RESUMEN
INTRODUCTION: There has been a rapid expansion in the use of point-of-care ultrasonography (POCUS) by emergency medical services (EMS). However, less than a third of UK EMS utilise imaging archiving for POCUS, and fewer review saved images as part of a clinical governance structure. This paper describes the implementation of a novel image archiving system and a robust clinical governance framework in our UK physician-paramedic staffed helicopter emergency medical service (HEMS). METHODS: A retrospective database review was conducted of all patients attended by East Anglian Air Ambulance (EAAA) between the introduction of a new POCUS device and image archiving system on 1 December 2020 to 31 January 2024. All patients with recorded POCUS examinations were included. Images from POCUS examinations at EAAA are archived on a cloud-based server, and retrospectively reviewed within 24 h by an EAAA POCUS supervisor. Image quality is graded using a 5-point Likert-type scale, agreement between reviewer and clinician is recorded and feedback is provided on scanning technique. T-tests were used to assess the difference in image quality between physicians and paramedics. Inter-rater reliability between reviewers and clinicians was assessed using Cohen's kappa (κ). RESULTS: During the study period, 5913 patients were attended by EAAA. Of these, 1097 patients had POCUS images recorded. The prevalence of POCUS during the study period was 18.6%. 1061 patient examinations underwent quality assurance (96.7%). The most common POCUS examination was echocardiography (60%), predominantly during cardiac arrest. The primary scanning clinician was a paramedic in 25.4% of POCUS examinations. Across all examination types; image quality was not significantly different between physicians and paramedics and agreement between reviewers and clinicians was strong (κ > 0.85). CONCLUSIONS: In this service evaluation study, we have described outcomes following the introduction of a new POCUS device, image archiving system and governance framework in our HEMS. Paramedics were the primary scanning clinician in a quarter of scans, with image quality comparable to physicians. Almost all scans underwent quality assurance and inter-rater reliability was strong between clinicians and reviewers. Further research is required to investigate the diagnostic accuracy of POCUS and to demonstrate the effect of utilising prehospital POCUS to refine diagnosis on clinical outcomes.
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Ambulancias Aéreas , Servicios Médicos de Urgencia , Sistemas de Atención de Punto , Ultrasonografía , Humanos , Estudios Retrospectivos , Ambulancias Aéreas/organización & administración , Reino Unido , Sistemas de Atención de Punto/organización & administración , Servicios Médicos de Urgencia/organización & administración , Médicos , Técnicos Medios en Salud , Gestión Clínica/organización & administración , ParamédicoRESUMEN
BACKGROUNDS: Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. METHODS: Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. RESULTS: In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. CONCLUSIONS: Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. TRIAL REGISTRATION: Not applicable.
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Liderazgo , Humanos , Estudios Prospectivos , Estudios Transversales , Masculino , Femenino , Encuestas y Cuestionarios , Grupo de Atención al Paciente/organización & administración , Adulto , Competencia Clínica , Servicios Médicos de Urgencia/organización & administración , Persona de Mediana Edad , Medicina de Emergencia/educación , Medicina de Emergencia/organización & administración , Ambulancias Aéreas/organización & administración , Estados Unidos , Europa (Continente)RESUMEN
OBJECTIVE: As part of the humanitarian response to the coronavirus disease 2019 (COVID-19) pandemic, the German and French Armed Forces provided air transport for patients from overwhelmed regional hospitals in Italy and France. The objective of this study was to analyze the characteristics of the missions and the medical conditions of COVID-19 patients transported during an air medical evacuation on fixed wing aircraft in March and April 2020. METHOD: This was a retrospective analysis of transport records as well as other documents for 58 COVID-19 patients requiring artificial ventilation. RESULTS: The median age of the transported patients was 61.5 years, and 61% of them had preexisting medical conditions. They had been ventilated for a median of 5 days and experienced the first symptoms 18 days before transport. The patients flown out of France had less days of ventilation before flight, a lower end-tidal carbon dioxide level at the beginning of the flight, and a lower Charlson Comorbidity Index. There were also some differences between the ventilation and the flight level flown by the 2 air forces. CONCLUSION: The intensive care transport of ventilated COVID-19 patients requires highly qualified personnel and appropriate equipment and should be planned appropriately.
