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1.
Indian Pediatr ; 61(3): 261-264, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38469845

RESUMO

Strategies for free transfer of sick neonates to hospitals are in place, but reports suggest suboptimal status of the same across the country. Over 7 years, our Sick Neonate Retrieval Service (SNRS) transported 165 neonates, of whom 92.1% survived. Safe, stable transportation mandates the presence of a neonatology-trained doctor and nurse in an equipped ambulance.


Assuntos
Ambulâncias , Transporte de Pacientes , Recém-Nascido , Humanos , Hospitais
2.
Aerosp Med Hum Perform ; 95(4): 219-222, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38486324

RESUMO

BACKGROUND: Neonatal air transportation is a crucial means of moving critically ill or sick neonates to specialized neonatal intensive care units or medical centers for consultation, regardless of distance or geographical limits. Proper preparation and consideration of air transport can help alleviate medical emergencies and ensure safe delivery. However, crewmembers and neonates may face stress during transportation. To date, there are few studies on neonatal air transportation in Taiwan.CASE REPORT: We present the case of a late preterm neonate born with neonatal respiratory distress syndrome and polycythemia, who was also diagnosed with patent ductus arteriosus and mild pulmonary arterial hypertension on echocardiography. Due to disease progression, the neonate underwent endotracheal intubation and was subsequently transported to a medical center in Taiwan via a rotary-wing aircraft at 3 d of age. During takeoff and landing, a temporary oxygen desaturation event occurred. The physiological changes in these patients have seldom been discussed. This case emphasizes the important considerations of neonatal transport in Taiwan.DISCUSSION: The air transport process could be influenced by both the patient's medical condition and environmental factors. In preterm infants with cardiopulmonary conditions, thorough assessment is necessary for ensuring safe transportation.Li S-P, Hsu P-C, Huang C-Y, Wu P-W, Fang H-H. Air transportation impact on a late preterm neonate. Aerosp Med Hum Perform. 2024; 95(4):219-222.


Assuntos
Permeabilidade do Canal Arterial , Síndrome do Desconforto Respiratório do Recém-Nascido , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Transporte de Pacientes , Unidades de Terapia Intensiva Neonatal , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
3.
Crit Care Nurs Q ; 47(2): 119-125, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38419175

RESUMO

Air medical transport of critically ill and injured patients began during World War II. Now air transport has become an integral part of health care, nationally and internationally. With the development of portable medical equipment critical care has extended beyond the hospital by bringing critical care to the scene or to rural hospitals. Air medical programs transport critically ill and injured patients by helicopter or airplane while continuously providing critical care enroute. These transports are interfacility from accident scenes, disaster areas, and remote locations where the patient is transported to a tertiary care center so that definitive care will be provided. The 2 modes of air transport are rotor wing (helicopters) and fixed wing (airplanes). Air medical transport is utilized when ground transportation is not conducive to patient criticality or location relative to a tertiary care center. There are many factors to consider when choosing a mode of transport, and each mode has its own unique advantages and disadvantages. Air medical programs place emphasis on clinical care, safety, and quality assurance, with the patient being the focused beneficiary. This article addresses implementation and management of rotor wing air medical transport with a focus on standards of care, safety, and quality.


Assuntos
Estado Terminal , Transporte de Pacientes , Humanos , Hospitais , Cuidados Críticos , Estudos Retrospectivos
4.
BMC Emerg Med ; 24(1): 21, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321422

RESUMO

BACKGROUND: During natural catastrophes, hospital staff members' readiness for crisis management-particularly concerning patient evacuation and improving their safety-becomes paramount. This study aimed to identify the components contributing to hospital staff members' preparedness to evacuate patients in an emergency. METHOD: A systematic review was conducted by searching databases such as Scopus, Web of Science, PubMed, ProQuest, and grey literature through May 2023. Studies that offered unique qualitative or quantitative data regarding hospital personnel readiness to evacuate patients in an emergency were included. Thematic analysis and descriptive statistics were used to examine the extracted data points. RESULTS: In total, there were 274 scientific articles. The total number of unique studies decreased to 181 after removing duplicate articles. 28 papers that were deemed appropriate for additional study were found based on the titles and abstracts of these articles. Eighteen papers that met the inclusion criteria were selected for the systematic review after their entire texts were finally assessed. Hospital staff preparedness for patient evacuation was divided into four primary topics and nineteen sub-themes. The four primary themes that emerged were management, communication, individual issues, and training on the evacuation process. CONCLUSION: The implementation of proper disaster evacuation training programs can be achieved by elevating the perceived sensitivity and protective motive of personnel and considering the personnel's stages of change. Training hospital staff to properly evacuate patients during disasters is also significantly impacted by other factors, such as effective administration, leadership and prompt and efficient communication.


