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2.
Air Med J ; 40(4): 220-224, 2021.
Article in English | MEDLINE | ID: covidwho-1245832

ABSTRACT

OBJECTIVE: There are limited data regarding the typical characteristics of coronavirus disease 2019 (COVID-19) patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision making needed to transport critically ill COVID-19 patients. METHODS: A retrospective chart review of persons under investigation for COVID-19 transported during the first 6 months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction assay were included in the analysis. RESULTS: Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and 1 (0.75%) received an inhaled pulmonary vasodilator. At least 1 ventilator setting change occurred for 59 patients (22.0%), and ventilation mode was changed for 11 patients (4.10%) during transport. CONCLUSION: The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking, and decision making.


Subject(s)
COVID-19/therapy , Clinical Competence , Clinical Decision-Making/methods , Critical Care/methods , Transportation of Patients/methods , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Combined Modality Therapy , Critical Care/standards , Critical Care/statistics & numerical data , Critical Illness , Female , Humans , Male , Maryland , Middle Aged , Patient Acuity , Patient Transfer/methods , Patient Transfer/standards , Patient Transfer/statistics & numerical data , Retrospective Studies , Transportation of Patients/standards , Transportation of Patients/statistics & numerical data
3.
Disaster Med Public Health Prep ; 14(6): e47-e50, 2020 12.
Article in English | MEDLINE | ID: covidwho-1174606

ABSTRACT

The Diamond Princess cruise ship, carrying 3711 passengers and crew members, docked at Yokohama Port in Japan on February 3, 2020. A quarantine was immediately instituted because 1 passenger who had disembarked in Hong Kong was confirmed to have tested positive for coronavirus disease 2019 (COVID-19). After the quarantine began, all passengers and crew were tested using the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction assay on the ship, 696 of whom tested positive. In total, 769 patients, including 696 with COVID-19, required transport to a hospital. The Japan Disaster Medical Assistance Team (DMAT) successfully picked up and safely transported the COVID-19 patients using a novel classification system to prioritize patients. The Japan DMAT transported 203 patients to hospitals in Kanagawa and another 566 patients to hospitals in 15 different prefectures.


Subject(s)
COVID-19/epidemiology , Transportation of Patients/methods , COVID-19/prevention & control , COVID-19/therapy , Health Care Rationing/organization & administration , Humans , Japan , Polymerase Chain Reaction , Quarantine/methods , SARS-CoV-2 , Ships
6.
Korean J Anesthesiol ; 73(6): 557-561, 2020 12.
Article in English | MEDLINE | ID: covidwho-961744

ABSTRACT

Background: As the coronavirus disease 2019 (COVID-19) pandemic spreads globally, hospitals are rushing to adapt their facilities, which were not designed to deal with infections adequately. Here, we present the management of a suspected COVID-19 patient. Case: A 66-year-old man with a recent travel history, infective symptoms, and chest X-ray was presented to our hospital. Considering his septic condition, we decided to perform an emergency surgery. The patient was given supplemental oxygen through a face mask and transported to an operating theatre on a plastic-covered trolley. An experienced anesthetist performed rapid sequence intubation using a video laryngoscope. Due to the initial presentation of respiratory distress, the patient remained intubated after surgery to avoid re-intubation. Precautions against droplet, contact, and airborne infection were instituted. Conclusions: Our objective was to facilitate surgical management of patients with known or suspected COVID-19 while minimizing the risk of nosocomial transmission to healthcare workers and other patients.


Subject(s)
COVID-19/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Perioperative Care/methods , Transportation of Patients/methods , Aged , COVID-19/surgery , Health Personnel , Humans , Male , Occupational Exposure/prevention & control , Pandemics , Personal Protective Equipment
7.
Perfusion ; 36(4): 358-364, 2021 05.
Article in English | MEDLINE | ID: covidwho-945126

ABSTRACT

The Coronavirus Disease 2019 (COVID-19) pandemic has required rapid and effective protocol adjustments at every level of healthcare. The use of extracorporeal membrane oxygenation (ECMO) is pivotal to COVID-19 treatment in cases of refractory hypoxemic hypercapnic respiratory failure. As such, our large, metropolitan air ambulance system in conjunction with our experts in advanced cardiopulmonary therapies modified protocols to assist peripheral hospitals in evaluation, cannulation and initiation of ECMO for rescue and air transportation of patients with COVID-19 to our quaternary center. The detailed protocol is described alongside initial data of its use. To date, 14 patients have been placed on ECMO support at an outside facility and successfully transported via helicopter to our hub hospital using this protocol.