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Ambulancias Aéreas , COVID-19/diagnóstico , COVID-19/terapia , Cuidados Críticos , Transferencia de Pacientes , Anciano , Ambulancias Aéreas/organización & administración , Ambulancias Aéreas/estadística & datos numéricos , COVID-19/epidemiología , Comorbilidad , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Cuidados Críticos/estadística & datos numéricos , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Transferencia de Pacientes/métodos , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Korea rarely has a system to transport patients from abroad. However, single-patient transfers are steadily being performed, and there was an experience of transferring a large number of personnel regardless of whether they were confirmed or not due to coronavirus disease 2019. Recently, a national soccer game was held abroad, and a total of 8 players and staff were infected. A total of 15 people were transported through a charter fully equipped with quarantine equipment by a medical response team with experience in air transport.
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Ambulancias Aéreas/organización & administración , Atletas , COVID-19/terapia , Cuarentena/métodos , Fútbol , Enfermedad Relacionada con los Viajes , Austria , COVID-19/diagnóstico , COVID-19/transmisión , Humanos , Cuarentena/organización & administración , República de CoreaRESUMEN
Virtually every country in the world has been affected by coronavirus disease 2019 (COVID-19). Nepal is a landlocked country located in Southern Asia. Nepal's population has suffered greatly due to a shortage of critical care facilities, resources, and trained personnel. For appropriate care, patients need access to hospitals mostly in the centrally located capital city of Kathmandu. Unfortunately, Nepal's resources and personnel dedicated to transferring COVID-19 patients are scarce. Road and traffic infrastructure problems and mountainous terrain prevent ground ambulances from performing effectively. This, in addition to Nepal lacking national standards for prehospital care, create great challenges for transferring patients via ground emergency medical services. The concept of helicopter emergency medical services (HEMS) began in 2013 in Nepal. Presently, 3 hospitals, Nepal Mediciti Hospital, Hospital for Advanced Medicine and Surgery (HAMS), and Grande International Hospital, coordinate with private helicopter companies to run proper HEMS. One entity, Simrik Air, has dedicated 2 Airbus H125/AS350 helicopters for the sole purpose of transferring COVID-19 patients. HEMS effectiveness is expanding in Nepal, but much remains to be accomplished.
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Ambulancias Aéreas/organización & administración , COVID-19/terapia , Servicios de Salud Rural/organización & administración , Ambulancias Aéreas/estadística & datos numéricos , COVID-19/epidemiología , Humanos , Nepal/epidemiología , Servicios de Salud Rural/estadística & datos numéricosRESUMEN
BACKGROUND: Endovascular treatment of large vessel occlusion in acute ischemic stroke patients is difficult to establish in remote areas, and time dependency of treatment effect increases the urge to develop health care concepts for this population. SUMMARY: Current strategies include direct transportation of patients to a comprehensive stroke center (CSC) ("mothership model") or transportation to the nearest primary stroke center (PSC) and secondary transfer to the CSC ("drip-and-ship model"). Both have disadvantages. We propose the model "flying intervention team." Patients will be transported to the nearest PSC; if telemedically identified as eligible for thrombectomy, an intervention team will be acutely transported via helicopter to the PSC and endovascular treatment will be performed on site. Patients stay at the PSC for further stroke unit care. This model was implemented at a telestroke network in Germany. Fifteen remote hospitals participated in the project, covering 14,000 km2 and a population of 2 million. All have well established telemedically supported stroke units, an angiography suite, and a helicopter pad. Processes were defined individually for each hospital and training sessions were implemented for all stroke teams. An exclusive project helicopter was installed to be available from 8 a.m. to 10 p.m. during 26 weeks per year. Key Messages: The model of the flying intervention team is likely to reduce time delays since processes will be performed in parallel, rather than consecutively, and since it is quicker to move a medical team rather than a patient. This project is currently under evaluation (clinicaltrials NCT04270513).
