medical evacuation
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2021 ◽  
Author(s):  
Michael F Loncharich ◽  
David F Desena ◽  
Angelique N Collamer ◽  
Jess D Edison

ABSTRACT Objective To compare patterns of rheumatology consultations and outcomes across four different platforms in the Military Health System (MHS): face-to-face, synchronous telehealth, and two asynchronous telehealth platforms. Methods We conducted a retrospective review comparing face-to-face rheumatology consults during 2019 with teleconsultations from three virtual systems in the MHS: an asynchronous email-based system from May 2006 to Feb 2018, a web-based platform from 2014 to 2018, and synchronous telehealth consults from March 2020 to March 2021. Consults were reviewed for diagnosis, and if medical evacuation was required for consults originating OCONUS or if face-to-face follow-up was required for synchronous teleconsults. Diagnoses of interest included inflammatory arthritis, noninflammatory arthritis, crystalline arthritis, myositis, lupus, vasculitis, fibromyalgia, antibody positivity without diagnosis, symptoms without specified diagnosis, and a composite of other rheumatic diseases. Results Leading diagnoses across platforms were inflammatory arthritis, noninflammatory arthritis, and a composite of other diagnoses. Consultation modality influenced the type of cases seen. Inflammatory arthritis accounted for significantly more consults in the synchronous telehealth (38.4%) and email-based (40.9%) models than in the web-based (23.7%) and face-to-face (32.0%) models. The composite of other diagnoses was the leading diagnosis for the asynchronous web-based model (32.9%), which was significantly more than the synchronous telehealth and face-to-face consults. Synchronous models saw significantly more cases of crystalline arthritis, vasculitis, and fibromyalgia. Email-based consultations resulted in medical evacuation in 25 cases and prevented evacuation in 5. Web-based consultations prompted medical evacuation in 100 cases. In the synchronous model, face-to-face follow-up was recommended in 142 (15%) cases. Conclusions Modality of consultation influences the type of cases seen. Both synchronous and asynchronous telerheumatology models were able to answer the consult question without referral for face-to-face evaluation in 79.9-85.0% of consults, suggesting teleconsultation is a viable method to increase access to high-quality rheumatology care.


2021 ◽  
pp. 44-47
Author(s):  
S.V. Yankina ◽  
◽  
N.V. Minaeva ◽  

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.


2021 ◽  
Author(s):  
Craig D Nowadly ◽  
Kyle E Foley ◽  
Maxwell L Davis ◽  
Erik J Hebert ◽  
Gabe A Corey

ABSTRACT Introduction Critical Care Air Transport Team (CCATT) is a three-person United States Air Force (USAF) medical asset, typically providing intercontinental medical evacuation on large military aircraft. The CCATT equipment Allowance Standard (AS) weighs approximately 272 kg (600 lbs). In austere locations, CCATT teams may augment contract medical evacuation (CME) personnel or Pararescue (PJ) in small aircraft with limited space for medical equipment. It was unknown what deployed PJ and CME carry within their packouts. We sought to design a packout or “Go Bag,” weighing less than 22.7 kg (50 lbs) and sourced from the CCATT AS, that a CCATT member could use to complement CME or PJ equipment to provide a higher level of care while limiting redundancy. Materials and Methods Equipment lists were obtained from a CME and PJs from two separate USAF squadrons. The equipment lists were combined to provide a reference for development of a CCATT Go Bag. Three members of a deployed CCATT team independently generated a list of necessary equipment from the CCATT AS. The list was peer reviewed by a separate, deployed CCATT team. Results A Go Bag was developed with the supplies and equipment necessary for video laryngoscopy, ventilation, invasive pressure monitoring, basic laboratory capability, chest tube placement, ultrasound, and advanced pharmacologic interventions. The Go Bag weighed 18.3 kg (40.4 lbs). A separate respiratory bag weighing 1.1 kg (2.4 lbs) was attached directly to a ventilator. Intravenous pumps and cardiac monitoring equipment were notable ICU equipment excluded from the Go Bag. Conclusion Major components of the CCATT AS can be reduced into a Go Bag and accompanying Ventilator Accessory Bag. This may benefit CCATT teams required to augment PJs or CME in small aircraft during prolonged field care scenarios.