Assuntos
Planejamento em Desastres , Desastres , Hospitais , Transporte de Pacientes , Humanos , Comunicação , Recursos Humanos em Hospital
5.
Sci Rep ; 14(1): 1736, 2024 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-38242912

RESUMO

Determining the optimal transportation for each stroke patient is critically important to achieve the best possible outcomes. In border regions the next comprehensive stroke center may be just across an international border, but bureaucratic and financial hurdles may prevent a simple transfer to the next stroke center. We hypothesized that in regions close to international borders, patients may benefit from an "open border, closed transfer scenario", meaning that patients in whom a large vessel occlusion (LVO) is detected in the primary stroke center will benefit from a transfer to the nearest stroke center offering endovascular thrombectomy-even if this may be across a national border. We used the Swiss-German-French trinational region as an example for a region with several international borders within close proximity to one another, and compared two feasible scenarios; (a) a "closed borders, open transfer" scenario, where the patient is transported to any center in the same country, (b) an "open border, closed transfer" scenario, where patients are always transported to the nearby primary stroke center first and then to the nearest comprehensive stroke center in either the same or a neighboring country and (c) and "open borders, open transfer" scenario. The outcome of interest was the predicted probability of acute ischemic stroke patients to achieve a good outcome using a conditional probability model which predicts the likelihood of excellent outcome (modified Rankin scale score of 0-1 at 90 days post-stroke) for patients with suspected LVO. Results were modeled in a virtual map from which the ideal transport concept emerged. For an exemplary LVO stroke patient in Germany, the probability of a good outcome was higher in an open border, closed transfer scenario than with closed borders, open transfer (33.1 vs. 30.1%). Moreover, time to EVT would decrease from 232 min in the first scenario to 169 min in an open border, closed transfer scenario. The catchment area of the University Hospital Basel was almost double the size in an open border, closed transfer scenario compared to closed borders (1674 km2 vs. 2897 km2) and would receive transfers from 3 primary stroke centers in other countries (2 in Germany and 1 in France). Stroke patients showed a higher likelihood of good outcome in the "open border" scenarios without transfer restrictions to a specific healthcare system. This probably has implications for stroke treatment in all border regions where EVT eligible stroke patients may benefit from transport to the closest EVT capable center whenever possible, regardless of whether this hospital is located in the same or a neighboring country/jurisdiction.


Assuntos
Arteriopatias Oclusivas , Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , AVC Isquêmico/etiologia , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/etiologia , Trombectomia , Transporte de Pacientes , Arteriopatias Oclusivas/etiologia , Procedimentos Endovasculares/efeitos adversos , Resultado do Tratamento , Isquemia Encefálica/etiologia
6.
Tidsskr Nor Laegeforen ; 144(1)2024 01 23.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-38258724

RESUMO

BACKGROUND: The Western Norway Regional Health Authority uses SATS Norge (SATS-N), a modified version of the South African Triage Scale, in all accident and emergency departments (A&E) and ambulance services in the region. The purpose of the study was to examine the validity of the paediatric component of SATS-N used for children transported to hospital by ambulance for emergency medical assistance. MATERIAL AND METHOD: We conducted a retrospective observational study which included all children in the age group 0-14 years, admitted by ambulance to A&E at Haukeland University Hospital for emergency medical assistance in the period from January to June 2020. The five triage levels in SATS-N were dichotomised to high triage level (the two highest triage categories) or low triage level (the three lowest triage categories). Sensitivity was calculated as the proportion of patients assigned to the high triage level among those who were directly transferred from A&E to a high dependency unit, and specificity as the proportion of patients assigned to the low triage level among those who were not directly transferred to a high dependency unit. RESULTS: Of a total of 303 patient transports, 270 (89 %) were triaged in the ambulance and 243 (80 %) in the A&E. In the pre-hospital and A&E settings, the sensitivity of SATS-N was 96 % and 88 %, and specificity was 46 % and 60 %, respectively. INTERPRETATION: For children admitted to hospital by ambulance, SATS-N had high sensitivity and low specificity for identifying patients who needed to be directly transferred from A&E to a high dependency unit.