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Ambulancias Aéreas/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico/terapia , Servicios de Salud Rural/organización & administración , Telemedicina/organización & administración , Trombectomía , Terapia Trombolítica , Áreas de Influencia de Salud , Procedimientos Endovasculares/efectos adversos , Humanos , Accidente Cerebrovascular Isquémico/diagnóstico , Trombectomía/efectos adversos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Tiempo de Tratamiento/organización & administración , Resultado del TratamientoRESUMEN
COVID-19, a highly infectious virus, presents self-evident problems with regards to aeromedical transportation. Droplet size, proximity of caregiver from the patient, severity of upper and lower respiratory symptoms, personal protective equipment (PPE) and turbulence of airflow are factors which may influence the transmission of any biological agent aboard an air transport platform. Given the relatively confined space of rotary-wing MEDEVAC helicopters and the lack of structural barriers between flight crew and passengers, transmission risk is high, particularly when close contact under these conditions last beyond 15 minutes.1 Some authorities strongly recommend against the rotary-wing evacuation of COVID-19 patients when ground or fixed-wing transport is available due to the high risk of transmission.2,3.
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Ambulancias Aéreas/organización & administración , COVID-19/prevención & control , COVID-19/transmisión , Control de Infecciones/organización & administración , Humanos , Equipo de Protección Personal , Guías de Práctica Clínica como AsuntoRESUMEN
PURPOSE: The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance 'Lifeliner 1' dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. METHODS: A retrospective review of all HEMS and HEMS-ambulance 'Lifeliner 1' dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. RESULTS: During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8-53). CONCLUSION: A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. LEVEL OF EVIDENCE: III, retrospective comparative study.
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Ambulancias Aéreas , COVID-19 , Servicios Médicos de Urgencia , Heridas y Lesiones , Adulto , Ambulancias Aéreas/organización & administración , Ambulancias Aéreas/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Control de Enfermedades Transmisibles/métodos , Urgencias Médicas/epidemiología , Operador de Emergencias Médicas/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicios Médicos de Urgencia/provisión & distribución , Femenino , Humanos , Masculino , Países Bajos/epidemiología , Salud Laboral/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , SARS-CoV-2 , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Heridas y Lesiones/terapiaRESUMEN
BACKGROUND: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. METHOD: We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20-22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests. RESULTS: Out of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all teams were physician staffed, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0-25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21-100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p < 0.01) and positive end-expiratory pressure (p = 0.04) of the patients were significantly higher compared to first patient contact. CONCLUSION: In this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS. TRIAL REGISTRATION: The survey was prospectively registered at Research Registry ( researchregistry2925 ).
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Ambulancias Aéreas/organización & administración , Aeronaves , Servicios Médicos de Urgencia/métodos , Sistema de Registros , Respiración Artificial/métodos , Adulto , Anciano , Anciano de 80 o más Años , Austria , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios , Suiza , Reino Unido , Adulto JovenRESUMEN
The aims of this article are to comment on pre-coronavirus disease 2019 (COVID-19) mental health activity in rural and remote Australia, including related air medical retrievals; to discuss how the current pandemic is likely to impact on this vulnerable population's mental health; and to provide potential solutions. The COVID-19 pandemic has resulted in significant air medical activity from rural and remote Australia. COVID-19 and the necessary public health and socioeconomic interventions are likely to significantly compound mental health problems for both the general public and the mental health workforce servicing rural and remote communities. However, the COVID-19 crisis provides a window of opportunity to develop, support, and build novel and sustainable solutions to the chronic mental health service vulnerabilities in rural and remote areas in Australia and other countries.
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COVID-19/psicología , Accesibilidad a los Servicios de Salud/organización & administración , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Servicios de Salud Rural/organización & administración , Adulto , Anciano , Ambulancias Aéreas/organización & administración , Ambulancias Aéreas/estadística & datos numéricos , Australia/epidemiología , COVID-19/epidemiología , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Servicios de Salud Mental/tendencias , Persona de Mediana Edad , Pandemias , Salud Rural/tendencias , Servicios de Salud Rural/tendencias , Telemedicina/métodos , Telemedicina/organización & administración , Telemedicina/tendenciasRESUMEN
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.
