Repatriation of a Critically Ill Coronavirus Disease 2019-Positive Patient Across Closed Borders.

We report on the international retrieval of a critically ill, ventilated, coronavirus disease 2019-positive patient from Dili, East Timor, into the intensive care unit of the Royal Darwin Hospital in Australia. The patient had severe respiratory failure, and the medical team in Dili was struggling to maintain adequate oxygenation with a fraction of inspired oxygen of 1 most of the time. This occurred during an outbreak of coronavirus disease 2019 in East Timor, placing strain on the local health system. Therefore, it was decided to transfer the patient to Australia. Given the closed international borders of Australia, organization of the retrieval and infection control measures were challenging and are described in the article. We discuss the need for a pathway to retrieve critically ill patients into a well-resourced country during a pandemic and the importance of public health measures including a robust vaccination program.

Impact of Critical Care Point-of-Care Ultrasound Short-Courses on Trainee Competence.

OBJECTIVES: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. DESIGN: Web-based survey. SETTING: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. SUBJECTS: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. INTERVENTIONS: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultrasound as a clinical diagnostic aid. MEASUREMENTS AND MAIN RESULTS: The response rate was 74.9% (182/243). Among the 182 respondents, only 12 (6.6%) had attained competence in their chosen point-of-care ultrasound modality, attributing their success to self-motivation and time management. For the remaining doctors who did not attain competence (170/182, 93.4%), the common reasons were lack of time, change of priorities, and less commonly, difficulties in accessing an ultrasound machine/supervisor. Common suggestions to improve short-courses included requests for scanning practice on acutely ill ICU patients and prior information on the challenges regarding point-of-care ultrasound competence. Suggestions to improve competence pathways included regular supervision and protected learning time. All 12 credentialled doctors regularly used point-of-care ultrasound as a clinical diagnostic aid. Of the 170 noncredentialled doctors, 123 (72.4%) reported performing unsupervised point-of-care ultrasound for clinical management, either sporadically (42/170, 24.7%) or regularly (81/170, 47.7%). CONCLUSIONS: In this survey of doctors attending point-of-care ultrasound short-courses in Australasia, the majority of doctors did not attain competence. However, the practice of unsupervised point-of-care ultrasound use by noncredentialled doctors was common. Further research into effective strategies to improve point-of-care ultrasound competence is required.