SVN2023 36 Medical Escort - Nurse

Under the supervision of the IOM Head of Office (HoO) in IOM Lebanon for administrative matters, and technical supervision and guidance of the Chief Migration Health Officer (CMHO) based in IOM Lebanon or a Regional Health Assessment Programme Coordinator, the incumbent will provide medical escort services to the beneficiary(ies) during all phases of their journey under IOM’s care, from pre-departure through to handover upon arrival.

The Medical Escort (ME) is expected to carry out his/her duties in accordance with the highest moral, ethical, and professional standards and with due respect for gender and socio-cultural differences of the beneficiary(ies) in their charge. The ME should remain flexible and adaptable in the event of any change in plans, as last-minute cancellations or changes to itineraries can occur. All MEs must adhere to and ensure full compliance with IOM guidelines as well as with national and airline regulations throughout the duration of duty travel.

The ME is responsible for having a valid passport and any applicable visas (the duration of validity of the passport should be at least six months from the end of the escort duty) as well as a valid license to practice in his/her country of residence and shall provide copies of these to IOM before undertaking the medical escort services.

Specific Duties and Responsibilities:

Prior to departure:

1. Verify validity of passport, which should have at least 6 months’ validity, visa and practicing license. Ensure that the copy of practicing license is prepared for the movement, and the immunization status is updated as required by the receiving country.
2. Undertake pre-departure preparations consisting of familiarization with the escorted beneficiary(ies) and their medical files, as well as discussion and planning with the IOM medical team in the country of departure or the Regional Office (RO) and with external specialists, as necessary. Remote consultations with the receiving healthcare provider, IOM HQ or specialists in other IOM country offices may be necessary depending on the situation and are particularly important for severe medical cases.[1]
3. Ensure that the Medical Information Form (MEDIF) or Medical Information Form for Air Travel (MEDA) has been submitted to the respective airline and their approval received.
4. Examine all aspects of the trip well in advance of departure, such as flight and layover duration, access to medical facilities, and special travel arrangements (e.g. wheelchair, special seating or stretcher, oxygen, ambulance, and others).
5. Become familiarized and agree with IOM medical movement (MM) focal point on the written Medical Escort Plan (MEP), which includes specific instructions and actions to be taken during transit and destination, such as focal persons to be met, communications to be maintained with identified parties, and options in the event of contingencies. The MEP may also specify the frequency and nature of vital signs and other parameters to monitor and document (e.g. oxygen saturation in flight), as well as which interventions to perform and the scope of an interim "fitness to travel" assessment that should be conducted between travel segments, as applicable. If such information is not provided, request clarifications of each point from the IOM MM focal point.
6. Obtain emergency contact information (for both Movement Operation and MHD staff) for use in transit, at the port of entry (POE) and at the final destination (FD).
7. Review the content of the medical escort’s kit and request additional medication or medical equipment as needed. Become familiarized with the equipment in the medical escort’s kit, as well as with the basic maintenance of the equipment. Maintain a written inventory of supplies used during travel to be submitted to the IOM mission upon return.
8. Become familiarized with the medication and dosing regimen for the beneficiary(ies) and confirm that the beneficiary(ies) has/have an adequate supply of medication to cover the movement and a period of at least 2 weeks after arrival.
9. Ensure that several copies of the Medical Escort forms MH06-B and MH06-D are prepared for the trip, and one set of forms MH06-A and MH06-C.
10. Ensure that a mobile phone with international roaming is available and in good order. Keep open communication channels before departure, in transit (if necessary, in-flight) and upon arrival.
11. Introduce him/herself and brief beneficiary(ies) in charge and their families on the MEP prior to travel. Explain beneficiary(ies) what to expect from the ME service, including the responsibilities of an IOM ME towards escorted cases (e.g. escorted beneficiary(ies) and their families should be aware that the escort is required to remain in close proximity to the escorted case throughout the journey).[2]
12. Ensure that the escorted beneficiary(ies) is/are fit to travel prior to departure. The ME reserves the right to cancel the escorted beneficiary(ies) from a flight after evaluating their clinical condition if they are deemed not fit to travel. The cancellation should be done in coordination with the MM focal point in IOM Lebanon or the relevant regional travel health coordinator if there is no MHD presence in the mission. Immediately notify the relevant MHD and Movement Operations staff of any event that may result in a delay/alteration of the plans. 

