recuperative period where the patient will unlikely be able to resume his or her work as a V/T; and

 

(e)  Cases that can be handled more effectively in the United States than at a regional medical evacuation location.     

4.2.4  Medevac to Regional Locations 

 

Regional locations are approved by OMS after consideration of the level of services available and the post's ability to support the site as a regional medical evacuation location.  A decision to medically evacuate a V/T to an approved regional location is appropriate when the PCMO (or APCMO, as appropriate), in concurrence with OMS, determines that the regional location facilities are adequate to treat the medical condition of the V/T. 

 

4.2.5  Special Travel Arrangements  

 

The majority of medevac'd V/Ts will travel from the post to the medevac location via economy class on a commercial airline.  The medical condition of the V/T may require special arrangements during travel.  Based on the medical needs of the V/T, the PCMO may authorize the following special arrangements:

(a)  Business or first class seating on the airplane;

 

(b)  Stretcher or more than one seat;

 

(c)  Medications en-route;  

 

(d)  An escort; and

 

(e)  Other medically necessary arrangements.

4.2.6  Escorts

 

The majority of medevac'd V/Ts travel without an escort from the post to the medevac location.  In some cases, however, it is necessary for an escort to travel with the V/T at Peace Corps expense. The PCMO shall determine the need to appoint an escort and the level of care needed for the V/T. (A second escort may be selected in unusual circumstances only if determined as necessary by the PCMO.)  As appropriate, the escort may provide medical care en-route, continuous medical monitoring for the V/T, emotional support, and/or physical assistance.  The escort may be a medical professional, a post staff member, or a PCV, but not a family member of the evacuee at Peace Corps expense.  Spouses or dependents may, under certain circumstances, accompany the evacuee during travel as set out in Section 4.2.7, but are not considered to be escorts. 

 

If the PCMO selects a post staff member or another Volunteer as an escort, the PCMO must obtain the concurrence of the CD so that the post staff and program needs are considered.

 

The PCMO shall ensure that the escort: 

(a)  Understands his or her responsibilities;

 

(b)  Is aware of the medical support needs of the patient, and be capable of providing the support;

 

(c)  Hand-carries the medical files and related evacuation documents, and provides the receiving medical staff with all necessary information;

 

(d)  Physically accompanies the patient from the point of overseas departure to the designated destination;

 

(e) Understands that the responsibility for the V/T remains with the escort until the V/T is accepted by a medical facility or by the OMS staff or PCMO at the destination;

 

(f)  Complies with the confidentiality requirements of the Privacy Act, HIPAA, and Peace Corps confidentiality policies, concerning the V/T's illness, symptoms, behavior revealed during travel, etiology or cause of illness, treatment, and other information related to the V/T's privacy; and

 

(g)  Is fully briefed and given written instructions concerning airports, hotels, taxis, contact telephone numbers and any other pertinent information.    

Once the escort has delivered the V/T to the appropriate destination, he or she is generally expected to return to country.  If the escort is another V/T or post staff, he or she is allowed a maximum of 72 hours at the evacuation site to recover from the trip before returning to post.  Any additional leave must be approved by the CD.  

 

4.2.7  Accompaniment by V/T Spouses, Dependents, and Parents of Dependents

 

Independent of whether or not an evacuee is provided an escort, the evacuee may be accompanied by his or her V/T spouse if the PCMO determines that the spouse's presence is advisable; or may be accompanied by the V/T spouse and dependent, if the cause for the evacuation is likely to result in a medical separation or death.  The PCMO's determination shall be based on such factors as the severity of the injury or illness, the need for major surgery, and/or the emotional status of the couple and their need for mutual support.  For the purposes of travel and allowances, accompanying V/T spouses and dependents will be treated the same as evacuees.

 

In all cases involving the medical evacuation of a minor child of a V/T, one parent must accompany the child.  If the PCMO determines, in consultation with OMS, that the child's condition is life-threatening, the PCMO will determine whether both parents should accompany the child.  In cases where the child's condition is not life-threatening, and where accompaniment by only one parent would cause a hardship to the parents (not mere inconvenience), the CD may authorize travel and allowances from post funds for the other parent. 

 

Travel and allowances for family members other than those provided for in this sub-section shall not be authorized.    