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Ambulancias Aéreas/organización & administración , Betacoronavirus , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital/organización & administración , Pandemias , Neumonía Viral/terapia , Transporte de Pacientes/métodos , COVID-19 , Infecciones por Coronavirus/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Estudios Retrospectivos , SARS-CoV-2RESUMEN
The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. Teams of five comprising two on-site junior ER physicians would be paired with two CAS doctors, who would be off-site but be in constant communication via teleconferencing to render real-time administrative support. They would be supervised by an ER attending. This reduces direct viral exposure to doctors, conserves precious personal protective equipment and allows ER physicians to focus on patient care. Medical students can also be involved in a safe and supervised manner. After 1 month, the average time to patient disposition was halved. General feedback was also positive. CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.
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Ambulancias Aéreas/organización & administración , Infecciones por Coronavirus/prevención & control , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Recursos Humanos/organización & administración , COVID-19 , Infecciones por Coronavirus/epidemiología , Medicina de Emergencia/organización & administración , Femenino , Humanos , Masculino , Innovación Organizacional , Evaluación de Resultado en la Atención de Salud , Pandemias/estadística & datos numéricos , Proyectos Piloto , Neumonía Viral/epidemiología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la CalidadRESUMEN
OBJECTIVE: to describe the experience of military nursing in "Operation Return to Brazil" in an aeromedical evacuation. METHOD: this is an experience report of the nursing staff in the Aeromedical Evacuation of potentially-contaminated Brazilians who were in Wuhan, China, after the outbreak of the new coronavirus. RESULTS: the report was constructed from nursing care performed in three stages: pre-flight, screening, and flight. Pre-flight care would include aircraft configuration and material prediction. In screening, the staff was concerned with being properly attired. In the health assessment of returnees, in-flight, attention was focused on Personal Protective Equipment handling to minimize the risk of contamination by prolonged contact with potentially-contaminated passengers. Final considerations: nursing was committed to planning all the actions of this mission, which was one of the longest, strenuous and unprecedented in the history of aeromedical transport in Brazil.
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Ambulancias Aéreas/organización & administración , Infecciones por Coronavirus/prevención & control , Enfermería Militar/organización & administración , Personal Militar/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/prevención & control , Adulto , Ambulancias Aéreas/estadística & datos numéricos , Betacoronavirus , Brasil , COVID-19 , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermería Militar/estadística & datos numéricos , Pandemias/prevención & control , SARS-CoV-2RESUMEN
Policy Points Out-of-network air ambulance bills are a type of surprise medical bill and are driven by many of the same market failures behind other surprise medical bills, including patients' inability to choose in-network providers in an emergency or to avoid potential balance billing by out-of-network providers. The financial risk to consumers is high because more than three-quarters of air ambulances are out-of-network and their prices are high and rising. Consumers facing out-of-network air ambulance bills have few legal protections owing to the Airline Deregulation Act's federal preemption of state laws. Any federal policies for surprise medical bills should also address surprise air ambulance bills and should incorporate substantive consumer protections-not just billing transparency-and correct the market distortions for air ambulances. CONTEXT: Out-of-network air ambulance bills are a growing problem for consumers. Because most air ambulance transports are out-of-network and prices are rising, patients are at risk of receiving large unexpected bills. This article estimates the prevalence and magnitude of privately insured persons' out-of-network air ambulance bills, describes the legal barriers to curtailing surprise air ambulance bills, and proposes policies to protect consumers from out-of-network air ambulance bills. METHODS: We used the Health Care Cost Institute's 2014-2017 data from three large national insurers to evaluate the share of air ambulance claims that are out-of-network and the prevalence and magnitude of potential surprise balance bills, focusing on rotary-wing transports. We estimated the magnitude of potential balance bills for out-of-network air ambulance services by calculating the difference between the provider's billed charges and the insurer's out-of-network allowed amount, including the patient's cost-sharing. For in-network air ambulance transports, we calculated the average charges and allowed amounts, both in absolute magnitude and as a multiple of the rate that Medicare pays for the same service. FINDINGS: We found that less than one-quarter of air ambulance transports of commercially insured patients were in-network. Two-in-five transports resulted in a potential balance bill, averaging $19,851. In the latter years of our data, in-network rates for transports by independent (non-hospital-based) carriers averaged $20,822, or 369% of the Medicare rate for the same service. CONCLUSIONS: Because the states' efforts to curtail air ambulance balance billing have been preempted by the Airline Deregulation Act, a federal solution is needed. Owing to the failure of market forces to discipline either prices or supply, out-of-network air ambulance rates should be benchmarked to a multiple of Medicare rates or, alternatively, air ambulance services could be delivered and financed through an approach that combines competitive bidding and public utility regulation.
