Interhospital transfers by helicopter: the first 50 patients of the Careflight project.

An interhospital helicopter transfer service was set up using a dedicated helicopter fitted with medical equipment and staffed by anaesthetists. The system proved to be safe and practical. Fifty patients were referred from 38 hospitals throughout the UK, with 84% of transfers preplanned. Patients were transferred a mean distance of 118 miles (range 35-397 miles) and there was no deterioration during transfer as measured by pre and post transfer sickness scores. Twenty-eight per cent of cases could not have been practically transferred by conventional means. The death rate of 20% was lower than that reported for specially equipped and staffed land transfer systems, which may indicate less physiological deterioration in the critically ill compared to road transfer. Dedicated helicopter transfer resulted in a 50% survival rate in patients with a sickness score over 18, a group found not to survive after land transfer. There was no correlation between distance moved and outcome. A helicopter transfer system using suitable equipment and staff is a practical and safe method of moving critically ill patients between hospitals, and may be preferable to land transfer for distances in excess of 25 miles.

A new portable oxygen system using liquid oxygen.

Liquid oxygen provides both practical and financial advantages in comparison with compressed oxygen when transferring patients within and between hospitals. We describe a portable liquid oxygen system and evaluate its uses and shortcomings in this area.

Interhospital transfer of a patient undergoing extracorporeal carbon dioxide removal.

Extracorporeal circulation techniques are being used increasingly in patients with acute cardiac or pulmonary failure. Some of these patients may subsequently require transportation, which has limited the use of these techniques in hospitals without on site transplantation facilities. We report a case of adult respiratory distress syndrome that demonstrates a solution to this problem.

A paediatric trial comparing midazolam/Syrpalta mixture with premixed midazolam syrup (Roche).

BACKGROUND: The bitter taste of midazolam is more acceptable to children when the drug is mixed with fruit juice or syrup. We use a thick grape syrup (Syrpalta), and children are sedated in 10-15 min. A premixed cherry-flavoured midazolam solution (Roche), 2 mg.ml (-1), is currently available. It has been our impression that the premixed midazolam has a slower onset of action. Our aim was to evaluate the effects of the midazolam mixtures (midazolam 0.5 mg.kg (-1), 2 mg.ml (-1)) on children's anxiety, sedation, separation anxiety, mask acceptance, and recovery time. METHODS: Seventy-six healthy children, 1-4 years of age, scheduled for elective placement of ear tubes, were enrolled. The trial was double-blinded and randomized. For premedication, one group received the premixed midazolam, and a second group received the midazolam/Syrpalta mixture. An independent blinded observer evaluated the children, using anxiety and sedation scales at baseline, at 5, 10 and 15 min and at parental separation. Mask acceptance and awakening time were evaluated. RESULTS: Children who received the midazolam/Syrpalta mixture had less anxiety at 15 min (P = 0.046) and at parental separation (P < 0.001) than those who received the premixed midazolam solution. Mask acceptance was not different. CONCLUSIONS: We concluded that the midazolam/Syrpalta mixture has a faster onset of action than the premixed midazolam solution.