During movement:

1. Perform fitness-to travel check before each travel segment.
2. Board together with the beneficiary(ies) in charge for travel, assisting them with embarkation and disembarkation.
3. Introduce him/herself to airplane cabin staff, briefly explain the ME’s duties and engage their assistance in case of a medical emergency. Provide medical assistance, as well as non-medical support, to other beneficiaries travelling under the auspices of IOM as needed.
4. Stay in close proximity to the beneficiary(ies) throughout the movement. Do not leave the beneficiary(ies) unattended without a legitimate reason and for longer than absolutely necessary. Inform beneficiary(ies) about your whereabouts and expected time of return whenever the absence is necessary.
5. Follow the MEP, and constantly monitor the condition of the beneficiary(ies) in charge during movement. The frequency of observations should not be less than every 4 hours. This relates not just to specific medical conditions but also to general health issues during the flight that may be related to reduced cabin pressure, low ambient humidity, and prolonged immobilization.
6. Ensure beneficiary(ies) maintain adequate hydration and avoid drinking alcohol and beverages containing caffeine. Encourage beneficiary(ies) who are able to occasionally move about the cabin or do simple leg exercises periodically while seated.
7. For beneficiary(ies) with cardiac or respiratory disease, regularly monitor their blood pressure, pulse rate and respiratory rate. Blood pressure should be monitored using an automated blood pressure cuff, as the digital readout eliminates the challenge of auscultation in a noisy environment. In case of doubt, the automated readings should be confirmed with the manual method.
8. Monitor blood oxygen saturation using pulse oximetry, which should be available and used for any person requiring supplemental oxygen during movement. For beneficiaries with diabetes, Use portable blood glucose monitors provide rapid, accurate and simple measurement.
9. Ensure that medications are taken as scheduled and that supplemental oxygen is properly delivered to those who require it.
10. Bring any medical emergency or significant deterioration in a passenger’s condition immediately to the attention of the cabin crew and captain and give the passenger immediate medical assistance to the fullest extent allowed by the circumstances.
11.  Document all clinical observations and interventions clearly in the IOM Observation and Intervention Report (MH06-B) indicating the time of and travel segment for each observation; form MH06-B is available in the package of documents for MEs. The local date and time at the point of observation (e.g. if during the flight, use the date and time of the port of departure). Document any coordination between the ME and the air crew, air captain or ground medical assistance team in form MH06-B.
12. In case of significant deterioration of the beneficiary’s condition that results in travel deviation or a need for special reception arrangements, such as unplanned hospitalization, immediately notify IOM staff in the sending and receiving missions and, if applicable, the transit mission. Stay with the patient until released by the IOM staff in sending or receiving missions, as well as the medical personnel assuming further care of the patient.

At the port of entry

1. Report to IOM staff on arrival at the POE. Note that MEs are subject to the same laws and requirements as other arriving passengers, including random security checks.
2. If same-day connections are not possible at the POE, stay at the same hotels as beneficiaries. If the beneficiary’s condition is unstable or deteriorates at the point of transit, contact local IOM staff for advice about local health services and request their assistance in arranging access to these services (e.g. hospital admission), if necessary. If the situation is critical call local medical emergency number, alert hotel staff, provide possible stabilization measures, and call IOM staff.

Upon arrival:

1. At the end of the itinerary, hand over the escorted beneficiary(ies) to a responsible entity. If a planned or emergency hospitalization is required immediately upon arrival or during transit, the handover should only be made to a medical professional at the hospital.
2. Ensure that any un-escorted onward travel connections are completely understood by the beneficiary(ies), accompanying family members, non-medical escorts, or partner agencies.
3. Upon handover of the beneficiary(ies) to the receiving party, fill in the Migrant Handover Notification Form (MH06-D) and get it signed by the receiving party. Provide one copy to the receiving party and retain the other copy. If the receiving party is not a medical professional, provide the medical records and a copy of the Observation and Intervention Report (MH06-B) to the beneficiary(ies) or his/her guardian.
4. If the medical handover appointment is the day after arrival at the final destination, arrange accommodation with or as near as possible to the beneficiary and be available to assist at all times until handover occurs.
5. If any special medical equipment, such as a portable oxygen concentrator (POC), was obtained for the beneficiary’s use during the movement from the POE to the FD, ensure that it is returned, or booked to return, to the IOM POE or an external service provider, as per instructions received before travel or at the POE.
6. Submit the Migrant Handover Notification Form (MH06-D), the Escort Report Forms (MH06-A and B), the Medical Escort Checklist (MH06-C), the medical escort kit and the mobile phone (if provided by IOM) to IOM Lebanon within 1 (one) week of return to the duty station, unless agreed otherwise.
7. Medical escort should remain communicable by phone and email through the escort trip on the ground and at least until 24 hours after the handover for any eventual need.
8. In a situation of travel-related incident or the complaint alleged against the escort, information requested from the escort must be honoured even after performing the escort duty.
9. Perform other duties as may be assigned.