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1.
J Spec Oper Med ; 21(1): 49-54, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33721307

RESUMO

BACKGROUND: The utility of prehospital thoracic needle decompression (ND) for tension physiology in the civilian setting continues to be debated. We attempted to provide objective evidence for clinical improvement when ND is performed and determine whether technical success is associated with provider factors. We also attempted to determine whether certain clinical scenarios are more predictive than others of successful improvement in symptoms when ND is performed. METHODS: Prehospital ND data acquired from one air ambulance service serving 79 trauma centers consisted of 143 patients (n = 143; ND attempts = 172). Demographic and clinical outcome data were retrospectively reviewed. Patients were stratified by prehospital characteristics and indications. Objective outcomes were measured as improvement in vital signs, subjective patient assessment, and physical examination findings. Univariate analysis was performed using chi-square for variable proportions and unpaired Student's t-test for variable means; p < .05 was considered statistically significant. RESULTS: The success rate of ND performed for hypoxia (70.5%) was notably higher than ND performed for hemodynamic instability (20.3%; p < .01) or cardiac arrest (0%; p < .01). Compared to vital sign parameters, clinical examination findings as part of the indication for ND did not reliably predict technical success (p > .52 for all indications). No difference was observed comparing registered nurse versus paramedic (p = .23), diameter of catheter (p > .13 for all), or length of catheter (p = .12). CONCLUSION: Prehospital ND should be considered in the appropriate clinical setting. Outcomes are less reliable in cases of cardiopulmonary arrest or hypotension with respiratory symptoms; however, this should not deter prehospital providers from attempting ND when clinically indicated. Additionally, the success rate of prehospital ND does not appear to be related to catheter type or the role of the performing provider.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Descompressão , Humanos , Estudos Retrospectivos , Centros de Traumatologia
2.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 108-110, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666921

RESUMO

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.


Assuntos
Resgate Aéreo/organização & administração , /transmissão , Controle de Infecções/organização & administração , Humanos , Equipamento de Proteção Individual , Guias de Prática Clínica como Assunto
3.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 118-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666923

RESUMO

Since December 2019, the novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) became an emerging infectious disease pathogen that led to a global pandemic with over 43 million cases reported worldwide and more than 1.1 million global deaths (as of 26 Oct 2020, from https://coronavirus.jhu.edu/map.html). Commonly known as coronavirus disease 2019 (COVID-19), this pathogen presents with a broad spectrum of disease progression and manifestations (no symptoms to acute respiratory distress syndrome leading to severe complications and death).1,2 Multiple publications have reported risk of disease and co-morbidities to include select underlying medical conditions and risks: older age (≥65 years), hypertension (HTN), cardiovascular disease, smoking, chronic respiratory disease, cancer, diabetes (DM), obesity (BMI ≥ 30 kg/m2), and male sex.2,3,4,5,6,7,8 In one study, researchers found severe obesity (BMI ≥ 35 kg/m2) associated with intensive care unit (ICU) admission alone.8 Nonetheless, risk factors for severity of the disease are determined by the pathogen, host, and environment.9.


Assuntos
Resgate Aéreo , /terapia , Controle de Infecções , Militares , Transferência de Pacientes , Adulto , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade
4.
Air Med J ; 40(2): 124-126, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33637276

RESUMO

In the current coronavirus disease 2019 (COVID-19) pandemic, air medical transport has been faced with many challenges that have been taken for granted in the past. The transport of these patients has been shrouded in many controversies, from the appropriate level of personal protective equipment, what facilities are appropriate for which patients, and the appropriate means of transport for COVID-19 patients. When you add in multiple high-risk comorbidities, as well as specialized devices and treatment, the care becomes even more complicated. The case of a 34-year-old, 150-kg, pregnant female who presented to a critical access hospital with shortness of breath and rapid decompensation presented unique challenges when she tested positive for COVID-19. The patient underwent a cesarean section and rapidly decompensated to the point where extracorporeal membrane oxygenation was required. A cardiothoracic surgeon and perfusionist were flown with the flight crew to the critical access hospital to cannulate the patient before transport because of the patient's severely unstable hemodynamic status. The patient was admitted to a tertiary facility for multiple rounds of treatments and was later discharged back to the critical access hospital for rehabilitation and recovery.