Assuntos
Ambulâncias , Serviços Médicos de Emergência , Triagem , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Doença Aguda , Ambulâncias/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Noruega/epidemiologia , Estudos Retrospectivos , Transporte de Pacientes , Triagem/classificação , Triagem/estatística & dados numéricos
7.
J Burn Care Res ; 45(1): 158-164, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-37698243

RESUMO

Specialized burn centers are critical to minimizing burn-associated morbidity and mortality. However, American Burn Association-verified burn centers are unequally distributed across the United States, and fewer centers are available for pediatric patients relative to adults. The economic burden of transporting patients to these centers contributes significantly to the high cost of burn care. This study quantifies inequitable burn care access in the contiguous United States due to age group and location as a function of physical proximity to a verified burn center and transportation cost. County-level distances to the nearest verified adult or pediatric burn center were determined and mapped. Distance calculations for each population were combined with transport cost data (2022 CMS Ambulance Fee Schedules) to estimate transportation costs for each population (adult vs pediatric, urban vs rural). Pediatric patients reside 30.5 miles further than adults from the nearest center, significantly increasing transportation costs. Ground and air transport costs also increased for rural versus urban patients. Notably, rural patients face almost double the cost of air transport. While physical proximity to burn care appears to differ only modestly across age and region, this marginal increase in distance is associated with significant economic impact. This study highlights physical and economic barriers to burn care access faced by rural and pediatric patients and underscores the critical need to improve equity in burn care access. Future studies should expand on this report's findings to more fully characterize the additional costs associated with inequitable burn care access.


Assuntos
Unidades de Queimados , Queimaduras , Adulto , Humanos , Estados Unidos , Criança , Queimaduras/terapia , Transporte de Pacientes , População Rural
8.
Air Med J ; 43(1): 60-62, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38154843

RESUMO

Fixed Wing Air Ambulance providers routinely transport patients agitated from traumatic brain injury sequelae across long distances in a unique environment. The current paradigm limits options available to air medical clinicians to those routinely found on ground based, short distance vehicles, plus whatever a sending facility might be willing to provide. We postulate that dexmedetomidine offers a safe, effective alternative to improve patient care and enhance the safe operation of aircraft.


Assuntos
Resgate Aéreo , Dexmedetomidina , Humanos , Transporte de Pacientes , Dexmedetomidina/uso terapêutico , Aeronaves
9.
OTJR (Thorofare N J) ; 44(1): 47-56, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37381903

RESUMO

Individuals with a spinal cord injury (SCI) have challenges using transportation. Autonomous shuttles (ASs), if accessible, may support their transportation needs. This study quantified the perceptions of AS for adults with and without SCI, before and after riding in the AS. We hypothesized that the perceptions of AS for individuals with SCI would improve, by the greatest magnitude, after riding in the AS. This mixed-method quasi-experimental design included 16 adults with SCI and 16 age-matched controls. While there were no differences between the groups, both groups reported having fewer perceived barriers to using AS after riding in the AS (p = .025). After riding in the AS, both groups stated that the AS must be available, accessible, and affordable if they are to use AS. In conclusion, adults with SCI should experience AS if they are to accept and adopt this mode of transportation.


