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1.
CJEM ; 22(S2): S79-S83, 2020 09.
Article in English | MEDLINE | ID: covidwho-1387052

ABSTRACT

Transporting patients with communicable diseases is common in critical care transport operations. At Ornge, Ontario's critical care transport provider, 13.7% of patients required contact, droplet, or airborne precautions during transport in 2019-2020. Ensuring that staff are protected while transporting patients with communicable diseases must remain a prime directive for medical transport administrators and operators. Success in safety requires a robust system of hazard identification and adherence to generally accepted methods of hazard control. This commentary will discuss some of the administrative and engineering controls, as well as the personal protective equipment (PPE) strategies deployed at Ornge.


Subject(s)
Coronavirus Infections/epidemiology , Emergency Medical Services/standards , Infection Control/standards , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Safety Management/standards , Transportation of Patients/standards , Betacoronavirus , COVID-19 , Humans , Ontario/epidemiology , Pandemics , SARS-CoV-2
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.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200657, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1130365

ABSTRACT

OBJECTIVE: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. METHOD: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. RESULTS: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. FINAL CONSIDERATIONS: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.


Subject(s)
Ambulances/standards , COVID-19/prevention & control , Emergency Medical Services/standards , Emergency Medical Technicians/standards , Patient Safety/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic , Transportation of Patients/standards , Adult , Ambulances/statistics & numerical data , Brazil , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Patient Safety/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , SARS-CoV-2 , Transportation of Patients/statistics & numerical data
5.
Pediatr Emerg Care ; 37(3): 175-178, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1005977

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has brought new challenges to pediatric transport programs. The aims of this study were to describe the transport of pediatric patients with confirmed COVID-19 and to review the operational challenges that our transport system encountered. METHODS: A retrospective descriptive study was performed to review all COVID-19 pediatric transport performed over a 6-month period during the initial pandemic surge in 2020. Pediatric patients with a known positive SARS-CoV-2 polymerase chain reaction test at the time of transport were included. Patients' hospital records, including their transport record, were reviewed for demographics, diagnoses, transport interventions and complications, and admission disposition. Descriptive statistics were used to describe the patient cohort. RESULTS: Of the 883 transports performed between April and October 2020, 146 (16%) tested positive for COVID-19 during the initial surge in our geographical area. Patient acuity was diverse with 40% of children having a chronic complex medical condition. More than 25% of children required aerosol-generating procedures during transport. The most common medical diagnosis was respiratory compromise, and the most common surgical diagnosis was appendicitis. No adverse events occurred during transports, and no transport team members contracted COVID-19 because of workplace exposure. Transport program operational challenges ranged from rapidly changing system logistics/policies to educational and utilization of proper personal protective equipment. CONCLUSIONS: Children with COVID-19 can be transported safely with adaption of transport program procedures. Change management and team stress should be anticipated and can be addressed with repeated education and messaging.


Subject(s)
COVID-19/epidemiology , Pandemics , Transportation of Patients/standards , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective Studies , Young Adult
8.
Am J Emerg Med ; 46: 669-672, 2021 08.
Article in English | MEDLINE | ID: covidwho-714498

ABSTRACT

During the pandemic of 2019-nCoV, large public hospitals are facing great challenges. Multi-hospital development will be the main mode of hospital administrative management in China in the future. West China Hospital of Sichuan University implemented multi-hospital integrated management, in which the branch district established the administrative multi-department collaboration mode. As an important part of the operation of branch district, how to effectively organize transportation of staffs and patients and to prevent and control the pandemic of 2019-nCoV simultaneously between different hospitals have been the key and difficult points, which should be solved urgently in the management of the branch district.


Subject(s)
COVID-19/epidemiology , Disease Management , Hospital Administration/methods , Hospitals, Public/statistics & numerical data , Hospitals, University/statistics & numerical data , Pandemics , Transportation of Patients/standards , China/epidemiology , Humans , SARS-CoV-2
9.
Pediatr Res ; 89(5): 1094-1100, 2021 04.
Article in English | MEDLINE | ID: covidwho-635338

ABSTRACT

BACKGROUND: The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS: A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, two-step modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS: The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS: Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively. IMPACT: We present European consensus recommendations on pertinent measures for transporting infants and children in times of the coronavirus (SARS-Cov-2 /COVID-19) pandemic. A panel of experts reviewed the evidence around transporting infants and children with proven or suspected COVID-19. Specific guidance on aspects of personal protective equipment, airway management and considerations for incubator and open stretcher transports is presented. Based on scant evidence, best-practice recommendations for neonatal and paediatric transport teams are presented, aiming for the protection of teams and patients. We highlight gaps in knowledge and areas of future research.


Subject(s)
COVID-19/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Transportation of Patients/standards , Adolescent , Airway Management/methods , Airway Management/standards , COVID-19/diagnosis , COVID-19/transmission , Cardiopulmonary Resuscitation/methods , Child , Child, Preschool , Disinfection/methods , Disinfection/standards , Equipment Contamination/prevention & control , Europe , Humans , Incubators, Infant , Infant , Infant, Newborn , Noninvasive Ventilation/methods , Noninvasive Ventilation/standards , Parents , Patient Safety/standards , Personal Protective Equipment , Respiration, Artificial/methods , Respiration, Artificial/standards , Societies, Scientific , Symptom Assessment
11.
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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