Transporte inter-hospitalar da pessoa em situação crítica: Vivências dos enfermeiros de uma ilha de Cabo Verde / Inter-hospital transport of the critically ill: The experience of nurses from a Cape Verdean Island / Transporte interhospitalario de pacientes en estado crítico: Experiencias del personal de enfermería en una isla de Cabo Verde

Resumo Enquadramento: A transferência inter-hospitalar da pessoa em situação crítica entre ilhas de um país insular decorre da necessidade de acesso a recursos de maior complexidade, cujas condições de transporte/assistência são determinantes para a sobrevivência do doente. Objetivo: Identificar os principais sentimentos e dificuldades vivenciados pelos enfermeiros de uma ilha de Cabo Verde no que concerne ao transporte inter-hospitalar da pessoa em situação crítica. Metodologia: Estudo qualitativo, por entrevista semiestruturada a um grupo focal de enfermeiros. Resultados: Das principais dificuldades apontadas emergiram como subcategorias - Carência/dificuldades ao nível dos meios de transporte; carência de recursos materiais apropriados para assistência durante o transporte; Dificuldades para assegurar o conforto e privacidade do doente; Problemas ao nível da rede referenciação/comunicação inter-hospitalar; Ausência de médico durante o transporte; Problemas relativos ao regresso dos enfermeiros ao hospital de origem. Um leque de sentimentos negativos como a angústia, o medo, as preocupações, entre outros, decorrem das dificuldades vivenciadas. Conclusão: Os relatos dos enfermeiros possibilitam um primeiro diagnóstico da situação, ao nível dos recursos, planeamento e efetivação do transporte.

Abstract Background: Inter-hospital transport of critically ill patients between islands in an island nation is driven by the need for access to more complex health resources. In this context, transport and care delivery conditions are crucial to patient survival. Objective: To identify the main feelings and difficulties of nurses from a Cape Verdean island regarding the inter-hospital transport of critically ill patients. Methodology: This qualitative study was conducted using semi-structured interviews with a focus group of nurses. Results: From the main difficulties identified, the following subcategories emerged: Lack of/difficulties with means of transport; Lack of adequate material resources to assist during transport; Difficulties in ensuring patient comfort and privacy; Problems with inter-hospital referral/communication network; Absence of a physician during transport; and Costs associated with the inability of the nurse to return immediately after delivering the patient. Several negative feelings, such as anguish, fear, and worry, resulted from the difficulties experienced by the nurses. Conclusion: The nurses' statements provide an initial diagnosis of the situation regarding the resources, planning, and execution of inter-hospital transport of critically ill patients.

Resumen Marco contextual: El traslado interhospitalario de un paciente en estado crítico entre islas de un país insular se debe a la necesidad de acceder a recursos más complejos, cuyas condiciones de transporte/asistencia son decisivas para la supervivencia del paciente. Objetivo: Identificar las principales sensaciones y dificultades experimentadas por los enfermeros de una isla de Cabo Verde en relación con el transporte interhospitalario de pacientes en estado crítico. Metodología: Estudio cualitativo, mediante entrevistas semiestructuradas con un grupo focal de enfermeros. Resultados: De las principales dificultades surgieron las siguientes subcategorías - Carencia/dificultades de medios de transporte; Carencia de recursos materiales adecuados para la asistencia durante el transporte; Dificultades para garantizar el confort y la intimidad del paciente; Problemas con la red de derivación/comunicación interhospitalaria; Ausencia de médico durante el transporte; Problemas relacionados con el regreso de los enfermeros al hospital de origen. De las dificultades experimentadas se derivan una serie de sentimientos negativos como angustia, miedo, preocupación, entre otros. Conclusión: Los informes de los enfermeros proporcionan un diagnóstico inicial de la situación, en cuanto a recursos, planificación y ejecución del transporte.

Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Background: The benefit of rapid transport from the scene to definitive in-hospital care versus extended on-scene resuscitation in out-of-Hospital Cardiac Arrest (OHCA) is uncertain. Aim: To assess the use of expedited transport from the scene of OHCA compared with more extended on-scene resuscitation of out-of-hospital cardiac arrest in adults. Methods: A systematic search of the literature was conducted using MEDLINE, Embase, and SCOPUS. Randomised control trials (RCTs) and observational studies were included. Studies reporting transport timing for OHCA patients with outcome data on survival were identified and reviewed. Two investigators assessed studies identified by screening for relevance and assessed bias using the ROBINS-I tool. Studies with non-dichotomous timing data or an absence of comparator group(s) were excluded. Outcomes of interest included survival and favourable neurological outcome. Survival to discharge and favourable neurological outcome were meta-analysed using a random-effects model. Results: Nine studies (eight cohort studies, one RCT) met eligibility criteria and were considered suitable for meta-analysis. On pooled analysis, expedited (or earlier) transfer was not predictive of survival to discharge (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.53 to 2.53, I2 = 99%, p = 0. 65) or favorable neurological outcome (OR 1.06, 95% CI 0.48 to 2.37, I2 = 99%, p = 0.85). The certainty of evidence across studies was assessed as very low with a moderate risk of bias. Region of publication was noted to be a major contributor to the significant heterogeneity observed amongst included studies. Conclusions: There is inconclusive evidence to support or refute the use of expedited transport of refractory OHCA.