Assuntos
Traumatismos da Medula Espinal , Transporte de Pacientes , Adulto , Humanos
11.
J Korean Med Sci ; 38(42): e317, 2023 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-37904654

RESUMO

BACKGROUND: This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the Emergency Medical Service (EMS) system in South Korea. The study focused on the differences in EMS time intervals following the COVID-19 outbreak, particularly for patients with fever. METHODS: A retrospective analysis of EMS patient transportation data from 2017 to 2022 was conducted using the national EMS database. RESULTS: Starting from the year 2020, coinciding with the COVID-19 outbreak, all EMS time intervals experienced an increase. For the years 2017 to 2022, the mean response time interval values were 8.6, 8.6, 8.6, 10.2, 12.8, and 11.4 minutes, and the mean scene time interval values were 7.1, 7.2, 7.4, 9.0, 9.8, and 10.9 minutes. The mean transport time interval (TTI) values were 12.1, 12.3, 12.4, 14.2, 16.9, and 16.2 minutes, and the mean turnaround time interval values were 27.6, 27.9, 28.7, 35.2, 42.0, and 43.1 minutes. Fever (≥ 37.5°C) patients experienced more pronounced prolongations in EMS time intervals compared to non-fever patients and had a higher probability of being non-transported. The mean differences in TTI between fever and non-fever patients were 0.8, 0.8, 0.8, 4.3, 4.8, and 3.2 minutes, respectively, from 2017 to 2022. Furthermore, the odds ratios for fever patients being transported to the emergency department were 2.7, 2.9, 2.8, 1.1, 0.8, and 0.7, respectively, from 2017 to 2022. CONCLUSION: The study findings highlight the significant impact of the COVID-19 outbreak on the EMS system and emphasize the importance of ongoing monitoring to evaluate the burden on the EMS system.


Assuntos
COVID-19 , Serviços Médicos de Emergência , Humanos , Estudos Retrospectivos , COVID-19/epidemiologia , Transporte de Pacientes , Serviço Hospitalar de Emergência , Surtos de Doenças
12.
Uisahak ; 32(2): 463-501, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37718560

RESUMO

This research examines the expansion and characteristics of the Korean Army's chain of medical evacuation in 1948-1953. The most important goal of the chain of medical evacuation was to conserve fighting strength, which cannot be achieved only by sending the sick and wounded to the rear for treatment. It was more important to maintain as many mission-capable wounded soldiers on the frontline. Therefore, triage for conserving strength was the priority in the evacuation process, and military doctors conducting triage played a significant role. Focusing on military doctors, this article studies the instability of the Korean Army's medical evacuation chain. Although Korea was liberated from Japanese colonial rule in August 1945, Korea had no army or army medical services. With the support of KMAG, the Korean Army was able to build a nationwide evacuation chain during the Korean War. However, the expansion of the medical evacuation chain resulted in instability. At the heart of the instability was manpower, rather than organization and transportation. Koreans had almost no experience with the military medical services before 1948, and during the Korean War, most doctors, who had been conscripted after the outbreak of the war, were not trained as military doctors. Therefore, the Korean Army had no other choice but to conduct medical evacuations using mobilized civilian doctors who were not sufficiently trained as military doctors. The escalating war revealed the problems of civilian doctors in military uniforms. Unlike the goal of the chain of medical evacuation, they easily evacuated patients and were reluctant to release patients to return to their duties. Korean Army doctors who were not sufficiently trained as military doctors struggled between the goals of military medical services and those of medical care. Consequently, the military doctors and the instability of the medical evacuation chain during the Korean War reflect the fundamental tension between war and medicine.


Assuntos
Guerra da Coreia , Medicina Militar , Militares , Transporte de Pacientes , Triagem , Ferimentos e Lesões , Humanos , Povo Asiático , República da Coreia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
13.
J Oral Maxillofac Surg ; 81(11): 1383-1390, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37572693

RESUMO

BACKGROUND: In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE: The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE: This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S): The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES: Patient, injury, and hospital-related covariates were collected. ANALYSES: Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS: Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE: HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Armas de Fogo , Ferimentos e Lesões , Ferimentos por Arma de Fogo , Masculino , Humanos , Adulto , Adolescente , Transporte de Pacientes/métodos , Estudos Retrospectivos , Estudos Transversais , Ferimentos por Arma de Fogo/terapia , Serviços Médicos de Emergência/métodos , Escala de Gravidade do Ferimento
14.
J Emerg Nurs ; 49(6): 962-969, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37462596