Assuntos
/transmissão , Controle de Doenças Transmissíveis/organização & administração , Oxigenação por Membrana Extracorpórea , Período Pós-Parto , Adulto , Resgate Aéreo , Cesárea , Comorbidade , Cuidados Críticos/métodos , Serviços Médicos de Emergência , Feminino , Humanos , Gravidez
5.
Air Med J ; 40(2): 130-134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33637278

RESUMO

The coronavirus disease 2019 pandemic disrupted health care delivery in every respect, including critical care resources and the transport of patients requiring extracorporeal membrane oxygenation. Innovative solutions allowing for safe helicopter air transport of these critical patients is needed because extracorporeal membrane oxygenation resources are only available in specialty centers. We present a case demonstrating the interfacility collaboration of care for a patient with coronavirus disease 2019 infection and the lessons learned from the air transport. Careful planning, coordination, communication, and teamwork contributed to the safe transport of this patient and several others subsequently.


Assuntos
Resgate Aéreo , Controle de Doenças Transmissíveis/organização & administração , Cuidados Críticos , Oxigenação por Membrana Extracorpórea , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Adulto , Comportamento Cooperativo , Humanos , Masculino , Gestão da Segurança
6.
Scand J Trauma Resusc Emerg Med ; 29(1): 41, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33637112

RESUMO

BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) outbreak in the Netherlands, the demand for intensive care beds exceeded availability within days. Initially, patients were redistributed regionally by ground transport. When transport over longer distances became necessary, we initiated a new Helicopter Emergency Medical Service (HEMS) operation. We hypothesize that the transport of contagious COVID-19 patients is feasible and safe for patients and HEMS personnel. METHODS: In this retrospective, single-centre observational study, flight and monitor data were used to calculate the exposure time of the retrieval team to COVID-19 patients. All the crew members (n = 18) were instructed on the proper use of personal protective equipment (PPE), dressing and undressing routine using buddy check supervision and cleaning procedures. All the team members were monitored for possible COVID-19 symptoms, as advised by our National Institute for Health and Environment. One month after completing the aeromedical transport all crew members were asked to donate a blood sample which was examined for the presence of IgG antibodies to SARS-CoV-2. RESULTS: From March 24 to May 25, 2020 the HEMS team transported 67 ventilated critical care COVID-19 patients. The exposure time was 7451 min (124 h and 11 min). One HEMS member reported pneumonia 6 weeks before the start of the patient transport. He tested positive for IgG SARS-CoV-2 by serology testing. We speculate that he was infected before the start of the operation; irrefutable evidence is lacking to support this claim because we did not perform serology testing before this operation started. CONCLUSION: Occupational COVID-19 exposure during helicopter transport of ventilated critical care COVID-19 patients can be performed safely when proper PPE is applied.


Assuntos
Resgate Aéreo , Aeronaves , Cuidados Críticos , Serviços Médicos de Emergência , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição Ocupacional/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Equipamento de Proteção Individual , Estudos Retrospectivos , Gestão da Segurança/organização & administração
7.
Air Med J ; 40(1): 16-19, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33455620

RESUMO

Helmet-based noninvasive ventilation (NIV) is a viable option for the safe transport of potential or known coronavirus disease 2019 patients. Given the most likely modes of transmission through droplets, aerosols, and fomite contact, airway procedures such as endotracheal intubation place air medical crews and other health care providers at high risk for exposure. This, together with data that suggest that a large cohort of coronavirus disease 2019 patients have better outcomes if we can avoid intubating them, creates a need for a safe method of NIV or high-flow oxygen delivery during transport. Commonly used and successful in-hospital regimens for these patients are high-flow nasal cannula and continuous positive airway pressure or bilevel positive airway pressure. In some studies, helmet NIV has been shown to be a viable, if not superior, alternative to these therapies for patients with acute hypoxemic respiratory failure. Furthermore, because it is a sealed and closed space that completely isolates the patient's airway and breathing, it provides a very high degree of protection from exposure to pathogens transmitted through droplets or aerosols. This article discusses practical implementation of helmet NIV in air medical transport.


Assuntos
Resgate Aéreo , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação não Invasiva/instrumentação , /transmissão , Humanos , Ventilação não Invasiva/métodos
8.
Air Med J ; 40(1): 54-59, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33455627