Subject(s)
Air Ambulances , COVID-19/therapy , Extracorporeal Membrane Oxygenation , Transportation of Patients , Adult , Critical Care/methods , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Intensive Care Units , Male , Retrospective Studies , SARS-CoV-2/isolation & purification , Transportation of Patients/methods
8.
Am J Emerg Med ; 46: 420-423, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-893419

ABSTRACT

OBJECTIVE: We aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients. METHODS: Hypoxic and awake patients with probable COVID 19 pneumonia who were referred to the Ankara City Hospital Emergency Department from 1 April to 31 May 2020 were included in this prospective study. Patients were transported in prone position and fixed on the stretcher. During the transport, patients continued receiving 2 l per minute oxygen with nasal cannula. Arterial blood gases were obtained from the patients before and after transport. The transport time was recorded as minutes. The primary outcome of the study is the increase of partial oxygen value in the arterial blood gas of patients after transport. RESULTS: It was found that pO2 and SpO2 end values were statistically significantly higher in the patient group compared to the initial values. In the group with transport duration of more than 15 min, a difference was found between the initial and end values in pO2 and SpO2 parameters similar to the whole group. However, there was no statistically significant difference between the initial and end values in the group with transport duration of 15 min or below. CONCLUSIONS: Awake hypoxemic patients can be transported without complications in prone position during transport. Transports more than 15 min, prone position may be recommended because the partial oxygen pressure of the patients increases.


Subject(s)
COVID-19/epidemiology , Intubation, Intratracheal/methods , Patient Positioning/methods , Prone Position/physiology , Respiration, Artificial/methods , Transportation of Patients/methods , Adult , Aged , Aged, 80 and over , COVID-19/therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Prospective Studies , SARS-CoV-2 , Young Adult
9.
Scand J Trauma Resusc Emerg Med ; 28(1): 94, 2020 Sep 22.
Article in English | MEDLINE | ID: covidwho-781501

ABSTRACT

BACKGROUND: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services-particularly helicopter services-caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients. METHODS: Nine different HEMS providers in seven different countries across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers in six countries agreed and reported their data regarding development of special procedures and safety instructions in preparation for the COVID-19 pandemic. Four providers agreed to provide mission related data. Three hundred eighty-five COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions. RESULTS: All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 4 (2-5) compared with 3 (1-7), needed significantly more medical interventions, were significantly younger (59.6 ± 16 vs 65 ± 21 years), and were significantly more often male (73% vs 60.5%). CONCLUSIONS: All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.


Subject(s)
Air Ambulances/organization & administration , Betacoronavirus , Coronavirus Infections/therapy , Emergency Service, Hospital/organization & administration , Pandemics , Pneumonia, Viral/therapy , Transportation of Patients/methods , COVID-19 , Coronavirus Infections/epidemiology , Europe/epidemiology , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2
13.
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
14.
Air Med J ; 39(4): 251-256, 2020.
Article in English | MEDLINE | ID: covidwho-197711

ABSTRACT

Recent coronavirus disease 2019 (COVID-19) events have presented challenges to health care systems worldwide. Air medical movement of individuals with potential infectious disease poses unique challenges and threats to crews and receiving personnel. The US Department of Health and Human Services air medical evacuation teams of the National Disaster Medical System directly supported 39 flights, moving over 2,000 individuals. Infection control precautions focused on source and engineering controls, personal protective equipment, safe work practices to limit contamination, and containment of the area of potential contamination. Source control to limit transmission distance was used by requiring all passengers to wear masks (surgical masks for persons under investigation and N95 for known positives). Engineering controls used plastic sheeting to segregate and treat patients who developed symptoms while airborne. Crews used Tyvek (Dupont Richmond, VA) suits with booties and a hood, a double layer of gloves, and either a powered air-purifying respirator or an N95 mask with a face shield. For those outside the 6-ft range, an N95 mask and gloves were worn. Safe work practices were used, which included mandatory aircraft surface decontamination, airflow exchanges, and designated lavatories. Although most patients transported were stable, to the best of our knowledge, this represents the largest repatriation of potentially contagious patients in history without infection of any transporting US Department of Health and Human Services air medical evacuation crews.


Subject(s)
Aerospace Medicine , Coronavirus Infections/prevention & control , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Transportation of Patients/methods , Betacoronavirus , COVID-19 , China , Coronavirus Infections/therapy , Disaster Medicine , Disinfection , Equipment and Supplies , Federal Government , Health Personnel , Humans , Medical Waste Disposal , Patient Isolation/methods , Personal Protective Equipment , Personnel Staffing and Scheduling , Pneumonia, Viral/therapy , Quarantine/methods , SARS-CoV-2 , Ships , United States , United States Dept. of Health and Human Services
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