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1.
Membranes (Basel) ; 11(3)2021 Mar 17.
Article in English | MEDLINE | ID: covidwho-1148306

ABSTRACT

The retrieval and transport of patients from peripheral hospitals to high volume extracorporeal membrane oxygenation (ECMO) centers aims to reduce complications and improve survival. In Sicily (Italy), our institute houses a mobile ECMO team that serves a population of around 10 million people for a vast area in southern Italy and Malta. This observational, descriptive study includes all patients that required veno-venous (V-V) ECMO and transport by a mobile team between October 2009 and May 2020. Linear and multiple logistic regressions were applied to explore the risk factors for mortality in the ICU. Kaplan-Meier estimates were generated to predict the survival in patients transported by helicopter or ambulance, and the two cohorts were compared according to their baseline characteristics. Of 122 patients transported, 89 (73%) survived to ICU discharge (50 (41%) patients were transported by ambulance, and 72 (59%) were transported by helicopter). Independent predictive factors associated with mortality in a stepwise multiple regression model were prone positioning, acute kidney injury, and the number of days spent on mechanical ventilation (MV). Kaplan-Meier estimates for survival favored the helicopter cohort (79%) rather than the ambulance cohort (64%). Patients transported by helicopter had better pre-ECMO profiles, with shorter hospital and ICU stays, a shorter duration of MV use, and higher RESP scores, which indicate better survival probabilities. ECMO transport can be carried out safely over long distances; in rural areas with underdeveloped roads, transportation via helicopter or ambulance can extend the arm of the hospital to remote areas. Early ECMO initiation can be crucial in improving survival outcomes, and when transportation is the limiting factor to starting ECMO support, it should be attempted at the earliest logistical stage possible.

2.
J Am Coll Emerg Physicians Open ; 2(2): e12389, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1122078

ABSTRACT

OBJECTIVE: Air medical transport of patients with known or suspected coronavirus disease 2019 (COVID-19) likely represents a high-risk exposure to crew members as aircraft cabins are quite small resulting in close personal contact. The actual risk to medical crew members is not known. METHODS: We conducted an institutional review board-exempt, retrospective study of air medical transport of patients with known or suspected COVID-19 by 8 programs in the Four Corners Region to determine the number of symptomatic COVID-19 among air medical crew members compared to total exposure time. All programs used similar routine personal protective equipment (PPE), including N-95 masks and eye protection. Total exposure time was considered from time of first patient contact until handoff at a receiving hospital. RESULTS: There were 616 air transports: 62% by fixed-wing and 38% by rotor-wing aircraft between March 15 and September 6, 2020. Among transported patients, 407 (66%) were confirmed COVID+ and 209 (34%) were under investigation. Patient contact time ranged from 38 to 432 minutes with an average of 140 minutes. The total exposure time for medical crew was 2924 hours; exposure time to confirmed COVID+ patients was 2008 hours. Only 30% of patients were intubated, and the remainder had no oxygen (8%), low-flow nasal cannula (42%), mask (11%), high-flow nasal cannula (4.5%), and continuous positive airway pressure or bilevel positive airway pressure (3.5%). Two flight crew members out of 108 developed COVID that was presumed related to work. CONCLUSIONS: Air medical transport of patients with known or suspected COVID-19 using routine PPE is considered effective for protecting medical crew members, even when patients are not intubated. This has implications for health care personnel in any setting that involves care of patients with COVID-19 in similarly confined spaces.

3.
Scand J Trauma Resusc Emerg Med ; 29(1): 41, 2021 Feb 26.
Article in English | MEDLINE | ID: covidwho-1105726

ABSTRACT

BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) outbreak in the Netherlands, the demand for intensive care beds exceeded availability within days. Initially, patients were redistributed regionally by ground transport. When transport over longer distances became necessary, we initiated a new Helicopter Emergency Medical Service (HEMS) operation. We hypothesize that the transport of contagious COVID-19 patients is feasible and safe for patients and HEMS personnel. METHODS: In this retrospective, single-centre observational study, flight and monitor data were used to calculate the exposure time of the retrieval team to COVID-19 patients. All the crew members (n = 18) were instructed on the proper use of personal protective equipment (PPE), dressing and undressing routine using buddy check supervision and cleaning procedures. All the team members were monitored for possible COVID-19 symptoms, as advised by our National Institute for Health and Environment. One month after completing the aeromedical transport all crew members were asked to donate a blood sample which was examined for the presence of IgG antibodies to SARS-CoV-2. RESULTS: From March 24 to May 25, 2020 the HEMS team transported 67 ventilated critical care COVID-19 patients. The exposure time was 7451 min (124 h and 11 min). One HEMS member reported pneumonia 6 weeks before the start of the patient transport. He tested positive for IgG SARS-CoV-2 by serology testing. We speculate that he was infected before the start of the operation; irrefutable evidence is lacking to support this claim because we did not perform serology testing before this operation started. CONCLUSION: Occupational COVID-19 exposure during helicopter transport of ventilated critical care COVID-19 patients can be performed safely when proper PPE is applied.