RESUMO

OBJECTIVE: The aeromedical transport of coronavirus patients presents risks to clinicians and aircrew. Patient positioning and physical barriers may provide additional protection during flight. This paper describes airflow testing undertaken on fixed wing and rotary wing aeromedical aircraft. METHODS: Airflow testing was undertaken on a stationary Hawker Beechcraft B200C and Leonardo Augusta Westland 139. Airflow was simulated using a Trainer 101 (MSS Professional A/S, Odense Sø, Syddanmark, Denmark) Smoke machine. Different cabin configurations were used along with variations in heating, cooling, and ventilation systems. RESULTS: For the Hawker Beechcraft B200C, smoke generated within the forward section of the cabin was observed to fill the cabin to a fluid boundary located in-line with the forward edge of the cargo door. With the curtain closed, smoke was only observed to enter the cockpit in very small quantities. For the Leonardo AW139, smoke generated within the cabin was observed to expand to fill the cabin evenly before dissipating. With the curtain closed, smoke was observed to enter the cockpit only in small quantities CONCLUSION: The use of physical barriers in fixed wing and rotary wing aeromedical aircraft provides some protection to aircrew. Optimal positioning of the patient is on the aft stretcher on the Beechcraft B200C and on a laterally orientated stretcher on the AW139. The results provide a baseline for further investigation into methods to protect aircrew during the coronavirus pandemic.


Assuntos
Resgate Aéreo , Ar Condicionado/métodos , Movimentos do Ar , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação/métodos , Ar Condicionado/instrumentação , Humanos , Ventilação/instrumentação
9.
JAMA Netw Open ; 4(1): e2033318, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33427886

RESUMO

Importance: Appropriate use of helicopter emergency medical service (HEMS) is important in ensuring that patients with critical illness or injury receive adequate treatment. Objective: To investigate the association between use of HEMS compared with use of ground EMS (GEMS) and mortality overall and in a subgroup of patients with critical illness or injury. Design, Setting, and Participants: This register-based, nationwide cohort study used data retrieved from Danish registries from October 1, 2014, to April 30, 2018. Patients receiving GEMS originated from dispatched HEMS missions for which a helicopter was unavailable. For the primary analysis, patients from accepted HEMS missions and patients from missions in which HEMS was dispatched but unavailable were included. The secondary analysis included patients assigned a hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis considered a critical illness or injury. These patients were selected via a consensus-based agreement among all authors by reviewing the Danish version of the World Health Organization's ICD-10 classification. Data were analyzed from March to June 2020. Exposures: Dispatch of HEMS vs GEMS unit (primary analysis) and treatment and transport by HEMS vs GEMS unit among patients with critical illness or injury (secondary analysis). Main Outcomes and Measures: One-year mortality was retrieved from the Danish Civil Registration System. Results: Among 10 618 patients (median [interquartile range] age, 60 [42-72] years; 6834 [64.4%] men) included in the primary analysis, 9480 patients (89.3%) received HEMS and 1138 patients (10.7%) received GEMS. Median (interquartile range) age was 60 (42-72) years, and 6834 patients (64.4%) were men. Adjusted cumulative 1-year mortality was 23.2% (95% CI, 22.4%-24.1%) among patients receiving HEMS vs 24.5% (95% CI, 21.9%-27.1%) among patients receiving GEMS. The difference in mortality risk for HEMS compared with GEMS was not statistically significant (hazard ratio, 0.94 [95% CI, 0.84-1.06]). Among 2260 patients with critical illness or injury receiving HEMS, compared with 315 patients with critical illness or injury receiving GEMS, adjusted cumulative 1-year mortality was 25.1% (95% CI, 23.5%-26.7%) vs 27.1% (95% CI, 22.0%-32.1%). The difference in mortality risk for HEMs compared with GEMs was not statistically significant (hazard ratio, 0.91 [95% CI, 0.73-1.14]). Conclusions and Relevance: This study found that 1 year after dispatch, the use of HEMS, compared with the use of GEMS, was not associated with a statistically significant difference in mortality overall or mortality among patients with critical illness or injury. Further research is needed to determine whether optimized dispatch systems may be associated with further improvements in survival among selected patients.


Assuntos
Resgate Aéreo , Ambulâncias , Estado Terminal/mortalidade , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Aeronaves , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
10.
J Trauma Acute Care Surg ; 90(2): 268-273, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33502145

