Thirty-six critical cases of emergency helicopter transferring between hospitals / 中华危重病急救医学

Objective:To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care.Methods:The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved. The mission acceptance, implementation results, disease spectrum composition, pre-transfer preparation and medical intervention on board were summarized.Results:① General information: a total of 168 patients of helicopter transfer requests were registered, of which 36 patients were transferred, 35 patients were successful, 1 patient had cardiac arrest during the landing phase, and died several hours after continuous resuscitation. Of the 36 patients 30 were males and 6 were females, with median age of 50.5 (29.8, 66.0) years old, the average transfer time was (54.95±17.89) minutes, and the average transfer distance was (205.74±74.68) km. ② Disease spectrum included 11 cases of stroke (30.55%), 7 cases of trauma (19.45%), 5 cases of severe pneumonia (13.89%), 5 cases of heart and macro-vascular diseases (13.89%), 5 cases of abdominal emergency (13.89%), and 3 other conditions (8.33%).③ Severity: 31 patients (86.11%) were severe (≥15) according to acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score; 19 patients (52.78%) were high-risk emergency transport (≥6) according to Hamilton early warning score (HEWS); 6 patients (85.71% of trauma patients) were severe trauma (≥16) according to injury severity score (ISS). ④ Preparation before transfer: remote consultation was carried out to evaluate the latest state of the patient's condition, especially the respiratory and circulatory conditions. Relevant items were reviewed and emergency treatments were implemented when necessary. Targeted preparation was made for accidents that might occur during transfer, such as electrocardiogram (94.44%), blood gas analysis (94.44%), brain CT (36.11%) and other auxiliary examinations, endotracheal intubation or tracheotomy (72.22%), deep vein catheterization (91.67%), placement of gastric tube (86.11%) and urinary tube (88.89%), adjustment of sedative (38.89%), vasoactive drugs (58.33%) and drugs for dehydration and lowering intracranial pressure (33.33%), and fixation of fracture (11.11%), etc. ⑤ On-board medical intervention: cardiac monitoring, blood pressure, respiration and blood oxygen monitoring were carried out in all patients. The parameters of patients using ventilator were adjusted in time (66.67%). The dosage of patients using micropump was adjusted in time (91.67%). Other aspects included the use of sedative and analgesics (38.89%), sputum suction nursing (75.00%), all kinds of catheter nursing (endotracheal intubation/incision nursing of 72.22%, indwelling catheter nursing of 88.89%), and cardiopulmonary resuscitation for patient with cardiac arrest (2.78%).Conclusion:As the patients transferred by helicopter are mainly those of critically ill at this stage, the requirements for airborne medical equipment and rescue technology are high, and there is an urgent need to establish technical specifications and personnel training standards.

Experience of transportation of mass severe burn patients for long distance by air ambulance with fixed wing / 中华烧伤杂志

Objective@#To explore the experience of transportation of mass severe burn patients for long distance by air ambulance with fixed wing.@*Methods@#The organization and implementation process of transportation of 5 patients in the devastating forest fire of Greater Khingan on 2nd, May 2017, for long distance by air ambulance with fixed wing were reviewed and analyzed. All the patients were severely burned and complicated with inhalation injury. Four hours after accident, the relevant authority dispatched national medical team with 2 specialists of burn, 1 specialist of intensive care medicine, 1 head nurse of burn intensive care unit (ICU) to treat and cure the patients before transportation. Three patients had tracheotomy and four patients had escharotomy. Patients and their relatives, expert group of transportation, and aircrew members were arranged according to the scheme before transportation. Patients were monitored and treated with the equipments of air ambulance during the transportation. Patients were transferred to the burn ICU in our hospital from the airport through the green channel.@*Results@#All the five patients were transported to the destination safely for long distance of 1 700 kilometres and air flight 3.5 hours one way by air ambulance with fixed wing in 4 batches at 26 to 44 hours post burn, and transported from tarmac to burn ICU of our hospital. All the patients were in stable condition during the transportation and had successful subsequent rescue. All the patients were discharged in three months.@*Conclusions@#It is feasible to transfer mass severe burn patients for long distance by air ambulance with fixed wing, and it is safer and more effective to transfer according to the standardization process, and the opportunity of transportation of severe burn patients can be moved up to shock stage.