RESUMO

INTRODUCTION: Air medical transport during the coronavirus disease 2019 pandemic was essential for transferring critically ill patients. This study aimed to comparatively analyze air-transported patients with and without coronavirus disease 2019 according to their clinical condition and complications that occurred during the flight. METHODS: This was a retrospective cohort study that analyzed the digital records of adult patients transported by fixed-wing aircraft from the interior of the state of Amazonas to the state capital Manaus, Brazil, from June 2019 to May 2021. Pearson's chi-squared, Fisher exact, and Wilcoxon-Mann-Whitney tests were applied (significance level of P < .05). RESULTS: The sample consisted of 741 patients (60.59% men, median age 54 years). The incidence of complications during the flight was 7.28%, with emphasis on dyspnea, psychomotor agitation, and pain. There was a significant difference between patients with (n = 466) and without coronavirus disease 2019 (n = 275) regarding the variables age (P < .001), comorbidities (P < .001), body mass index (P < .001), impact (P < .001) and priority (P = .002) of the transfer, physiological severity (P < .001), use of vasoactive drugs when boarding the aircraft (P = .033), and occurrence of respiratory complications during air medical transport (P = .003). DISCUSSION: Patients with coronavirus disease 2019 were older, had more comorbidities and were severely ill, and had higher body mass index, frequency of vasoactive drug use, and respiratory complications. Although there are minimal differences among these patients, the role that interhospital transfer plays in reducing burden on local, less well-equipped hospitals is a primary role of medical transport, particularly during pandemics.


Assuntos
COVID-19 , Masculino , Adulto , Humanos , Pessoa de Meia-Idade , Feminino , COVID-19/epidemiologia , Pandemias , Estudos Retrospectivos , Transporte de Pacientes , Comorbidade
15.
J Gen Intern Med ; 38(16): 3566-3573, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37464149

RESUMO

BACKGROUND: Over five million people in the USA miss or delay medical care because of a lack of transportation. Transportation barriers are especially relevant to Medicare Advantage (MA) health plan enrollees, who are more likely to live with multiple chronic conditions and experience mobility challenges. Non-Emergency Medical Transportation (NEMT) helps to address transportation gaps by providing rides to and from routine medical care (for example, medical appointments, laboratory tests, and pharmacy visits) and has been added as a supplemental benefit to some MA health plans. OBJECTIVE: We aimed to characterize MA enrollees' experiences with supplemental NEMT benefits. DESIGN: Qualitative interviews focused on participants' experiences with existing NEMT benefits, transportation, and mobility. PARTICIPANTS: Twenty-one MA enrollees who used their MA NEMT benefit in 2019 and who remained eligible for ongoing transportation benefits through 2021. APPROACH: Using purposive sampling from a list of eligible participants, we recruited individuals who used their MA NEMT benefit in 2019 and who remained eligible for benefit-covered transportation services through 2021. KEY RESULTS: Participants considered NEMT an essential service, particularly because these services helped them decrease social isolation, reduce financial insecurity, and manage their own medical needs. Navigating logistical challenges associated with arranging NEMT services required participants to commit considerable time and energy and limited the effectiveness and reliability of NEMT. CONCLUSION: Participants described NEMT as a valued service essential to their ability to access health care. They suggested ways to increase service flexibility and reliability that could inform future NEMT policy and practice. As health systems and payers learn how to best address social risks, particularly as the US population ages, our findings underscore the importance of NEMT services and highlight opportunities to advance comprehensive transportation solutions for MA participants.


Assuntos
Serviços Médicos de Emergência , Medicare Part C , Idoso , Humanos , Estados Unidos , Reprodutibilidade dos Testes , Transporte de Pacientes , Acesso aos Serviços de Saúde
16.
Artigo em Inglês | MEDLINE | ID: mdl-37510636

RESUMO

BACKGROUND: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients' healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. METHODS: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. RESULTS: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). CONCLUSIONS: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams' resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.


