scholarly journals Helicopter transport of critical care COVID-19 patients in the Netherlands: protection against COVID-19 exposure-a challenge to critical care retrieval personnel in a novel operation

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Ed J. Spoelder ◽  
Marijn C. T. Tacken ◽  
Geert-Jan van Geffen ◽  
Cor Slagt
Keyword(s):  
Critical Care ◽  
The Netherlands ◽  
Exposure Time ◽  
Helicopter Emergency Medical Service ◽  
Team Members ◽  
Patient Transport ◽  
Retrieval Team ◽  
Cleaning Procedures ◽  
Aeromedical Transport ◽  
Serology Testing

Abstract 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.

scholarly journals ASSESSMENT OF PHYSICA L ACT IVITY OF MEMBERS OF THE HELICO PTER EMERGENCY MEDICA L SERVICE (HEMS)

2019 ◽  
Vol 7 (2) ◽  
pp. 91-98
Author(s):  
Agata Gaździńska ◽  
Paweł Jagielski ◽  
Robert Gałązkowski
Keyword(s):  
Physical Activity ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Team Members ◽  
Winter Sport ◽  
Study Population ◽  
Downhill Skiing ◽  
The Mean ◽  
The Relationship ◽  
Financial Issues

The aim: Assessment of physical activity of members of the Helicopter Emergency Medical Service. Material and methods: The study was conducted in a group of 131 people (65 paramedics, 66 pilots), members of HEMS teams from all bases in Poland, aged 27-59. The characteristics of physical activity was obtained using the author’s questionnaire. Results: The mean age of the study population was 42.73 ± 9.58 years. Pilots were significantly older than paramedics and had significantly higher BMI values (p < 0.05). No significant relationship between the age and BMI in the analyzed groups was found (p > 0.05), while the relationship between the frequency of physical activity and BMI was demonstrated. 70% of subjects undertook physical activity less than three times a week. The most frequently chosen forms were cycling, walking and swimming. Paramedics statistically significant more often than pilots chose wall climbing (p = 0.001). Downhill skiing (61%) was the most common declared winter sport played by pilots, while hiking in the mountains – by paramedics (49%). The most important reason for pilots to take up physical activity was concern for their health (47%), while for paramedics – the pleasure (63%). Paramedics statistically significant more often than pilots indicated a large number of other activities (90.6 vs. 74.2%) and financial issues (18.8 vs. 6.1%) as barriers that prevented more involvement in physical activities. Conclusions: The frequency of physical activity undertaken by HEMS members is insufficient. Low physical activity of HEMS team members has an adverse effect on their nutritional status. It is necessary to take initiatives to promote physical activity in this professional group.

Organization and Structure of the Cardiothoracic Intensive Care Unit

2015 ◽  
pp. 86-104
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽  
2017 ◽  
pp. 709-727
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Coronary Care by Nurses in the PreHospital Phase

1985 ◽  
Vol 1 (S1) ◽  
pp. 147-148
Author(s):  
Henry N. Hart
Keyword(s):  
The Netherlands ◽  
Family Physician ◽  
Emergency Services ◽  
Private Firms ◽  
Health Departments ◽  
District Health ◽  
Patient Transport ◽  
The Family ◽  
Central District ◽  
Coronary Care

The Netherlands, due to its density of population (415 residents per square kilometer) has ambulance services organized under municipal and district health departments (emergency services) or private services (routine transportation). The law requires that each patient be reached by an ambulance within 15 minutes everywhere in the country.Emergency services are generally performed by the health departments, whereas more routine patient transport is carried out by private firms. In the Netherlands, it is usual that emergency complaints are first directed to the family physician who makes further decisions concerning the use of ambulance services. All ambulance services are coordinated from central district ambulance posts.

Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

2017 ◽  
Vol 32 (5) ◽  
pp. 536-540 ◽  
Author(s):  
Domhnall O’Dochartaigh ◽  
Matthew Douma ◽  
Chris Alexiu ◽  
Shell Ryan ◽  
Mark MacKenzie
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Medical Patients ◽  
Shock Index ◽  
Patient Acuity ◽  
Emergency Medical

AbstractIntroductionPrehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.ProblemWhich patients may benefit from PHUS has not been clearly identified.MethodsA multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”ResultsBoth models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).Conclusions:In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.O’DochartaighD, DoumaM, AlexiuC, RyanS, MacKenzieM. Utilization criteria for prehospital ultrasound in a Canadian critical care Helicopter Emergency Medical Service: determining who might benefit. Prehosp Disaster Med. 2017;32(5):536–540.

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service

2015 ◽  
Vol 30 (3) ◽  
pp. 239-243 ◽  
Author(s):  
James S. Lee ◽  
Domhnall O’Dochartaigh ◽  
Mark MacKenzie ◽  
Darren Hudson ◽  
Stephanie Couperthwaite ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Positive Pressure Ventilation ◽  
Helicopter Emergency Medical Service ◽  
Positive Pressure ◽  
Factors Associated ◽  
Non Invasive ◽  
Emergency Medical ◽  
The Impact

AbstractIntroductionNon-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.Hypothesis/ProblemThe authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.MethodsA retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.ResultsFrom a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS) <15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).ConclusionPatients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.LeeJS, O’DochartaighD, MacKenzieM, HudsonD, CouperthwaiteS, Villa-RoelC, RoweBH. Factors associated with failure of non-invasive positive pressure ventilation in a critical care helicopter Emergency Medical Service. Prehosp Disaster Med2015; 30(2): 1–5

Sign in / Sign up

Export Citation Format

Share Document