Q&A with our Neonatal Flight Coordinator

Every time Lia’s Wings flies a baby home, there’s someone working behind the scenes to make sure every detail is in place. From talking to anxious parents overseas to securing hospital cots and arranging air ambulances, our Neonatal Flight Coordinator is at the centre of every mission. In this Q&A, Clare Miller (Advanced Neonatal Nurse Practitioner) shares what a typical day looks like, the challenges of neonatal air transfers, and the moments that will stay with them forever.

Clare taking care of our families and the complex logistics of moving a baby across the world — and sometimes the world!

What does a Neonatal Flight Coordinator do on a typical day?

It can be incredibly varied: talking to families overseas to establish their needs and work out how we can best support them, helping parents to understand the treatment their child is receiving (my role in the NHS as an Advanced Neonatal Nurse Practitioner facilitates this). Liasing with overseas doctors, Emergency Travel Document Officials, air ambulance providers, insurance companies and UK hospitals to secure cots for babies when they reach the UK. 

When there are no live missions, I am involved in training, developing care pathways, presenting at conferences and  study days for NHS transport providers around the UK, as well as working on projects to help medical assistance companies improve care for families. Evaluating the experience of the transfer by talking to parents and staff to see where we can improve is also a vital part of my role.

What goes into preparing for a neonatal transfer by air, and what are some of the biggest challenges?

There is a lot of work that goes into the preparation for an air transfer. After speaking to families, we need to obtain medical reports and open lines of communication with the hospital. Next, the family has to obtain an emergency travel document to allow the newborn baby (who has no passport) to travel. The baby needs to be accepted into a cot by a hospital in the UK, depending on their postcode and clinical needs. We then have to make sure the baby is clinically stable for transfer, book an air ambulance and team, and facilitate discussion between all parties. If an air ambulance is not a viable option, then families have to wait until the baby fits the criteria to travel on a commercial airline. This then involves more logistics, such as travelling with oxygen and lithium batteries that need authorisation from the airline in advance. In either case, ground transport must be arranged both to and from the airport so that a cot-to-cot service is provided by the medics undertaking the transfer. On the day of transfer, there is consistent communication between all parties to ensure all of the factors come together to provide the most comfortable, stress-free experience for our families. The language barrier is by far the biggest challenge in communicating with clinicians overseas, as well as the misconception around neonatal transfer held by insurance companies.

How do overseas transfers differ from UK-based ones?

UK transfers follow a recognised pathway where there are procedures and systems in place; this is what we are familiar with in the NHS. Explaining to clinicians in UK hospitals that it works differently overseas can be a bit of a challenge at times. With overseas transfers, the path is often untrodden, and we have to be more flexible and think outside the box. Although we have many years of experience, every family has a different set of circumstances, and every country, embassy, and hospital has a different process.

Clare caring for Jack during his air transfer after he was born prematurely in Turkey.

What are the main differences between a neonatal transfer by air ambulance and by medical escort, and how do you decide which is right for a baby?

In an air ambulance, we have control over the environment and can create a mini hospital in the sky, meaning babies can be transferred sooner (once stable), even if they require high levels of clinical support. For a commercial medical escort flight, there are different criteria to be met, and the babies have to be almost ready for discharge, ie needing minimal clinical support. Although we can still deal with emergencies if they arise, we take far less equipment and have less control over the external environment of travelling on a commercial airline. The decision between the two is based on a number of factors and is not made by one individual. The circumstances of the family as well as the clinical condition of the baby are discussed between the treating clinicians overseas, the consultant of the air ambulance company, as well as the clinicians in the receiving hospital, myself, Charlotte and most importantly the parents, to make sure we find the most suitable solution for each family.

What impact have you seen Lia’s Wings flights have on babies and their families, and is there a particular family or moment that stands out to you?

Sometimes families are in absolute despair when they find us, unable to obtain documents due to lack of support from embassies, not being able to visit or hold their baby in hospital, sometimes uninsured, or finding out they are not covered by their insurers for their specific situation. They might be struggling with finances and/or accommodation, have partners who need to return to the UK to work, or other children who have had to go back to school. Lia’s Wings has a huge impact on making sure these parents feel supported and not alone until we can fly their baby home and reunite them with their wider family and support networks.

Every family and their unique story holds a place in my heart. We become so invested in their journey that it is an absolute privilege to be able to help. If I had to pick a stand-out moment, it would be: 20-plus family and friends at the airport at 5am, holding banners, cheering as we came through arrivals after 23 hours of flying, to welcome a family back after almost four months away.

A family that we managed to get home three days before Christmas despite every barrier that was thrown at us during the months we were supporting them. There were even storms and flash floods in the country they were in on the day of the transfer, leading me to wonder if I’d spend Christmas overseas with them!

But perhaps the most poignant is a family we transferred that had given birth to twins prematurely, very far from home. After many months, we were able to bring one twin home, but sadly, her twin had passed away when she was just a week old. Throughout the transfer, as well as caring for the surviving twin, I carried her ashes, transiting through a number of airports and boarding several planes. When we reached the UK, their grandparents were waiting at the airport to meet their grandchild for the first time. After they had welcomed her and her parents home, I handed them the ashes of the other twin. It was such a bittersweet and incredibly moving moment that is etched in my heart forever.

Clare meeting Wilf's parents at the hospital in Crete before his air transfer back to the UK.

Finally, what message would you like to share with donors and supporters who make this work possible?

Please don’t underestimate how life-changing this service is for families. Even when families are brought home by their insurers, the testimonies from parents are about the invaluable support they get from Lia’s Wings — especially overseas. Language and culture barriers, sometimes not being able to visit or hold their baby, not understanding what is happening to their child in hospital or how to obtain the documents to get home, is incredibly frightening, and families often feel very isolated away from the support of their wider family. We give them the space to be able to celebrate the birth of their baby without being completely overwhelmed by the stress of their circumstances. Knowing we are alongside them for the journey, sometimes being able to talk to other parents who have been through similar experiences and being supported by Lia’s Wings make all the difference.