RESUMO

BACKGROUND: Assessment of blood consumption (ABC), shock index (SI), and Revised Trauma Score (RTS) are used to estimate the need for blood transfusion and triage. We compared Bleeding Risk Index (BRI) score calculated with trauma patient noninvasive vital signs and hypothesized that prehospital BRI has better performance compared with ABC, RTS, and SI for predicting the need for emergent and massive transfusion (MT). METHODS: We analyzed 2-year in-flight data from adult trauma patients transported directly to a Level I trauma center via helicopter. The BRI scores 0 to 1 were derived from continuous features of photoplethymographic and electrocardiographic waveforms, oximetry values, blood pressure trends. The ABC, RTS, and SI were calculated using admission data. The area under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) was calculated for predictions of critical administration threshold (CAT, ≥3 units of blood in the first hour) or MT (≥10 units of blood in the first 24 hours). DeLong's method was used to compare AUROCs for different scoring systems. p < 0.05 was considered statistically significant. RESULTS: Among 1,396 patients, age was 46.5 ± 20.1 years (SD), 67.1% were male. The MT rate was 3.2% and CAT was 7.6%, most (92.8%) were blunt injury. Mortality was 6.6%. Scene arrival to hospital time was 35.3 ± (10.5) minutes. The BRI prediction of MT with AUROC 0.92 (95% CI, 0.89-0.95) was significantly better than ABC, SI, or RTS (AUROCs = 0.80, 0.83, 0.78, respectively; 95% CIs 0.73-0.87, 0.76-0.90, 0.71-0.85, respectively). The BRI prediction of CAT had an AUROC of 0.91 (95% CI, 0.86-0.94), which was significantly better than ABC (AUROC, 077; 95% CI, 0.73-0.82) or RTS (AUROC, 0.79; 95% CI, 0.74-0.83) and better than SI (AUROC, 0.85; 95% CI, 0.80-0.89). The BRI score threshold for optimal prediction of CAT was 0.25 and for MT was 0.28. CONCLUSION: The autonomous continuous noninvasive patient vital signs-based BRI score performs better than ABC, RTS, and SI predictions of MT and CAT. Bleeding Risk Index does not require additional data entry or expert interpretation. LEVEL OF EVIDENCE: Prognostic test, level III.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência/métodos , Hemorragia/classificação , Hemorragia/terapia , Centros de Traumatologia , Ferimentos e Lesões/classificação , Ferimentos e Lesões/terapia , Adulto , Idoso , Feminino , Previsões/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Sinais Vitais
11.
PLoS One ; 16(1): e0245082, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33465116

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland. METHODS: During 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups. RESULTS: We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h. CONCLUSIONS: Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.


Assuntos
Resgate Aéreo , Trombectomia , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ilhas , Japão , Masculino , Pessoa de Meia-Idade
12.
Air Med J ; 40(1): 76-78, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33455633

RESUMO

This short communication highlights the US Air Force's recent success with having their aeromedical evacuation crews use the Transportation Isolation System for the first time operationally to transport patients positive for coronavirus disease 2019.


Assuntos
Medicina Aeroespacial/métodos , Resgate Aéreo , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Medicina Militar/métodos , Militares , Medicina Aeroespacial/instrumentação , Medicina Aeroespacial/tendências , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/tendências , Medicina Militar/instrumentação , Medicina Militar/tendências , Estados Unidos
16.
Air Med J ; 39(5): 340-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33012469

RESUMO

In late 2019, a novel coronavirus was identified as the cause of a cluster of atypical pneumonia cases in Wuhan, China. It subsequently spread throughout China and around the world, quickly becoming a public health emergency. In March 2020, the World Health Organization declared coronavirus disease 2019 a pandemic. This article explores the preparation and early experiences of a large Canadian critical care transport program during the coronavirus disease 2019 pandemic focused on 6 broad strategic objectives centered around staff welfare, regular and transparent communication, networking, evidenced-based approach to personal protective equipment, agile mission planning, and an expedited approach to clinical practice and policy updates and future state modeling.


Assuntos
Comunicação , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Disseminação de Informação , Liderança , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral , Transporte de Pacientes/organização & administração , Medicina Aeroespacial , Resgate Aéreo , Ambulâncias , Betacoronavirus , Colúmbia Britânica , Prática Clínica Baseada em Evidências , Humanos , Equipamento de Proteção Individual/provisão & distribução , Resiliência Psicológica
17.
PLoS One ; 15(9): e0239272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976507

