Advanced Medical Devices for Preparation and Administration of Chemotherapeutic Agents: Results from a Multi-Dimensional Evaluation.

PURPOSE: To evaluate the incremental benefits concerning the implementation of closed-system medical devices for the preparation and administration of chemotherapy agents (integrated or not with traceable workflow), within an Italian clinical practice, in which the use of such technologies is not standardized. METHODOLOGY: Four Scenarios, implying different levels of technologies introduction, were analyzed, based on the presence and/or absence of closed systems and traceable workflow, in the preparation and in the administration phase. A literature review was conducted, in order to retrieve efficacy and safety measures. Economic and organizational benefits, assuming a hospitals perspective, were assessed by means of health-economics tools, considering 27,660 (±695.86) drugs on average prepared, on an annual basis, by 12 hospitals involved. The typology of medical devices and other devices/equipment used, the human resources involved, and the time spent for the preparation and administration phases were collected. RESULTS: Literature stated that the introduction of advanced technologies (CSTDs in the preparation phase, closed-system in the administration phase, both integrated by a traceable workflow) could: i) decrease surface contamination (12.24% vs 26.39%, P<0.001) and ii) improve the capability to identify dosage errors (7% vs 0.096%, P<0.05). The above technologies presented the best trade-off between cost sustained and efficacy gained. Despite marginal investments (ranging from +1% to +6%) being required for their acquisition, an organizational saving equal to more than 1,000 working hours emerged, which could be spent on other hospital activities. CONCLUSION: The implementation of closed systems, integrated with a traceable workflow grounding on gravimetric control, may be considered a valid technological alternative within the investigated setting. The marginal incremental costs could be absorbed already in the first year after their introduction, in particular, because of the potential time saving in using closed systems in both the preparation and administration phases, demonstrating the sustainability and feasibility of such advanced technologies.

Flight vibrations and bleeding in helicoptered patients with pelvic fracture.

Depending on their amplitude and frequency, vibrations may facilitate bleeding and worsen the prognosis of patients with pelvic fractures transported by helicopter emergency medical services (HEMS). We measured the range of frequencies and amplitudes of forced vibrations produced by the helicopter used by the HEMS of the Italian Friuli Venezia Giulia region on the pelvis of transported persons. We performed 3 flight tests with 3 different volunteers (mass 70, 80, and 90 kg, respectively) loaded on the helicopter's stretcher and recorded the amplitudes and frequencies of vibrations through a triaxis sensor placed on the HEMS stretcher in the pelvis area. The flight profile planned was identical for each of the 3 iterations. Over the whole flight, the frequencies of vibration were between 26.4 and 53.5 Hz, and the greastest amplitude was 0.035 mm. The vibrations recorded in the helicopter may facilitate bleeding in unstable fractures. In the management of patients with pelvic fractures, HEMS crews should provide prehospital care that includes the use of specific splinting devices in addition to the spinal board, which allows an early immobilization of fractures and the limitation of pelvic motion.

Influence of helicopter flight on temperature of helicopter EMS crewmembers.

INTRODUCTION: Thermoregulation of critically ill patients during helicopter emergency medical service (HEMS) transport can be influenced by the flight, increasing the risk of hypothermia. However, the literature is unclear as to whether temperature decrease among those patients is affected by the flight itself or by the patients' clinical status and therapies. We evaluated the effect of helicopter flight on the body temperature of the healthy members of the HEMS crew of the Friuli Venezia Giulia region, Italy. METHODS: From August 12 to September 3, 2009, and from February 12 to April 1, 2010, tympanic temperature was measured, on a voluntary basis, before and after the flight among the crewmembers. The effect of flight and personal characteristics on temperature after the flight was analyzed through multivariate regression. RESULTS: Ninety-five records were analyzed. On average, the temperature increased by 0.2 ± 0.5°C. In 29.5% of the cases, however, it decreased. The only factors that were significantly associated with the temperature after the flight were temperature at liftoff and mountain rescue flights. CONCLUSION: Among healthy subjects, the helicopter vibrations may induce an increase in body temperature. Small sample size and lack of information on a number of potential confounders prevented the identification of the possible determinants of a temperature decrease among some subjects.

Influence of stressors on HEMS crewmembers in flight.

INTRODUCTION: Helicopter emergency medical service (HEMS) crew are subject to various sources of environmental, physical, and psychological stress. We measured the changes in heart rate and blood pressure as indicators of stress among the crewmembers of the regional HEMS of the Region Friuli Venezia Giulia, Italy. METHODS: From August 12 to September 3, 2009, and from February 12 to April 1, 2010, heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) were measured, on a voluntary basis, before and after each flight among the crewmembers. Oxygen saturation (SpO(2)) was also recorded. The effects of flight and personal characteristics on the parameters after the flight were analyzed through multivariate regression. RESULTS: Data on 95 work shifts, corresponding to 162 flights, were collected. Only the HR changed significantly after the flight (median change: 15 beats/min considering all the flights). The increase in HR was significantly greater in flights with adverse weather conditions, in hostile environments, and at high altitude than in the others. The change in HR was inversely correlated with that of SpO(2). After adjusting for potential confounders, the HR after the flight was significantly higher among technical personnel than among physicians and nurses. CONCLUSIONS: The increase in HR after the flight indicates that the HEMS crew are exposed to stressful conditions during the mission. Monitoring such parameters may be helpful in recognizing the onset of acute stress and ensuring the safety of the patients and the crew themselves.