Aeromedical Transport for Critically Ill Patients.

Aeromedical transport (AMT) is an integral part of healthcare systems worldwide. In this article, the personnel and equipment required, associated safety considerations, and evidence supporting the use of AMT is reviewed, with an emphasis on helicopter emergency medical services (HEMS). Indications for HEMS as guideded by the Air Medical Prehospital Triage Score are presented. Lastly, physiologic considerations, which are important to both AMT crews and receiving clinicians, are reviewed.

Accuracy of Prehospital Services' Estimated Time to Arrival for Ground Transport to the Emergency Department.

BACKGROUND: Emergency medical services (EMS) transporting patients to the emergency department (ED) typically call ahead to provide an estimated time to arrival (ETA). Accurate ETA facilitates ED preparation and resource allotment in anticipation of patient arrival. OBJECTIVE: The study purposed to determine the accuracy of ETA provided by EMS ground units. METHODS: We performed a single-center, prospective, observational study of ED patients arriving via EMS ground transport. The primary outcome was the time difference between EMS-reported ETA and actual time of arrival (ATA). The difference between ATA and ETA was compared using the two-sided Wilcoxon Signed-Rank Test. Subgroup analysis was performed to evaluate ETA accuracy for specific types of transports and assess variability by month and time of day. RESULTS: We included 1176 patient transports in the final analysis. The overall median difference ATA-ETA was 3 min (interquartile range 1-5 min) with a range of -26-48 minutes (Z = -25.139, p < 0.001). EMS underestimated ETA in 961 cases (81.7%), and 94 ETAs (8.0%) were accurate to within 1 min. The largest difference between ATA and ETA occurred between 07:00-07:59 and 16:00-16:59 (5 min, interquartile range 2-7). CONCLUSION: Our data demonstrate that prehospital providers underestimate time to ED arrival in most ground transports; however, the median difference between estimated and actual time to arrival is small.

Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System.

Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and transport times and adherence to proposed time benchmarks for patients with suspected ACS in North Carolina from 2011 to 2017. Methods and Results We conducted a population-based, retrospective study with the North Carolina Prehospital Medical Information System, a statewide electronic database of all EMS patient care reports. We analyzed 2011 to 2017 data on patient demographics, incident characteristics, EMS care, and county population density for EMS-suspected patients with ACS, defined as a complaint of chest pain or suspected cardiac event and documentation of myocardial ischemia on prehospital ECG or prehospital activation of the cardiac care team. Descriptive statistics for each EMS time interval were computed. Multivariable logistic regression was used to quantify relationships between meeting response and scene time benchmarks (11 and 15 minutes, respectively) and prespecified covariates. Among 4667 patients meeting eligibility criteria, median response time (8 minutes) was shorter than median scene (16 minutes) and transport (17 minutes) time. While scene times were comparable by population density, patients in rural (versus urban) counties experienced longer response and transport times. Overall, 62% of EMS encounters met the 11-minute response time benchmark and 49% met the 15-minute scene time benchmark. In adjusted regression analyses, EMS encounters of older and female patients and obtaining a 12-lead ECG and venous access were independently associated with lower adherence to the scene time benchmark. Conclusions Our statewide study identified urban-rural differences in response and transport times for suspected ACS as well as patient demographic and EMS care characteristics related to lower adherence to scene time benchmark. Strategies to reduce EMS scene times among patients with ACS need to be developed and evaluated.

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.

Pre-hospital assistance by ambulance in the context of coronavirus infections.

OBJECTIVE: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. METHOD: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. RESULTS: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. FINAL CONSIDERATIONS: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.

Safe Ground Transport of Pediatric COVID-19 Patients-A Single-Center First-Surge Experience.

OBJECTIVES: The COVID-19 pandemic has brought new challenges to pediatric transport programs. The aims of this study were to describe the transport of pediatric patients with confirmed COVID-19 and to review the operational challenges that our transport system encountered. METHODS: A retrospective descriptive study was performed to review all COVID-19 pediatric transport performed over a 6-month period during the initial pandemic surge in 2020. Pediatric patients with a known positive SARS-CoV-2 polymerase chain reaction test at the time of transport were included. Patients' hospital records, including their transport record, were reviewed for demographics, diagnoses, transport interventions and complications, and admission disposition. Descriptive statistics were used to describe the patient cohort. RESULTS: Of the 883 transports performed between April and October 2020, 146 (16%) tested positive for COVID-19 during the initial surge in our geographical area. Patient acuity was diverse with 40% of children having a chronic complex medical condition. More than 25% of children required aerosol-generating procedures during transport. The most common medical diagnosis was respiratory compromise, and the most common surgical diagnosis was appendicitis. No adverse events occurred during transports, and no transport team members contracted COVID-19 because of workplace exposure. Transport program operational challenges ranged from rapidly changing system logistics/policies to educational and utilization of proper personal protective equipment. CONCLUSIONS: Children with COVID-19 can be transported safely with adaption of transport program procedures. Change management and team stress should be anticipated and can be addressed with repeated education and messaging.

European consensus recommendations for neonatal and paediatric retrievals of positive or suspected COVID-19 patients.

BACKGROUND: The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS: A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, two-step modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS: The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS: Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively. IMPACT: We present European consensus recommendations on pertinent measures for transporting infants and children in times of the coronavirus (SARS-Cov-2 /COVID-19) pandemic. A panel of experts reviewed the evidence around transporting infants and children with proven or suspected COVID-19. Specific guidance on aspects of personal protective equipment, airway management and considerations for incubator and open stretcher transports is presented. Based on scant evidence, best-practice recommendations for neonatal and paediatric transport teams are presented, aiming for the protection of teams and patients. We highlight gaps in knowledge and areas of future research.