RESUMO

OBJECTIVE: The aim of the current study was to investigate how cerebral and splanchnic oxygen saturation (rSO2-C and rSO2-A) in critically ill children transported in air ambulance was affected by flight with cabin pressurization corresponding to ≥ 5000 feet. A second aim was to investigate any differences between cyanotic and non-cyanotic children in relation to cerebral and splanchnic oxygen saturation during flight ≥ 5000 feet. The variability of the cerebral and splanchnic Near Infrared Spectroscopy (NIRS) sensors was evaluated. DESIGN: NIRS was used to measure rSO2-C and rSO2-A during transport of critically ill children in air ambulance. rSO2 data was collected and stored by the NIRS monitor and extracted and analyzed off-line after the transport. Prior to evaluation of the NIRS signals all zero and floor-effect values were removed. SETTING: The Pediatric Intensive Care Unit (PICU) at Astrid Lindgren Children's Hospital, Karolinska University Hospital in Stockholm, Sweden. PATIENTS: In total, 44 critically ill children scheduled for inter-hospital transport by a specialized pediatric transport team were included in the study between January 2014 and January 2019 (convenience sampling). INTERVENTION: No interventions were conducted. MEASUREMENTS: All study patients were monitored with a cerebral NIRS-sensor placed over the forehead and an abdominal NIRS-sensor placed in the infra-umbilical area for cerebral and splanchnic regional oxygen saturation monitoring, rSO2-C and rSO2-A, respectively. MAIN RESULTS: Complete rSO2-C and rSO2-A data was obtained in 39 patients. Median age was 12 days. Cyanotic congenital heart malformations were present in 9 patients (23%). In 22 patients (56%) rSO2-C decreased at altitude ≥ 5000 feet and in 24 patients (61%) rSO2-A decreased at altitude ≥ 5000 feet compared to baseline (p<0.0001). In 25 patients (64%) the rSO2-C/rSO2-A ratio was greater at altitude ≥ 5000 feet than at baseline. A ratio ≥ 1 was seen in 77% of patients at altitude ≥ 5000 feet compared to in 67% of patients at baseline. CONCLUSION: Both cerebral and splanchnic oxygen saturation decreased at altitude ≥ 5000 feet compared to baseline. In most patients, both cyanotic and non-cyanotic, cerebral oxygen saturation was preserved more than splanchnic oxygen saturation.


Assuntos
Encéfalo/metabolismo , Cardiopatias Congênitas/epidemiologia , Monitorização Fisiológica , Oxigênio/metabolismo , Resgate Aéreo , Altitude , Encéfalo/patologia , Pré-Escolar , Estado Terminal/epidemiologia , Feminino , Cardiopatias Congênitas/metabolismo , Cardiopatias Congênitas/patologia , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Oximetria , Suécia/epidemiologia
18.
J Spec Oper Med ; 20(3): 122-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969017

RESUMO

BACKGROUND: US Air Force (USAF) pararescuemen (PJs) perform long-range ocean rescue missions for ill or injured civilians when advanced care and transport are not available. The purpose of this case series is to examine the details of these missions, review patient treatments and outcomes, and describe common tactics, techniques, and procedures for these missions. METHODS: Cases in which the USAF PJs preformed long-range ocean rescue for critically ill or injured civilians between 2011 and 2018 were identified. Case information was obtained, including patient demographics, location, infiltration/exfiltration methods, diagnoses, treatments, duration of patient care, patient outcome, and lessons learned. RESULTS: A total of 14 pararescue missions involving 22 civilians were identified for analysis. Of the 22 patients, 10 (45%) suffered burns, six (27%) had abdominal issues, four (18%) had musculoskeletal injuries, one had a traumatic brain injury, and one had a necrotizing soft-tissue infection. Medical care of these patients included intravenous fluid and blood product resuscitation, antibiotics, analgesics, airway management, and escharotomy. The median duration of patient care was 51 hours. CONCLUSION: This case series illustrates the complex transportation requirements, patient and gear logistical challenges, austere medicine, and prolonged field care (PFC) unique to USAF PJ open-water response.


Assuntos
Resgate Aéreo , Militares , Lesões Encefálicas Traumáticas , Queimaduras , Humanos , Oceanos e Mares , Ressuscitação
19.
Scand J Trauma Resusc Emerg Med ; 28(1): 94, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962739

RESUMO

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.


Assuntos
Resgate Aéreo/organização & administração , Betacoronavirus , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência/organização & administração , Pandemias , Pneumonia Viral/terapia , Transporte de Pacientes/métodos , Infecções por Coronavirus/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
20.
PLoS One ; 15(8): e0237192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785294

RESUMO

BACKGROUND: Helicopter emergency medical services' (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients. METHODS: This retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score. RESULTS: Overall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42-1.58). CONCLUSIONS: HEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS.


Assuntos
Resgate Aéreo , Aeronaves , Serviços Médicos de Emergência/métodos , Mortalidade Hospitalar , Transporte de Pacientes/métodos , Ferimentos e Lesões/mortalidade , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Japão , Masculino , Mortalidade , Estudos Retrospectivos , Fatores de Tempo
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