Effective Medical Training Courses for Medical Helicopter Crews in South Korea

PURPOSE: The Ministry of Health and Welfare of korea started operating the Helicopter Emergency Medical Service (HEMS) System in 2011 to improve emergency medical services given by physicians aboard helicopters. The purpose of this study was to evaluate the HEMS education program for its effectiveness and satisfaction from trainees. METHODS: A survey of trainees was conducted at the very end of training and education. Trainees for a HEMS crew surveyed included doctors (8), nurses (4), emergency medical technicians (12), pilots (10), flight dispatchers (4) and an administrator (1). The study period was from August 8, 2011 to August 12, 2011. The amount of HEMS education was 16 hours, including 8 hours of theoretical education, 5 hours of simulation and 3 hours of table-top simulation. RESULTS: In an analysis of programs according to trainee satisfaction, the theoretical training program received an average of 4.2+/-0.7 points and; the practical and simulation training program received; 4.4+/-0.8 points. The simulated practical training program thus received a higher score than theoretical education, but the difference was insignificant (p=0.834). CONCLUSION: For the HEMS training programs, the practical and simulation training satisfaction score were higher than the theoretical program. A focus on simulation programs for HEMS could therefore serve as a goal of the HEMS education program.

Traslado aéreo civil de pacientes / Patients being transported by civil airline companies

Objetivo Las operaciones aéreas iniciaron en Colombia en 1919 pero no hay conocimiento sobre el traslado aéreo de pacientes en el país. El estudio fue realizado con empresas en Bogotá que realizaron traslados aéreos de pacientes durante los años 2005 a 2007. El objetivo es mejorar el conocimiento sobre las operaciones de traslado aéreo de pacientes en Colombia. Método Estudio descriptivo de los traslados aéreos de pacientes realizados por tres empresas durante los tres años seleccionados. La escala de valoración del riesgo para el transporte de pacientes fue usada en cada uno de los registros. Resultados Solo tres empresas autorizaron el acceso a los registros médicos, encontrando 98 en total, 24 en 2005, 28 en 2006, y 46 en 2007, pero solo se realizaron 96 traslados, debido a que dos fueron cancelados por malas condiciones médicas del paciente. Todos fueron traslados secundarios (entre hospitales) realizados en ala fija, es decir en avión, 61 % hombres, 38 % mujeres, 51 % adultos y 49 % fueron menores de 18 años (57 % neonatos). De acuerdo con la escala 27 % de los pacientes estaban inestables, 48 % moderadamente inestables y 25 % estables. El 90 % de los traslados fueron realizados por personal médico, 14 casos tuvieron complicaciones durante el vuelo pero la mortalidad fue solo del 4 %. Conclusiones El traslado aéreo de pacientes requiere una valoración y un registro completos de todas las variables relacionadas con el traslado y de personal entrenado en la atención de pacientes críticos de todas las edades.

Objective Colombian aviation operations began in 1919; however, no knowledge is currently available concerning medical air transport in the country. This study involved local companies in Bogota which provided air medical transfer for patients from 2005 to 2007; it was aimed at improving knowledge regarding air transport for patients in Colombia. Method This was a descriptive study of patient air transfer by three companies during the aforementioned three-year period. The Risk Score for Transport Patients' (RSTP) scale was used in each report. Results Only three companies authorized access to their medical reports; 98 reports were found, 24 in 2005, 28 in 2006 and 46 in 2007 but only 96 patients were transferred because two flights were cancelled because of the patients' poor medical condition. All the records dealt with secondary air transfer (between facilities) in fixed-wing aircraft. 61 % of the patients so transferred were male and 38 % female; 51 % were adults and 49 % were less than 18 years old (57 % of the latter being newborn). According to the RSTP scale, 27 % of the patients were unstable, 48 % moderately unstable and 25 % were stable. 90 % of the transfers were accompanied by medical staff, 14 cases had complications during their flights but mortality was just 4 %. Conclusion Patients' air transfer requires complete assessment and a complete record of all the variables related to transporting patients by air and personnel trained in dealing with critically-ill patients of all ages.

