Becoming seriously ill or injured while on holiday is something that most travellers are not prepared for. First, they need to seek treatment, and then another question quickly emerges: How do I get home?
With years of experience organizing international medical transportation, I can say that it might be quite difficult for patients and their families to realize that they need to understand how and who should do it. Who will organize the repatriation process? Should the travel insurance company get involved? Can they travel on a commercial flight, and what happens to their medical treatment along the way?
In my experience, this uncertainty is often one of the most difficult parts for families. They understand the hospital environment because they can see the doctors, nurses and treatment taking place. What happens between that hospital bed and getting home is much less visible.
Our statistics show how often our activity begins in the countries where tourists love to spend their holidays. In a sample of 400 medical flights we coordinated during 2026, 9.25% started in Spain, 9% in France, and 4% in Greece. Together, these three countries accounted for more than one in five missions in the sample.
Obviously, not every patient was a tourist, but the starting point shows how often the need to organize medical transportation arises in countries many international travelers visit.
For me, the important point behind these numbers is not the destination itself. It is how quickly an ordinary holiday can become an international medical and logistical problem that a family has never had to navigate before.
So, what happens when you are lying in a hospital abroad and are told you need to be brought home?
Starting the process
The medical repatriation process may start through different channels. The patient or their relatives can initiate it, or the travel insurance company, assistance company, hospital, or any other institution responsible for the patient’s repatriation.
For travelers with travel insurance, contacting the insurance company or assistance company can be an important first step if they want their policy to cover repatriation. The patient and his/her relatives can also contact the medical air transportation company directly, although experience has taught me that some insurance companies don’t cover the costs unless they are involved from the start
Once the first communication channel is established, it is time to gather information about the patient’s condition. It usually includes diagnosis, recent interventions, cardiovascular and respiratory stability, mobility, the list of drugs, the need for oxygen, and other factors that may affect transportation.
Families often think nothing can be done until all documents are ready. However, coordination can usually begin while collecting additional information.
This is one area where experience makes a significant difference. Once that information begins to come together, the next question is not which aircraft is available. It is whether the patient can travel at all and, if so, under what conditions.
Deciding the method of transportation
Being discharged from the hospital and being fit to travel internationally are not the same.
I think this is one of the most important distinctions for families to understand. A hospital assesses whether someone still needs a hospital bed. Medical transportation professionals are asking a different question: can this patient safely complete the specific journey being proposed?
Doctors who treat the patient abroad provide information about the patient’s condition, while medical transportation professionals evaluate it in terms of the proposed journey. When needed, medical information can also be shared with the team that will receive the patient at the destination.
This information helps determine not only whether the patient can travel, but also what kind of transport to use.
One of the biggest misconceptions is that a patient needing repatriation automatically needs an air ambulance. Only 49% of our 2026 missions were performed with the help of an air ambulance. This means just over half of the patients we transported did not need an air ambulance and could travel using other medically appropriate transport options.
Patients requiring intensive monitoring, ventilation, or other medical assistance can use an air ambulance. A stable patient who still needs some assistance may travel commercially with a medical escort and might even need a ground ambulance during the last mile of the journey.
The decision has to start with the patient’s needs, not the aircraft.
That is an important principle in this work. The objective is not to put every patient onto the most medically intensive form of transport available. It is to identify the level of support that is appropriate for that particular patient and that particular journey.
Getting from one hospital bed to another
If the patient needs further treatment after returning home, the receiving hospital must also be included in the process.
The travel insurance company or assistance company, the patient and his/her doctors, or the medical transport coordinator can choose the hospital. The only requirement is that the receiving institution confirms acceptance, if necessary, and receives the patient’s medical information.
Ground transportation also needs to be arranged. The patient may require an ambulance from the foreign hospital to the airport and from the arrival airport to the patient’s home or their receiving hospital.
That is why I usually tell patients’ relatives that the aircraft is just one element of the operation.
