Case Study: Training combined with Experience and Equipment can, and does save lives.

A patient presented to a medical treatment facility on a remote site. He had been previously diagnosed with malaria, was sweaty and had a fever. He was nauseous, anxious, had chest discomfort and was very tired.

He is a smoker and suffers from high blood pressure.

It would be easy to focus on the malaria, providing oral or even intra-venous anti-malaria medications, as well as treat the nausea, fever and muscle aches.

While performing a thorough assessment, the site paramedic measured the patient’s blood pressure and found it to be very high.

The high blood pressure and history of chest discomfort meant that the next logical step was to perform a 12 Lead ECG.

This was when a heart attack was confirmed – and demonstrated the value of experience.

The chest discomfort was actually a sign of an Acute Myocardial Infarction. The 12 Lead ECG confirmed this and directed immediate treatment away from malaria and towards an Acute Coronary Syndrome.

Following Advanced Cardiac Life Support guidelines, the patient was immediately stabilised, chest pain controlled, blood pressure reduced and vital signs stabilised.

As a national worker in the country of operations, he was rapidly transported to a local facility, which was fortunately able to continue care.

An expatriate patient would have urgently been evacuated to a point of definitive care where a Cardiologist would take steps to unblock the arteries and restore blood flow to the heart muscle.

What is Definitive Care?

Definitive Care is the “end point” medical facility where the patient receives medical care that definitively manages a medical condition. This can be a surgeon, cardiologist or neurologist with their associated specialised units, operating theater and ICU.

What this means:

In serious cardiac events they say “Time is Muscle”; the longer it takes to provide definitive care and unblock the arteries, the more heart muscle is damaged beyond repair.

The faster a condition is diagnosed, the faster that treatment is started and the faster the patient reaches definitive care, the better the outcome.


On a remote site, properly organised and equipped healthcare facilities with trained and experienced healthcare professionals can, and does, save lives.

The 12 Lead ECG shown is the patients actual ECG, showing the changes that indicate a ST Elevated Myocardial Infarction – STEMI, known as a Heart Attack.

Left unrecognised and untreated, this case could have resulted in cardiac arrest.



Starting and running a hospital in such a challenging environment is a demonstration of our capabilities, innovative thinking and unique approach.

We take this approach to our clients in the harshest offshore and most remote onshore environments.

Location:                 Mogadishu – Somalia

Dates:                       2013 – ongoing

Client:                       European Union Training Mission

Service:                 Role 2 Medical Facility, comprising:

       General Surgery        Orthopedic Surgery
       Anesthetist        ICU
       Emergency Blood Bank        Operating Theater
       ICU & Scrub Nurses        Project Manager
MSS Operating Room Mogadishu



After a comprehensive skills analysis of National Healthcare practitioners on a project in the Democratic Republic of Congo, our client has requested us to place an Advanced Life Support Paramedic on the site.

In addition to providing ALS cover, MSS is conducting an ambitious program aimed at up-skilling the National Healthcare Practitioners on the project.

The program is tailored to the client’s needs and the capabilities of the Congolese Healthcare Professionals and includes reading, tutoring, lectures and practical sessions.

The candidates have already demonstrated improved skills in the initial management of a suspected snake bite and in emergency drill scenarios.

MSS paramedic with Congolese health care professionals