Aerotransporte: aspectos básicos y clínicos / Air transport: basic and clinical aspects

El transporte aéreo de pacientes es una realidad cada vez más frecuente. Las condiciones y el ambiente presentado durante un vuelo, así como los cambios fisiológicos que ahí ocurren en los pacientes y en la tripulación son parámetros que el equipo médico debe conocer antes de enfrentarse a esta actividad. En este artículo se revisarán elementos propios de la aviación y de cómo estos influyen en el organismo humano; también se analizarán algunas recomendaciones a considerar.

Air transport of patients is an increasingly common reality. The conditions and the environment presented during a flight, as well as the physiological changes that occur in patients there and the crew are parameters that the medical team should know before taking on this activity. This article will review elements of aviation and how they affect the human organism also discusses some recommendations to consider.

Avaliação inicial do Serviço de Atendimento Móvel de Urgência na Cidade de Porto Alegre / Initial evaluation of the Mobile Emergency Medical Services in the city of Porto Alegre, Brazil / Evaluación inicial del servicio de atención móvil de urgencia en la ciudad de Porto Alegre

FUNDAMENTO: Os Serviços de Atendimento Móvel de Urgência (SAMU) no Brasil têm resultados imediatos pouco conhecidos. OBJETIVO: Avaliar os preditores clínicos de sobrevida dos pacientes em parada cardiorrespiratória (PCR) no ambiente não hospitalar atendidos pelo SAMU de Porto Alegre. MÉTODOS: Estudo observacional e prospectivo. Os desfechos avaliados foram sobrevida em 30 dias e até a alta hospitalar, além de escore do Cerebral Performance Category (CPC) I-II. RESULTADOS: De janeiro a outubro de 2008, foram atendidos 593 pacientes em PCR não traumática e foram realizadas 260 tentativas de ressuscitação cardiopulmonar (RCP). Houve sucesso inicial em 52 (20,0 por cento) casos, estando 16 pacientes vivos no 30º (6,0 por cento) dia, 10 tendo recebido alta hospitalar (3,9 por cento), sendo que 6 (2,3 por cento) com escore CPC I-II. A PCR no domicílio associou-se inversamente com a sobrevida no 30º dia (p = 0,001) e na alta hospitalar (p = 0,02). Um ritmo inicial "chocável" (p = 0,008) associou-se à sobrevida aos 30 dias. O intervalo tempo-resposta e tempo colapso até início da RCP foram significativamente menores em sobreviventes aos 30 dias. Em análise multivariada, foram preditores independentes de mortalidade aos 30 dias um ritmo inicial chocável (razão de chance [RC] = 0,28 e intervalo de confiança [IC] de 95,0 por cento = 0,10 - 0,81; p = 0,02) e PCR no domicílio (RC = 3,0 e IC 95,0 por cento = 1,04 - 8,7; p = 0,04). CONCLUSÃO: O atendimento pré-hospitalar da PCR em Porto Alegre tem resultados limitados, porém equiparáveis a outras localidades internacionais. É necessário o reforço de cada elo da corrente da sobrevivência para aperfeiçoar o atendimento pré-hospitalar, visando melhora de resultados clinicamente relevantes.