Subject(s)
Air Ambulances , Aircraft , COVID-19/transmission , Critical Care , Emergency Medical Services , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/prevention & control , Adult , Aged , Female , Humans , Male , Middle Aged , Netherlands , Personal Protective Equipment , Retrospective Studies , SARS-CoV-2 , Safety Management/organization & administration
4.
Energy Res Soc Sci ; 68: 101688, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-635159

ABSTRACT

This study explores the dynamics of energy use patterns, climate change issues and the relationship between social-psychological factors, with residents' acceptance of and willingness to pay (WTP) for home energy management systems (HEMS) during the COVID-19 pandemic in New York. The results of our survey suggest that there were no longer morning or evening usage peaks on weekdays, and a significant portion of respondents are experiencing higher or much higher electricity use than average. Most residents' perception of climate change issues during COVID-19 remained unchanged. Attitude, perceived behavioral control, and social norms are overall the strongest predictors of adoption intention and WTP for HEMS. Regarding WTP for specific well-being features, attitude was the strongest positive predictor of telemedical and home security features, and social norms are the strongest positive predictor of elderly assistance and job search. Technology anxiety, surprisingly, positively influences WTP for the well-being features. Trust in utilities is not related to adoption intention, but is positively associated with WTP for the well-being features. Although cybersecurity concerns are positively associated with HEMS adoption intention for energy and well-being features, this relationship is not significant in WTP. Residents who had moderate perceived risk of getting COVID-19 are willing to pay more than the high- and low-risk groups. This paper addresses the interactions among technology attributes, and users' social-psychological and demographics factors. Additionally, this study provides insights for further research in examining technology adoption and energy dynamics during times of crises, such as the COVID-19.

5.
Scand J Trauma Resusc Emerg Med ; 28(1): 43, 2020 May 25.
Article in English | MEDLINE | ID: covidwho-361427

ABSTRACT

The novel coronavirus SARS-CoV2 emerged in December 2019 and is now pandemic. Initial analysis suggests that 5% of infected patients will require critical care, and that respiratory failure requiring intubation is associated with high mortality.Sick patients are geographically dispersed: most patients will remain in situ until they are in need of critical care. Additionally, there are likely to be patients who require retrieval for other reasons but who are co-incidentally infected with SARS-CoV-2 or shedding virus.The COVID-19 pandemic therefore poses a challenge to critical care retrieval systems, which often depend on small teams of specialists who live and work together closely. The infection or quarantining of a small absolute number of these staff could catastrophically compromise service delivery.Avoiding occupational exposure to COVID-19, and thereby ensuring service continuity, is the primary objective of aeromedical retrieval services during the pandemic. In this discussion paper we collaborated with helicopter emergency medical services(HEMS) worldwide to identify risks in retrieving COVID-19 patients, and develop strategies to mitigate these.Simulation involving the whole aeromedical retrieval team ensures that safety concerns can be addressed during the development of a standard operating procedure. Some services tested personal protective equipment and protocols in the aeromedical environment with simulation. We also incorporated experiences, standard operating procedures and approaches across several HEMS services internationally.As a result of this collaboration, we outline an approach to the safe aeromedical retrieval of a COVID-19 patient, and describe how this framework can be used to develop a local standard operating procedure.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Practice Guidelines as Topic , Aircraft , COVID-19 , Decision Making , Humans , Personal Protective Equipment , Respiratory Insufficiency , SARS-CoV-2
6.
Scand J Trauma Resusc Emerg Med ; 28(1): 40, 2020 May 14.
Article in English | MEDLINE | ID: covidwho-260034

ABSTRACT

BACKGROUND: The current COVID-19 pandemic highlights the challenges air ambulance services are facing when transporting highly infectious patients for several hours in enclosed spaces. This overview provides an example of a standard operating procedure (SOP) for infection prevention measures in HEMS missions during the COVID-19 pandemic. Furthermore, we describe different methods used by several organizations in Europe and the experience of the Swiss air rescue organization Rega in transporting these patients. Possible benefits of the use of small patient isolation units (PIU) are discussed, including the fact that accompanying medical personnel do not need to wear personal protective equipment (PPE) during the transport but can still maintain full access to the patient. Rega has developed and patented its own PIU. This device allows spontaneously breathing or mechanically ventilated patients to be transported in pressurized jet cabins, small helicopters and ambulance vehicles, without the need to change between transport units. This PIU is unique, as it remains air-tight even when there is a sudden loss of cabin pressure. CONCLUSION: A wide variety of means are being used for the aeromedical transport of infectious patients. These involve isolating either the patient or the medical crew. One benefit of PIUs is that the means of transport can be easily changed without contaminating the surroundings and while still allowing access to the patient.


Subject(s)
Air Ambulances/organization & administration , Air Ambulances/standards , Aircraft/standards , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Transportation of Patients/methods , Transportation of Patients/standards , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Europe , Health Personnel , Humans , Infection Control/methods , Infection Control/standards , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Switzerland
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