2021 ◽  
Vol 16 (2) ◽  
pp. 63-67
Author(s):  
Nasima Begum ◽  
Shahnaz Akhter ◽  
Luna Laila

Introduction: Misoprostol is increasingly used to treat women who have a failed pregnancy may be due to blighted ovum (anembryonic gestation), incomplete abortion, missed abortion, inevitable abortion in the first trimester. Medical treatment with Misoprostol is an alternative to conventional surgical treatment. Use of Misoprostol is simple, highly acceptable, noninvasive and preferred by women. In addition to surgical risk and patient's preference, medical evacuation reduces the need for hospital stay and the overall management cost. Objective: To determine the efficacy and safety of Misoprostol for evacuation of uterus in early pregnancy loss and to compare the result with surgical evacuation. Materials and Methods: It was a prospective randomized study conducted on 50 patients at the department of Obstetrics and Gynaecology, Border Guard Hospital, Dhaka during the period from February 2018 to July 2019. Here 25 patients received Misoprostol as medical treatment and 25 patients received surgical treatment. Results: Of the 25 women assigned to receive Misoprostol, 19(76%) had complete expulsion by 24 hours and 22(88%) by 7 days. Complete evacuation after 1st dose was 68% and after 2nd dose 88%. Misoprostol treatment failed in 3(12%) cases and required surgical evacuation. Among the respondents 80% women stated that they would use Misoprostol again if the need arises. Conclusion: Medical treatment with Misoprostol is a cheaper alternative to surgery. Given its success rate near about 88% with mild side effects controllable with additional medication and above all patient’s satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 63-67


2021 ◽  
pp. 29-33
Author(s):  
A.O. Lebedev ◽  
◽  
A.S. Samoylov ◽  
V.Yu. Solovyev ◽  
N.N. Baranova ◽  
...  

One of the methods of biological dosimetry is the use of information on the concentration of lymphocytes in the peripheral blood of victims in the first days after irradiation. The aim of the study was to validate the lymphocyte test method for predicting the severity of acute radiation injury, taking into account the dose rate factor. Materials and research methods. The method of investigation was a correlational analysis of clinical, dosimetric and laboratory data of the victims of the accident at the Chernobyl nuclear power plant in 1986 (n=65) and in radiation accidents with gamma-neutron irradiation (n=19). The data were taken from the database of acute radiation injuries in humans of A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia. Results of the study and their analysis. The results of correlation analysis indicated that average lymphocyte concentration in the range of 0.4-0.8×109/l on day 3-6 post-irradiation with dose rates greater than 2 Gy/h resulted in an average dose estimate which was 40.0% higher than that for dose rates of less than 2 Gy/h. Absolute error of dose estimation is (±1.0-1.5) Gy. For lymphocyte concentrations higher than 0.8×109/l the prognosis is uncertain: the range of dose assessment variability is 1-4 Gy. At a lymphocyte concentration of less than 0.4×109/l the average dose estimate is more than 4.0 Gy, corresponding to a severe or extremely severe degree of acute radiation disease. The predicted degree of severity of radiation injuries in the presence of the neutron component of radiation is lower in comparison with the predictions based on the data on the victims of the Chernobyl accident. It is concluded that the identified dependencies can be used for medical triage of the victims at advanced stages of medical evacuation. For the purpose of correct routing of medical evacuation to specialized centers, it is advisable to allocate 4 treatment-evacuation groups.


2021 ◽  
Vol 11 (2) ◽  
pp. 15
Author(s):  
Arief Sukmono Akbar ◽  
Imam Musani ◽  
Oktav Bayu D

