Shift in Prehospital Mode of Transportation for Trauma Patients During the COVID-19 Pandemic.

INTRODUCTION: Since the start of the COVID-19 pandemic, we experienced alterations to modes of transportation among trauma patients suffering penetrating injuries. Historically, a small percentage of our penetrating trauma patients use private means of prehospital transportation. Our hypothesis was that the use of private transportation among trauma patients increased during the COVID-19 pandemic and was associated with better outcomes. METHODS: We retrospectively reviewed all adult trauma patients (January 1, 2017 to March 19, 2021), using the date of the shelter-in-place ordinance (March 19, 2020) to separate trauma patients into prepandemic and pandemic patient groups. Patient demographics, mechanism of injury, mode of prehospital transportation, and variables such as initial Injury Severity Score, Intensive Care Unit (ICU) admission, ICU length of stay, mechanical ventilator days, and mortality were recorded. RESULTS: We identified 11,919 adult trauma patients, 9017 (75.7%) in the prepandemic group and 2902 (24.3%) in the pandemic group. The number of patients using private prehospital transportation also increased (from 2.4% to 6.7%, P < 0.001). Between the prepandemic and pandemic private transportation cohorts, there were reductions in mean Injury Severity Score (from 8.1 ± 10.4 to 5.3 ± 6.6: P = 0.02), ICU admission rates (from 15% to 2.4%: P < 0.001), and hospital length of stay (from 4.0 ± 5.3 to 2.3 ± 1.9: P = 0.02). However, there was no difference in mortality (4.1% and 2.0%, P = 0.221). CONCLUSIONS: We found that there was a significant shift in prehospital transportation among trauma patients toward private transportation after the shelter-in-place order. However, this did not coincide with a change in mortality despite a downward trend. This phenomenon could help direct future policy and protocols in trauma systems when battling major public health emergencies.

Methodology for designing intrahospital transportation of patients with suspected infectious disease that limits infection spread risk in China.

Aims: The transport of patients suspected of having COVID-19 requires careful consideration. Using paths selected at random and not accounting for person flow along the path are risk factors for infection spread. Intrahospital transportation (IHT) protocols and guidelines should be used to help reduce the risk of secondary virus transmission during transport. This study aimed to propose optimal IHT for patients with an infectious disease presenting in an out-patient area. Design: The map of a West China Hospital was used. We also used field investigation findings and simulated person flow to establish pathway length and transportation time. We identified three optimum pathways and estimated safety boundary marks, including a patient transportation border (PTB) and safety transportation border (STB). Finally, IHT, PTB, and STP formed a virtual transport pipeline (VTP) and a traceable IHT management system, which can generate a virtual isolation space. Results: The three pathways met efficiency, accessibility, and by-stander flow criteria. No facility characteristic modification was required. Conclusions: Using virtual models to identify pathways through out-patient hospital areas may help reduce the risk of infection spread.

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective.

BACKGROUND: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services-particularly helicopter services-caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients. METHODS: Nine different HEMS providers in seven different countries across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers in six countries agreed and reported their data regarding development of special procedures and safety instructions in preparation for the COVID-19 pandemic. Four providers agreed to provide mission related data. Three hundred eighty-five COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions. RESULTS: All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 4 (2-5) compared with 3 (1-7), needed significantly more medical interventions, were significantly younger (59.6 ± 16 vs 65 ± 21 years), and were significantly more often male (73% vs 60.5%). CONCLUSIONS: All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.

Decision Making and Interventions During Interfacility Transport of High-Acuity Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

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.

Medical Transport for 769 COVID-19 Patients on a Cruise Ship by Japan Disaster Medical Assistance Team.

The Diamond Princess cruise ship, carrying 3711 passengers and crew members, docked at Yokohama Port in Japan on February 3, 2020. A quarantine was immediately instituted because 1 passenger who had disembarked in Hong Kong was confirmed to have tested positive for coronavirus disease 2019 (COVID-19). After the quarantine began, all passengers and crew were tested using the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction assay on the ship, 696 of whom tested positive. In total, 769 patients, including 696 with COVID-19, required transport to a hospital. The Japan Disaster Medical Assistance Team (DMAT) successfully picked up and safely transported the COVID-19 patients using a novel classification system to prioritize patients. The Japan DMAT transported 203 patients to hospitals in Kanagawa and another 566 patients to hospitals in 15 different prefectures.

Inter-hospital COVID ECMO air transportation.

The Coronavirus Disease 2019 (COVID-19) pandemic has required rapid and effective protocol adjustments at every level of healthcare. The use of extracorporeal membrane oxygenation (ECMO) is pivotal to COVID-19 treatment in cases of refractory hypoxemic hypercapnic respiratory failure. As such, our large, metropolitan air ambulance system in conjunction with our experts in advanced cardiopulmonary therapies modified protocols to assist peripheral hospitals in evaluation, cannulation and initiation of ECMO for rescue and air transportation of patients with COVID-19 to our quaternary center. The detailed protocol is described alongside initial data of its use. To date, 14 patients have been placed on ECMO support at an outside facility and successfully transported via helicopter to our hub hospital using this protocol.

Transport of awake hypoxemic probable COVID 19 patients in the prone position.

OBJECTIVE: We aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients. METHODS: Hypoxic and awake patients with probable COVID 19 pneumonia who were referred to the Ankara City Hospital Emergency Department from 1 April to 31 May 2020 were included in this prospective study. Patients were transported in prone position and fixed on the stretcher. During the transport, patients continued receiving 2 l per minute oxygen with nasal cannula. Arterial blood gases were obtained from the patients before and after transport. The transport time was recorded as minutes. The primary outcome of the study is the increase of partial oxygen value in the arterial blood gas of patients after transport. RESULTS: It was found that pO2 and SpO2 end values were statistically significantly higher in the patient group compared to the initial values. In the group with transport duration of more than 15 min, a difference was found between the initial and end values in pO2 and SpO2 parameters similar to the whole group. However, there was no statistically significant difference between the initial and end values in the group with transport duration of 15 min or below. CONCLUSIONS: Awake hypoxemic patients can be transported without complications in prone position during transport. Transports more than 15 min, prone position may be recommended because the partial oxygen pressure of the patients increases.

Mass Air Medical Repatriation of Coronavirus Disease 2019 Patients.

Recent coronavirus disease 2019 (COVID-19) events have presented challenges to health care systems worldwide. Air medical movement of individuals with potential infectious disease poses unique challenges and threats to crews and receiving personnel. The US Department of Health and Human Services air medical evacuation teams of the National Disaster Medical System directly supported 39 flights, moving over 2,000 individuals. Infection control precautions focused on source and engineering controls, personal protective equipment, safe work practices to limit contamination, and containment of the area of potential contamination. Source control to limit transmission distance was used by requiring all passengers to wear masks (surgical masks for persons under investigation and N95 for known positives). Engineering controls used plastic sheeting to segregate and treat patients who developed symptoms while airborne. Crews used Tyvek (Dupont Richmond, VA) suits with booties and a hood, a double layer of gloves, and either a powered air-purifying respirator or an N95 mask with a face shield. For those outside the 6-ft range, an N95 mask and gloves were worn. Safe work practices were used, which included mandatory aircraft surface decontamination, airflow exchanges, and designated lavatories. Although most patients transported were stable, to the best of our knowledge, this represents the largest repatriation of potentially contagious patients in history without infection of any transporting US Department of Health and Human Services air medical evacuation crews.