Exploration on the safe management of multi-hospital transportation in a large public hospital during the pandemic of 2019-nCoV.

During the pandemic of 2019-nCoV, large public hospitals are facing great challenges. Multi-hospital development will be the main mode of hospital administrative management in China in the future. West China Hospital of Sichuan University implemented multi-hospital integrated management, in which the branch district established the administrative multi-department collaboration mode. As an important part of the operation of branch district, how to effectively organize transportation of staffs and patients and to prevent and control the pandemic of 2019-nCoV simultaneously between different hospitals have been the key and difficult points, which should be solved urgently in the management of the branch district.

Construction and validation of checklist for disinfecting ambulances to transport Covid-19 patients / Construcción y validación de checklist para la desinfección de ambulancias para el transporte de pacientes Covid-19 / Construção e validação de checklist para desinfecção de ambulâncias para transporte de pacientes Covid-19

ABSTRACT Objective To build and validate a checklist for disinfecting ambulances transporting patients with Covid-19. Method Methodological study composed by the construction of a checklist and validation by 42 professionals, of which 35 professionals had expertise in patient transport/transfer and seven in hospital infection control. The item with a minimum agreement of 80% was considered valid, based on the Content Validation Index and binomial test. Results The checklist had the steps performed for terminal disinfection of ambulances. It had 54 items, which included the personal protective equipment and used materials, disinfection of the driver's cabin, equipment, and the patient care cabin. The minimum agreement obtained was 85% and the mean of the Content Validation Index was 0.96. Conclusion The checklist was considered valid in terms of content and can be used to disinfect ambulances transporting patients with Covid-19.

RESUMEN Objetivo Construir y validar checklist para desinfectar ambulancias que transportan pacientes con Covid-19. Método Un estudio metodológico compuesto por la construcción de un checklist y validación por 42 profesionales, de los cuales 35 profesionales tenían experiencia en transporte/transferencia de pacientes y siete en control de infecciones hospitalarias. El ítem con un acuerdo mínimo del 80% se consideró válido, según el índice de validación de contenido y la prueba binomial. Resultados El checklist tenía los pasos a seguir para la desinfección terminal de ambulancias. Tenía 54 artículos, que incluían el equipo de protección individual y los materiales utilizados, la desinfección de la cabina del conductor, el equipo y la cabina de atención al paciente. El acuerdo mínimo obtenido fue del 85% y el promedio del Índice de Validación de Contenido fue de 0,96. Conclusión El checklist se consideró válido en términos de contenido y puede usarse para desinfectar ambulancias que transportan pacientes con Covid-19.

RESUMO Objetivo Construir e validar checklist para desinfecção de ambulâncias que transportam pacientes com Covid-19. Método Estudo metodológico composto pela construção de checklist e validação por 42 profissionais, dos quais 35 profissionais possuíam expertise em transporte/transferência de pacientes e sete em controle de infecção hospitalar. Foi considerado válido o item com concordância mínima de 80%, a partir do Índice de Validação de Conteúdo e teste binomial. Resultados O checklist possuiu as etapas que devem ser realizadas para desinfecção terminal das ambulâncias. Possuiu 54 itens, que contemplaram os equipamentos de proteção individual e materiais utilizados, desinfecção da cabine do condutor, dos equipamentos e da cabine de atendimento ao paciente. A concordância mínima obtida foi de 85% e a média do Índice de Validação de Conteúdo foi de 0,96. Conclusão O checklist foi considerado válido quanto ao conteúdo e pode ser utilizado para desinfecção das ambulâncias que transportam pacientes com Covid-19.

Primera experiencia de traslado de pacientes con COVID-19 en tren de alta velocidad en Europa: la necesidad de ir rápido y con seguridad / First high-speed rail transport of patients with COVID-19 in Europe: the need for speed and safety

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Webpalestra COVID-19 (Coronavírus): transporte intra e extra-hospitalar de pacientes com COVID-19

Assista mais vídeos sobre COVID-19 no link abaixo: https://www.youtube.com/playlist?list... Acesse os slides das nossas palestras na Biblioteca Virtual do Telessaúde ES! Confira a data da exibição e encontre o material desejado. Faça download e tenha o material preparado pelos nossos palestrantes. https://telessaude.ifes.edu.br/biblio...

Consenso en el transporte interhospitalario ante la pandemia de COVID-19 / Consensus on interhospital transfers during the COVID-19 pandemic

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Nota técnica nº 01, de 26 de março de 2020: orienta a atenção primária à saúde dos municípios para o enfrentamento do novo Coronavírus (COVID-19) / Technical note No. 01, of March 26, 2020: guides primary health care in municipalities to face the new Coronavirus (COVID-19)

Orienta os serviços de Atenção Primária à Saúde (APS) ou Atenção Básica (AB), por meio da Estratégia Saúde da Família (ESF), no manejo e controle da infecção COVID-19. Indica os instrumentos de orientação clínica para os profissionais do Sistema Único de Saúde (SUS) a partir da transmissão do novo Coronavírus (COVID-19) no Tocantins.

It guides the Primary Health Care (PHC) or Basic Care (AB) services, through the Family Health Strategy (FHS), in the management and control of the COVID-19 infection. Indicates the instruments of clinical guidance for professionals of the Unified Health System (SUS) from the transmission of the new Coronavirus (COVID-19) in Tocantins.

Orienta a los servicios de Atención Primaria de Salud (APS) o Atención Básica (AB), a través de la Estrategia de Salud de la Familia (ESF), en el manejo y control de la infección por COVID-19. Indica los instrumentos de orientación clínica para profesionales del Sistema Único de Salud (SUS) a partir de la transmisión del nuevo Coronavirus (COVID-19) en Tocantins.

Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA.

Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.