A journey might start in a hospital bed in Spain, continue by ambulance to the airport, fly across Europe, and end with another ambulance. All these elements must connect properly.
From an operational perspective, a successful repatriation isn’t necessarily the one with the fastest flight. It is the one in which every stage connects safely, without creating gaps in the patient’s care.
What happens to medication and treatment?
Patients often worry that their treatment will stop once they leave the hospital.
The goal is to ensure continuity of treatment. Before departure, staff assess medications, allergies, therapies, oxygen, and other patient requirements to provide the appropriate level of assistance during transport.
If the patient travels in an air ambulance, they may need oxygen, monitoring equipment, infusion pumps, ventilation, and other medical equipment, depending on their condition. A patient who travels commercially with a medical escort will have different requirements.
It all depends on the individual patient’s needs.
What matters is thinking about the journey as a continuation of care rather than a pause between two healthcare environments. The patient may be changing countries and modes of transport, but their medical needs do not disappear in the process.
The role of relatives during an air medical flight
This can be one of the most important questions for the patients. Whether their partner, children, or other relatives can travel with them depends on the mode of transport, available capacity, and the patient’s medical needs.
On air ambulance flights, one medically and operationally eligible relative may travel with the patient, subject to aircraft capacity and the patient’s condition. However, the aircraft’s intensive care configuration may require additional personnel or equipment, which limits cabin space.
The patients’ relatives should ask this question early to avoid misconceptions about whether they will travel together or separately.
Professionally, we tend to think about cabin capacity and medical configuration. Families see this very differently. For them, whether a husband, wife or child can stay with the patient may be one of the most important parts of the entire journey. That difference in perspective is something medical transport teams should never overlook.
Changing health conditions
Patients’ relatives should understand that the plan can change.
Someone who is stable enough to travel with one type of transport in the morning may worsen in the afternoon and require additional oxygen, medical personnel, or equipment. The mode of transport may also change completely.
The opposite can happen too. Further treatment might improve the patient’s condition so much that they need a less intensive transport option.
That is why medical evaluation continues until departure. Sometimes, the safest decision is to delay the journey.
Obviously, patients’ families get frustrated, especially if they are waiting to return home. But flexibility is not just an advantage in medical transportation. It is an element of safety.
Experience has taught me that one of the hardest messages to give a family can also be one of the most important: the plan has changed. In medical transportation, sticking to the original plan is never more important than responding to the patient’s current condition.
Why it might take longer than expected
Usually, families think the search for an aircraft is the main factor affecting repatriation speed.
In fact, delays can occur elsewhere. The receiving hospital can still need to accept the patient. Some medical documents might still be missing. Ground ambulances have to be arranged. International permits or some other organizational arrangements may be required. The most important thing is that the patient’s condition can change.
All of this work is invisible from the hospital room. Families may simply see several hours pass without their relatives departing, while medical, aviation, and ground teams work to connect the elements of the journey.
This is probably the biggest gap between how a family experiences a repatriation and how we experience it operationally. For the family, waiting can look like inactivity. For the coordination team, those same hours can involve dozens of behind-the-scenes decisions and conversations.
That is why I think one of the most useful things families can do is ask who exactly coordinates their repatriation and what still needs to be done before departure.
Having years of experience in these cases, I can say that the patient obviously sees the flight as a journey home. While organizing the repatriation, the flight is only a middle part of a much longer journey.
That has probably been one of my biggest lessons from working in this field. Medical transportation is often associated with aircraft, but the aircraft alone does not bring a patient home. People, medical decisions, ground transportation, hospitals, and aviation must work as one continuous operation.
When someone becomes seriously ill on holiday, getting them home starts with understanding what that individual patient needs, then connecting the medical and operational pieces around them.
The objective is not simply to get someone onto an aircraft as quickly as possible. It is to ensure that from the moment they leave their hospital bed abroad until they reach their home or receiving hospital, their journey fits their medical condition and their care continues safely.