BACKGROUND: Little is known about the immediate outcomes of the Mobile Emergency Medical Services (SAMU) in Brazil. OBJECTIVE: To evaluate clinical predictors of survival of patients in cardiorespiratory arrest (CRA) in the nonhospital environment treated by the SAMU in the city of Porto Alegre. METHODS: The present study has a prospective and observational design. The evaluated outcomes were 30-day survival and hospital discharge, in addition to the Cerebral Performance Category (CPC) score I-II. RESULTS: From January to October 2008, a total of 593 patients in nontraumatic CRA were treated and 260 cardiopulmonary resuscitation (CPR) attempts were made. There was an initial successful outcome in 52 (20.0 percent) cases, with 16 patients (6.0 percent) alive on the 30th day and 10 being discharged from the hospital (3.9 percent), of which 6 (2.3 percent) presented CPC I-II score. The CPR at home was inversely associated with 30-day survival (p = 0.001) and hospital discharge survival (p = 0.02). An initial "shockable" rhythm (p = 0.008) was associated with 30-day survival. The response-time and collapse-time intervals until CPR start were significantly shorter in 30-day survivors. At multivariate analysis, independent 30-day mortality predictors were an initial shockable rhythm (odds ratio [OR] = 0.28 and 95 percent confidence interval [95 percentCI] = 0.10 - 0.81; p = 0.02) and CPR at home (OR = 3.0 and 95CI percent = 1.04 - 8.7; p = 0.04). CONCLUSION: The pre-hospital care of CRA in the city of Porto Alegre has limited results; however, they are comparable to the results from other international locations. It is necessary to reinforce each link of the survival chain to improve pre-hospital care, aiming at improving clinically relevant outcomes.

FUNDAMENTO: Los Servicios de Atención Móvil de Urgencia (SAMU) en el Brasil han resultados inmediatos poco conocidos. OBJETIVO: Evaluar los predictores clínicos de sobrevida de los pacientes en parada cardiorrespiratoria (PCR) en el ambiente no hospitalario atendidos por el SAMU de Porto Alegre. MÉTODOS: Estudio observacional y prospectivo. Los desenlaces evaluados fueron sobrevida en 30 días y hasta el alta hospitalaria, además de escore del Cerebral Performance Category (CPC) I-II. RESULTADOS: De enero a octubre de 2008, fueron atendidos 593 pacientes en PCR no traumática y fueron realizadas 260 tentativas de resucitación cardiopulmonar (RCP). Hubo éxito inicial en 52 (20,0 por ciento) casos, estando 16 pacientes vivos en el 30º (6,0 por ciento) día, 10 teniendo recibido alta hospitalaria (3,9 por ciento), siendo que 6 (2,3 por ciento) con escore CPC I-II. La PCR en el domicilio se asoció inversamente con la sobrevida en el 30º día (p = 0,001) y en el alta hospitalaria (p = 0,02). Un ritmo inicial pasible de "shockeable" (p = 0,008) se asoció a la sobrevida a los 30 días. El intervalo tiempo-respuesta y tiempo colapso hasta comienzo de la RCP fueron significativamente menores en supervivientes a los 30 días. En análisis multivariado, fueron predictores independientes de mortalidad a los 30 días un ritmo inicial "shockeable" (razón de posibilidad [RC] = 0,28 y intervalo de confianza [IC] de 95,0 por ciento = 0,10 - 0,81; p = 0,02) y PCR en el domicilio (RC = 3,0 y IC 95,0 por ciento = 1,04 - 8,7; p = 0,04). CONCLUSIÓN: La atención prehospitalaria de la PCR en Porto Alegre tiene resultados limitados, sin embargo equiparables a otras localidades internacionales. Es necesario el refuerzo de cada eslabón de la cadena de supervivencia para perfeccionar la atención prehospitalaria, buscando mejora de resultados clínicamente relevantes.

Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter

PURPOSE: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. METHODS: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. RESULTS: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS or =3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). CONCLUSION: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.

Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter

PURPOSE: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. METHODS: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. RESULTS: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS or =3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). CONCLUSION: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.