Pemerintah melalui Satuan Tugas Penanggulangan Covid-19 melaporkan total kasus Covid-19 di Indonesia hingga 16 Juli 2021, mencapai 2.780.803 orang sejak kasus pertama diumumkan. TNI Angkatan Laut (TNI-AL) selain melaksanakan tugas pertahanan juga membantu Satgas penanggulangan Covid-19 serta operasi kemanusiaan lainnya. Pelaksanaan tugas tersebut dilaksanakan oleh Pusat Penerbangan TNI AL (Puspenerbal). TNI Angkatan Laut belum pernah mengoperasikan Helicopter Air Ambulance (HAA) yang memiliki kemampuan Helicopter Emergency Medical Services (HEMS). Penelitian ini menggunakan pendekatan kualitatif dengan tempat penelitian di pusat penerbangan TNI Angkatan Laut (Puspenerbal) Juanda Sidoarjo Jawa Timur. Pengolahan data menggunakan model Miles, Huberman dan Saldan dengan tiga langkah yaitu pemadatan data, penyajian data, dan penarikan kesimpulan yang prosesnya dilakukan bersamaan. Pengumpulan data dengan metode menelaah dokumen dan informan. Penggunaan informasi pelaku lapangan dibatasi pada informan yang memiliki pengalaman operasi sebagai penerbang helikopter terkait subyek penelitian. Tujuan dari penelitian untuk memberikan gambaran tentang urgensi keberadaan peralatan helikopter ambulans TNI AL dalam mendukung satuan tugas coronavirus disease-2019. Adapun helikopter yang ditetapkan peneliti berjenis Bell-412 atau peralatan medical evacuation (Medevac portable) yang bisa dipasang pada helikopter jenis Bell-412 TNI AL. Temuan atau kebaharuan dari penelitian ini adalah dengan adanya helikopter Medevac TNI AL ini dapat melakukan tindakan penyelamatan darurat mengevakuasi korban ke RS terapung/KRI BRS milik TNI AL atau RSAL terdekat. Helikopter AL dipilih karena hanya penerbang helikopter TNI AL yang terlatih yang mendapatkan rekomendasi landing/mendarat di geladak heli KRI BRS TNI AL. Kesimpulan bahwa helikopter jenis Bell-412 sebagai ambulans udara dan peralatan Medevac portable-nya sangat dibutuhkan dalam membantu satgas covid-19 dan operasi kemanusiaan lainnya.


2021 ◽  
Vol 10 (2) ◽  
pp. 276-284
Author(s):  
E. A. Vorobyov ◽  
V. G. Dashyan ◽  
N. V. Savvina ◽  
M. Y. Makievskij ◽  
S. A. Chugunova ◽  
...  

Relevance. To provide emergency specialized neurosurgical care to patients living in rural areas, medical evacuation to a neurosurgical hospital is required. Despite the fact that medical evacuation is a necessary stage of medical care, there are not enough studies on the impact of transportation of patients with a ruptured cerebral aneurysm over long distances. There is little information about the time intervals for transportation, the timing of the start of treatment and the outcomes of the disease in patients who are at a considerable distance from the neurosurgical hospital.Aim of the study. To analyze the impact on the extensive results of surgical treatment of patients with cerebral aneurysm rupture.Material and methods. A retrospective analysis of the results of surgical treatment of 145 patients with cerebral aneurysm rupture in the acute period of hemorrhage, hospitalized in the regional vascular center of the State Budgetary Institution of the Sakha Republic (Yakutia) “Republican Hospital No. 2 — Center for Emergency Medical Aid” in the period from 01.01.2017 to 31.12.2018. Patients were divided into two groups: Group I — patients from remote areas of the Republic of Sakha (Yakutia) who underwent medical evacuation by the Disaster Medicine Service of the Sakha Republic (Yakutia); Group II — hospitalized from the territory of the city of Yakutsk and its nearest suburbs.Results. 145 patients were hospitalized at the regional vascular center in Yakutsk. Sanaviation (Sanitary Aviation) delivered 91 patients from the districts of the republic to the regional vascular center (62.8% of the total number of patients) (Group I), 54 patients (37.2%) were hospitalized from the territory of the urban district of Yakutsk (Group II). The distance of transportation by ambulance aircraft in Group I ranged from 45 to 1330 kilometers. Deterioration from admission to the local medical organization to admission to the regional vascular center was noted in 8 patients (8.8%), improvement in the condition in 25 (27.5%) patients, there were no dynamics of changes in the state of 58 (63.7%) patients. The total number of deaths in two groups of patients was 11 (12.1%) patients. Postoperative mortality had no statistically significant differences between the two study groups: in Group I — 7.7% (7 patients), in Group II — 7.4% (4 observations) (p=1,000).Conclusions. With an established system of medical evacuation, transportation over a considerable distance does not worsen the course of the disease and the results of surgical treatment of patients with cerebral aneurysm ruptures in the acute period of hemorrhage. 


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