Pretransport Risk Assessment of Agitated Patients in Air Medical Transport.

OBJECTIVE: To determine the ability for a simple pretransport mental health risk assessment tool for patients who are agitated or experiencing an acute psychiatric illness to predict in-transit disruptive behavior necessitating additional intervention(s) while being transported via air ambulance. METHODS: We conducted this retrospective cohort study using existing data from the provincial air and land critical care transport system (Ornge) in Ontario, Canada, from April 2019 until March 2020. A total of 498 cases were included in this study. Transport medicine physicians fill in the modified mental health risk assessment tool as part of their pretransport assessment of each mental health patient undergoing transport. The transport medicine physician-derived risk score is categorized as low, moderate, and high. The primary outcomes were sensitivity, specificity, and predictive values of the modified tool for predicting pre- or in-transit disruptive behavior necessitating escalation in care. RESULTS: Of those patients meeting the study criteria, 207, 198, and 93 cases were assessed as low, moderate, and high risk, respectively, for potential agitation or disruptive behavior requiring escalation of care during transport. The sensitivity, specificity, positive predictive value, and negative predictive value were 70% (95% confidence interval [CI], 69.2%-70.8%), 87.1% (95% CI, 86.9%-87.2%), 37.6% (95% CI, 37.0%-38.2%), and 96.3% (95% CI, 96.2%-96.4%), respectively. CONCLUSION: A simple pretransport risk assessment tool can reliably rule out the need for escalation of care during air medical transport of the potentially agitated patient. This may help improve resource utilization and safety, without sacrificing quality of care.

Clinical considerations for out-of-hospital cardiac arrest management during COVID-19.

Managing out-of-hospital cardiac arrest requires paramedics to perform multiple aerosol generating medical procedures in an uncontrolled setting. This increases the risk of cross infection during the COVID-19 pandemic. Modifications to conventional protocols are required to balance paramedic safety with optimal patient care and potential stresses on the capacity of critical care resources. Despite this, little specific advice has been published to guide paramedic practice. In this commentary, we highlight challenges and controversies regarding critical decision making around initiation of resuscitation, airway management, mechanical chest compression, and termination of resuscitation. We also discuss suggested triggers for implementation and revocation of recommended protocol changes and present an accompanying paramedic-specific algorithm.