Patients Air Medical Transport During the COVID-19 Pandemic: A Retrospective Cohort Study.

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.

Clinical Policies and Procedures for Critical Care Transport during a Respiratory Pandemic.

The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.

Optimizing Emergency Medical Service Structures Using a Rule-Based Discrete Event Simulation-A Practitioner's Point of View.

Many studies in research deal with optimizing emergency medical services (EMS) on both the operational and the strategic level. It is the purpose of this method-oriented article to explain the major features of "rule-based discrete event simulation" (rule-based DES), which we developed independently in Germany and Switzerland. Our rule-based DES addresses questions concerning the location and relocation of ambulances, dispatching and routing policies, and EMS interplay with other players in prehospital care. We highlight three typical use cases from a practitioner's perspective and go into different countries' peculiarities. We show how research results are applied to EMS and healthcare organizations to simulate and optimize specific regions in Germany and Switzerland with their strong federal structures. The rule-based DES serves as basis for decision support to improve regional emergency services' efficiency without increasing cost. Finally, all simulation-based methods suggest normative solutions and optimize EMS' performance within given healthcare system structures. We argue that interactions between EMS, emergency departments, and public healthcare agencies are crucial to further improving effectiveness, efficiency, and quality.

[Analysis of functioning of two-person primary care emergency medical team - single-centre study].

OBJECTIVE: Introduction: Under the Act on State Emergency Medicine System, an emergency medical team consists of at least two members, including a specialist system nurse or paramedic, who have the license to perform medical rescue activities. However, this does not exclude the possibility of expanding the team. In practice, however, it appears that in most cases a head of healthcare institution decides to have teams with a number of members limited to two persons in which a paramedic or nurse also fulfil the function of a driver. PATIENTS AND METHODS: Materials rial and methods: An originally designed questionnaire was used to collect data. The sample group included 138 employees working in two-person emergency medical teams at the Regional Ambulance Station in Poznan. RESULTS: Results: Over half of the subjects (N=90; 65,2%) rarely requests assistance from another emergency medical team as support in intervention, however, when transporting patients such teams are often assisted by patients' families (N=129; 93,5%). The patient's weight is one of the most frequently cited reasons for using such assistance. Every third respondent knows standards on weight limits for manual transport. 77,5 % of respondents believe that the Act on State Emergency Medicine should be amended by increasing the minimum number of members in primary care emergency medical teams from two to three. CONCLUSION: Conclusions: It may be concluded that formation of two-person teams constitutes an infringement of occupational health and safety regulations on manual transport, which increases the risk of injury occurrence.

Dificuldades no transporte inter-hospitalar de recém-nascido crítico realizado pelas equipes do Serviço de Atendimento Móvel de Urgência / Dificultades en el transporte inter-hospitalario del recien nacido crítico realizado por los equipos del Servicios de Atendimiento Movil de Urgencia / Difficulties in critical newborn interhospital transport carried out by the Emergency Mobile Care Services

RESUMO Objetivo: investigar as dificuldades das equipes do Serviço de Atendimento Móvel Urgência para a realização do transporte inter-hospitalar de recém-nascido crítico em ambulância. Método: estudo qualitativo, realizado com 17 profissionais de saúde, dentre médicos, enfermeiros e condutores de veículos atuantes no Serviço de Atendimento Móvel de Urgência de um município do interior do Ceará, no período de novembro a dezembro de 2014. Os dados foram produzidos por meio de entrevista semiestruturada, sendo as entrevistas gravadas. Os dados foram analisados por meio da análise temática de conteúdo. Resultados: as categorias apreendidas foram: escassez de materiais, de equipamentos e de veículos exclusivos para o transporte inter-hospitalar do recém-nascido; conhecimento, prática e treinamento deficientes para assistência ao recém-nascido crítico; e falha na comunicação entre os profissionais e dificuldade para a mobilidade da ambulância em via pública. Conclusão: as dificuldades mencionadas estão atreladas a todos os níveis de gestão e necessitam de um olhar diferenciado para que se garanta assistência de elevado nível de excelência.

RESUMEN Objetivo: investigar las dificultades de los equipos del Servicio de Atendimiento Móvil de Urgencia para la realización del transporte inter-hospitalaria del recién nacido critico en ambulancia. Método: investigación cualitativa, realizado con 17 profesionales de salud, dentro de médicos, enfermeros y conductores de vehículos actuantes en el servicio de Atención Móvil de Urgencias de un municipio del interior de Ceará, en el periodo de noviembre a diciembre de 2014. Los datos fueron producidos por medio de entrevistas semiestructurada, siendo las entrevistas grabadas. Los datos fueron analizados por medio del análisis temático de contenido. Resultados: las categorías aprendidas fueron: escasez de materiales, equipos y vehículos exclusivos para el transporte inter-hospitalario del recién nacido; conocimiento, practica y entrenamiento deficientes para la asistencia al recién nacido crítico; falla en la comunicación entre los profesionales y dificultades para la movilidad de la ambulancia en vía pública. Conclusión: las dificultades mencionadas están relacionadas en todos los niveles de gestión y necesitan de una mirada diferenciada para que se garantice la asistencia con excelencia.