Assuntos
Serviços Médicos de Emergência , Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Feminino , Ambulâncias , Serviço Hospitalar de Emergência , Transporte de Pacientes , Hospitais
17.
Curr Probl Cardiol ; 48(10): 101855, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37321282

RESUMO

The aeromedical transportation (AMT) of critically ill cardiac patients can enable access to advanced specialized medical attention, or provide improved care for operational, psychosocial, political, or economic reasons. However, AMT is a complex undertaking necessitating extensive clinical, operational, administrative, and logistical planning to ensure that the patient receives an equivalent level of critical care monitoring and management in the air as on the ground. This paper is the second of a 2-part series. Part 1 focused on the preflight planning and preparation for critically ill cardiac patients during AMT aboard commercial platforms, while this current part aims to provide an overview of in-flight considerations for the same population.


Assuntos
Resgate Aéreo , Humanos , Transporte de Pacientes , Estado Terminal/terapia
18.
Anaesthesiologie ; 72(9): 635-642, 2023 09.
Artigo em Alemão | MEDLINE | ID: mdl-37369813

RESUMO

BACKGROUND: Although most people would like to die at home, many die in hospitals. The study shows physicians' and paramedics' experiences with prehospital care of patients at the end of life. METHOD: Using an anonymous online questionnaire, primary care physicians and ambulance personnel in the Frankfurt am Main metropolitan area were surveyed about their experiences with end of life care. RESULTS: A total of 63 primary care physicians (PCP) and 62 emergency medical service staff (EMS) answered the questionnaire (female 31.2%, male 68.8%). Of the respondents 65.8% reported that patients are often still transported to hospital at the end of life. Of the participants 17.9% felt confident in their assessment of a patient at the end of life, 33.3% of PCP and 8.5% of EMS felt confident about subsequent treatment and 91.9% of PCP and 96.2% of EMS reported that they always/often ask about an advance healthcare directive. Of the participants 98.3% felt that EMS rarely/never ask about advance care planning, 78.7% of all participants would rarely/never ask about it and 90.4% of EMS would like to have a legally secure emergency document to guide their actions. CONCLUSION: Transporting patients at the end of life is part of everyday prehospital practice. There are uncertainties in the assessment and care of these patients. In the future, rescue service and medical training should include specific palliative care strategies. Advance healthcare directive and advance care planning must be more widely recognized by the medical community, so that in emergency situations the desired corridors of action in the best interests of the patient are quickly made known.


Assuntos
Serviços Médicos de Emergência , Assistência Terminal , Transporte de Pacientes , Humanos , Ambulâncias , Cuidados Paliativos , Médicos de Atenção Primária
19.
Travel Med Infect Dis ; 54: 102613, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37331494

RESUMO

INTRODUCTION: With international travel for leisure and business almost back to pre-pandemic levels, demand for repatriation due to illness and injury abroad is increasing [1,2]. In any repatriation, there is considerable pressure on all involved to organize a rapid transport back home. Delay in such action may be perceived by the patient, relatives, and the public as an attempt by the underwriter to hold off on an expensive air ambulance mission [3-5]. METHODS: Review of the available literature and analysis of assistance and air ambulance Companies' infrastructure and processes to identify risk and benefit of executing or delaying aeromedical transport for international travellers. KEY FINDINGS: While patients of almost any severity can be safely transported over great distances in modern air ambulance aircraft, immediate transport is not always in the patient's best interest. Each call for assistance requires a complex and dynamic risk-benefit analysis with multiple stakeholders involved to achieve an optimized outcome. Opportunities for risk mitigation within the assistance team include active case management with clearly assigned ownership, as well as medical and logistical experience with knowledge on local treatment opportunities and limitations. On the air ambulance side, modern equipment, experience, standards and procedures as well as accreditation can reduce risk. CONCLUSIONS: Each patient evaluation remains a highly individual risk-benefit assessment. Optimal outcomes require a clear understanding of responsibilities, flawless communication and significant expertise among the key decision-makers. Negative outcomes are mostly associated with insufficient information, communication, inadequate experience or a lack of ownership/assigned responsibility.


Assuntos
Resgate Aéreo , Humanos , Transporte de Pacientes/métodos , Aeronaves , Medição de Risco , Tomada de Decisões
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