 

4.2.8 Transfer and Care of Medevac Documents and Information

 

When OMS has authorized a medevac to the United States, the following information shall be sent to OMS:

(a)  The evacuee's name, Social Security Number, date of birth, and status (Volunteer, Trainee, or dependent), the date the V/T entered on duty (EOD), and the projected close-of-service date (COS);

 

(b)  The diagnosis of the evacuee;

 

(c)  The evacuee's departure and arrival information, including (1) the airline carrier and flight numbers and airport; (2) the estimated time of arrival (ETA); (3) information about an escort or accompanying spouse, dependent, or parents of dependent, if any; (4) whether hospitalization is required upon arrival; (5) whether the medical condition requires being met upon arrival with an ambulance and attendant; and

 

(d)  Whether family or others identified as appropriate should be notified and what information may be conveyed to them and when. 

PCMOs are responsible for ensuring that: 

(a)  The evacuee or escort hand-carries the evacuee's health record, including reports and in-country x-rays, in a sealed envelope to the medevac destination;

 

(b)  The evacuee has his or her passport with the World Health Organization card, the Medevac Guide, and the health benefits card; and

 

(c)  The Country Director and the AO have been notified of the decision to medevac a V/T or dependent and provided the name of the evacuee, departure information and any special transportation needs.

 

Country Directors (or designee) are responsible for ensuring that:

 

(a)  Each medical evacuee has been given an advance of at least three (3) days' per diem for immediate expenses (see MS 221 Sections 9.4 and 10.1);

 

(b)  Each evacuee or escort hand-carries all appropriate documentation or forms necessary for the medevac and care of the V/T or dependent; and

 

(c) The applicable Country Desk is informed that a V/T is on medevac. 

The OMS staff shall routinely provide the PCMO information on the ongoing and final status of the V/T.  Once final decisions are made, OMS shall inform the PCMO of either the V/T's ETA in country if the V/T has been medically cleared, or the termination date of a medically separated V/T. The PCMO is responsible for keeping the CD apprised of the ongoing status.  OMS will inform the CD of the final status of the V/T, including the V/T's ETA in country or termination date. 

 

The staff (PCMO or APCMO) at a regional medevac site shall routinely provide the post PCMO and OMS staff with information on the status of the V/T and the final decision regarding return to country or date of termination for a medically separated V/T.  The PCMO is also responsible for apprising the CD of this information. 

4.3  Return to Service

 

OMS will determine whether a V/T can be medically cleared to return to service or will be medically separated pursuant to Section 3.0 of MS 284. 

 

A V/T who is medically cleared for further service by OMS will return to post unless he or she elects to resign or the CD has initiated or plans to initiate procedures to administratively separate the V/T.  If the CD has initiated or plans to initiate such procedures, OMS will consult with the CD on whether the V/T should be returned to country.

 

Medically evacuated V/Ts who have less than ninety days of service remaining will usually be given an advanced completion of service (COS) date.  Such a V/T will be returned to post only where the CD determines that the V/T's absence would adversely affect the project or Peace Corps' effectiveness in the host country.

5.0  Post Medical Evacuation Plans

5.1  The Plan shall include the following information:

(a)  In-country medical facilities and physicians, e.g., various private facilities, including flying doctors;

 

(b)  Medical facilities and physicians in neighboring countries that provide regular and specialized services;

 

(c)  Local resources that could be used in an emergency, e.g., various private, or police radio networks;

 

(d)  Available transportation (U.S., host country or neighboring country) systems.  This should include information on availability, request procedures and landing field capabilities;

 

(e)  Current State Department regulations concerning medical evacuations; and

 

(f)  Current format used by embassy or consulate to request aeromedical evacuation and all required standard information.

5.2  The CD shall ensure that all staff members are familiar with the medical evacuation plan.  At a minimum, the Country Director shall:

(a)  Ensure the plan is complete and current in all respects;

 

(b)  Brief all new employees concerning the plan's contents;

 

(c)  Include responsibilities for plan preparation in the PCMO position description or in the contract;

 

(d)  Hold periodic drills to ensure that staff can perform their assignments; and

 

(e)  Provide each staff member with information listing the immediate steps to be taken in case of life-threatening emergencies.  This information is to be carried by all staff and kept close to telephones in staff residences and offices.  The information shall also contain the name of the Embassy staff person most likely to be able to assist the PCMO.  Information should also be printed in the host country language, if necessary.  

6.0  Effective Date