ABSTRACT Objective: to investigate the difficulties of the Emergency Mobile Care Service teams to interhospital transport critical newborn in an ambulance. Method: this is a qualitative study carried out with 17 healthcare professionals, as physicians, nurses and drivers of vehicles working in the Emergency Mobile Care Service of a municipality in the interior of Ceará, from November to December 2014. Semi-structured, recorded interview produced the data, which we analyzed through thematic content analysis. Results: the categories we gathered were shortage of materials, equipment and vehicles exclusive to interhospital transport; knowledge, deficient practice and training to assist critical newborns; and failure to communicate among professionals and difficulty in ambulance mobility on public roads. Conclusion: these difficulties connect to all levels of management and require a differentiated approach in order to guarantee high level of excellence.

Visibilidade do transporte intra-hospitalar em unidade de terapia intensiva: estudo descritivo / Visibilidad del transporte intrahospitalario en unidad de terapia intensiva: estudio descriptivo / Visibility of intrahospital transport in an intensive care unit: a descriptive study

RESUMO Objetivo Verificar a percepção dos profissionais de enfermagem sobre a segurança do paciente durante o transporte intra-hospitalar do paciente internado em unidade de terapia intensiva. Método Estudo descritivo, qualitativo, com participação de 21 profissionais de enfermagem que atuavam em unidade de terapia intensiva de um hospital público na região sul do Brasil. Os dados foram obtidos por meio de entrevistas semiestruturadas em novembro de 2012 e analisados através da análise de conteúdo de Minayo. Resultados Foram evidenciadas três categorias: responsabilidade do profissional de saúde no transporte intra-hospitalar; situação de risco para o paciente no transporte intra-hospitalar; qualidade em estrutura para o transporte intra-hospitalar, revelando preocupação dos profissionais em realizar um transporte seguro. Conclusão Os profissionais de enfermagem têm conhecimento sobre a segurança do paciente durante o transporte intra-hospitalar, porém, há a necessidade de protocolos institucionais e de capacitações para o manejo desta prática, com a finalidade de reduzir ocorrências de eventos adversos.

RESUMEN Objetivo Verificar la percepción de los profesionales de enfermería sobre la seguridad del paciente internado en unidad de terapia intensiva durante el transporte intrahospitalario. Método Estudio descriptivo, cualitativo, con participación de 21 profesionales de enfermería que actuaban en unidad de terapia intensiva de un hospital público en la región sur de Brasil. Los datos fueron obtenidos por medio de entrevistas semiestructuradas en noviembre de 2012 y analizados a través del análisis de contenido de Minayo. Resultados Fueron evidenciadas tres categorías: responsabilidad del profesional de salud en el transporte intrahospitalario; situación de riesgo para el paciente en el transporte intrahospitalario; calidad en estructura para el transporte intrahospitalario, revelando la preocupación de los profesionales en realizar un transporte seguro. Conclusión Los profesionales de enfermería tienen conocimiento sobre la seguridad del paciente durante el transporte intrahospitalario, pero son necesarios protocolos institucionales y capacitaciones para el manejo de esta práctica con la finalidad de reducir ocurrencias de eventos adversos.

ABSTRACT Objective To verify the perception of the nursing staff about patient´s safety during the intrahospital transport of patients in an intensive care unit. Method Qualitative, descriptive study with the participation of 21 nursing professionals who worked at the intensive care unit of a public hospital in the southern region of Brazil. The data were collected using semi-structured interviews, in November 2012, and analysed using Minayo's content analysis. Results The results led to three main categories: responsibility of the health professional in intra-hospital transport; risk situation for the patient in intra-hospital transport; quality in the structure for intra-hospital transport, revealing the concern of professionals in providing safe transport. Conclusion Although the nursing professionals are aware of the patient safety during intra-hospital transport, there is a need for institutional protocols and training on this practice to reduce the incidence of adverse events.

Los factores de riesgos del paciente en condición crítica sometido a traslado interhospitalario / The risk factors of the patient in critical condition undergoing interhospital transfer

En variadas ocasiones los recursos de los hospitales no satisfacen todas las demandas del paciente crítico, requiriendo ser transferido a otro centro hospitalario en búsqueda de esas demandas. Este artículo pretende recopilar investigaciones que determinen el riesgo que adquiere el paciente transferido. Información que resulta fundamental para la generación de sistemas de evaluación que permitan fundamentar las decisiones en salud y generar intervenciones que proporcionen mejorías en relación a la calidad de atención, permitiendo promover servicios adecuados a las expectativas legítimas de la población trasladada.

At various times the resources of hospitals do not meet all the demands of the critical patient, requiring transfer to another hospital in search of those demands. This article aims to gather research to determine the risk that the patient acquires transferred. Information that is essential for the generation of evaluation systems that allow health inform decisions and create interventions that provide improvements in relation to the quality of care, allowing adequate promote the legitimate expectations of the population moved. Key words: critical patient mortality, transport of patients, adverse events.