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Ambulancias Aéreas/economía , Financiación Personal/estadística & datos numéricos , Política de Salud , Ambulancias Aéreas/organización & administración , Ambulancias Aéreas/estadística & datos numéricos , Honorarios y Precios/estadística & datos numéricos , Financiación Personal/economía , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/organización & administración , Seguro de Salud/estadística & datos numéricos , Prevalencia , Estados UnidosAsunto(s)
Ambulancias Aéreas/organización & administración , Infecciones por Coronavirus/prevención & control , Salud Laboral , Pandemias/prevención & control , Neumonía Viral/prevención & control , COVID-19 , Canadá , Infecciones por Coronavirus/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Servicios Médicos de Urgencia/organización & administración , Femenino , Humanos , Control de Infecciones/métodos , Masculino , Pandemias/estadística & datos numéricos , Seguridad del Paciente , Neumonía Viral/epidemiología , Medición de RiesgoRESUMEN
Disasters cause a huge number of injured patients in a short time while existing emergency facilities encountered devastation and cannot respond properly. Here, the importance of implementing temporary emergency management becomes clear. This study aims to locate some temporary emergency stations across the area by maximal covering after a disaster. Furthermore, a multi-mode fleet is used for transferring patients using different modes of transportation (e.g. helicopter ambulance and bus ambulance). Since the type of patients may change over periods, medical servers can displace among temporary emergency stations dynamically according to disaster severity. For this purpose, a new bi-objective dynamic location-helicopter ambulance allocation-ambulance routing model with multi-medical servers is presented. The first objective function minimizes the operational costs related to the newly designed Emergency Medical Service along with the rate of human loss. The second objective function minimizes the critical time spent before the medical treatment. To validate the developed model, the augmented ε-constraint method is used and applied for the Tehran city, which shows the applicability of the model. Finally, two meta-heuristic algorithms are customized for large-sized problems, and the related results are compared based on multi-objective algorithms' performance comparison metrics to find the more efficient one.
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Ambulancias/organización & administración , Planificación en Desastres , Servicios Médicos de Urgencia/organización & administración , Ambulancias Aéreas/organización & administración , Humanos , IránRESUMEN
BACKGROUND: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012-2018. METHODS: All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines. RESULTS: The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification. CONCLUSIONS: Gathering detailed and comprehensive data nationally on all HEMS missions is feasible. A national database provides valuable insights into where the operation of HEMS could be improved. We observed a high number of cancelled or denied missions and a low percentage of patients transported by helicopter. The medical problem of encountered patients also differs from comparable systems.
Asunto(s)
Ambulancias Aéreas/organización & administración , Aeronaves/estadística & datos numéricos , Servicios Médicos de Urgencia/organización & administración , Paro Cardíaco Extrahospitalario/terapia , Sistema de Registros , Adulto , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: The current COVID-19 pandemic highlights the challenges air ambulance services are facing when transporting highly infectious patients for several hours in enclosed spaces. This overview provides an example of a standard operating procedure (SOP) for infection prevention measures in HEMS missions during the COVID-19 pandemic. Furthermore, we describe different methods used by several organizations in Europe and the experience of the Swiss air rescue organization Rega in transporting these patients. Possible benefits of the use of small patient isolation units (PIU) are discussed, including the fact that accompanying medical personnel do not need to wear personal protective equipment (PPE) during the transport but can still maintain full access to the patient. Rega has developed and patented its own PIU. This device allows spontaneously breathing or mechanically ventilated patients to be transported in pressurized jet cabins, small helicopters and ambulance vehicles, without the need to change between transport units. This PIU is unique, as it remains air-tight even when there is a sudden loss of cabin pressure. CONCLUSION: A wide variety of means are being used for the aeromedical transport of infectious patients. These involve isolating either the patient or the medical crew. One benefit of PIUs is that the means of transport can be easily changed without contaminating the surroundings and while still allowing access to the patient.