Use of Helicopter Emergency Medical Services in the Transport of Patients With Known or Suspected Coronavirus Disease 2019

The leading "blended" civil medical evacuation operation (MEDEVAC) in unforeseen health emergency. From military use to civil development

INTRODUCTION

Medical evacuation has historically been rooted in military contexts. It involves the systematic transfer of sick or injured individuals from the battlefield to designated medical facilities. Medical evacuation has found application in civilian settings: the Ebola outbreak and the COVID-19 pandemic. This paper examines the medical evacuation that occurred during the COVID-19 pandemic in Lombardy, Italy (Operation "MEDEVAC"), where overloaded hospitals required the transfer of patients to other regions and even internationally.

METHODS

MEDEVAC was implemented by the Regional Emergency and Urgency Agency (AREU). Data from MEDEVAC were analysed using the AREU register, detailing patient characteristics, transfer logistics, and outcomes.

RESULTS

From March to April 2020, 121 intensive care patients were transferred via MEDEVAC, primarily by air. 65 % of patients were moved to other Italian regions. The Federal Republic of Germany received 35 % of patients, all transported by air. Outcome and mortality rates among transferred patients were comparable to those within regional intensive care units. One life-threatening event was reported during transport. The return of patient to Lombardy showed a 100 % survival rate.

CONCLUSION

This study emphasises the importance of standardised protocols, improved information exchange systems, and enhanced training for medical personnel involved in medical evacuation. MEDEVAC was found to be feasible and able to cope with demands that were excessive in relation to available resources. This study proposes the development of a shared protocol for air transport of patients and a model for international cooperation among emergency response agencies to optimise future medical evacuation activities in civil context.

The Impact of the Coronavirus Disease 2019 Pandemic on Helicopter Emergency Medical Services

The coronavirus disease 2019 pandemic has profoundly affected the Lombardy healthcare system. Although air transport of critical patients played a crucial role, there are still gaps in understanding how the pandemic impacted helicopter emergency medical services (HEMS). A retrospective observational analysis was performed using data from the regional emergency-urgency online portal. The investigation focused on patients airlifted by helicopter to the Lombardy emergency departments from January 1, 2019, to December 31, 2021. A total of 12,953 admissions to the emergency departments have been recorded (5,733 in 2019, 3,550 in 2020, and 3,670 in 2021). The monthly average of events changed significantly over the 3 years (2019 [477.7], 2020 [295.8], and 2021 [305.8]) (P < .001). Additionally, there was a notable increase in the percentage of severe cases with red triage codes in 2020 (28.9%) and 2021 (33.5%) compared with 2019 (19.9%). Moreover, the number of hospitalized patients increased in 2020 (39.9%) and 2021 (37.2%) compared with 2019 (27.7%). The HEMS documented a noteworthy decrease in mission numbers and an increase in patient clinical severity during the pandemic. Consequently, the HEMS might be allocated for specific roles in national pandemic plans during the alert phase activation, such as secondary transport between hospital facilities.

An Updated Review of Literature for Air Medical Evacuation High-Level Containment Transport During the Coronavirus Disease 2019 Pandemic

OBJECTIVE

In 2019, our team conducted a literature review of air medical evacuation high-level containment transport (AE-HLCT) of patients infected with high-consequence pathogens. Since that publication, the coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous air medical evacuations. We re-examined the new literature associated with AE-HLCTs to determine new innovations developed as a result of the pandemic.

METHODS

A literature search was performed in PubMed/MEDLINE from February 2019 to October 2021. The authors screened abstracts for the inclusion criteria and reviewed full articles if the abstract was relevant to the aim.

RESULTS

Our search criteria yielded 19 publications. Many of the early transports of patients with COVID-19 used established protocols for AE-HLCT, which were built from the most recent transports of patients with Ebola virus disease. Innovations from the identified articles are subdivided into preflight considerations, in-flight operations, and postflight operations.

CONCLUSION

Lessons gleaned from AE-HLCTs of patients with COVID-19 in the early weeks of the pandemic, when little was known about transmission or the severity of the novel disease, have advanced the field of AE-HLCT. Teams that had never conducted such transports now have experience and processes. However, more research into AE-HLCT is needed, including research related to single-patient portable isolation units as well as containerized/multipatient transportation systems.

Initiation of Inhaled Nitric Oxide by Air Transport Team in Adult COVID-19 Respiratory Failure

The coronavirus disease 2019 (COVID-19) pandemic has caused a significant increase in the volume of critical care flight transports between outlying referral hospitals and tertiary care facilities. Because of the tropism of severe acute respiratory syndrome coronavirus 2, flight crews are often asked to transport mechanically ventilated patients in refractory hypoxemic respiratory failure. The authors present a case series of 5 patients with COVID-19 acute respiratory distress syndrome (ARDS) who were initiated on inhaled nitric oxide (iNO) by the transport team before rotor wing transport and survived the journey in stable or improved condition upon arrival. Previously, no case reports have described adults with COVID-19 ARDS transported after iNO initiation by the transport team. This case series shows the feasibility of iNO initiation by trained air medical transport teams and suggests a short-term stabilizing effect of iNO in patients with ARDS from COVID-19.

Prehospital Noninvasive Ventilation: An NAEMSP Position Statement and Resource Document

Noninvasive ventilation (NIV), including bilevel positive airway pressure and continuous positive airway pressure, is a safe and important therapeutic option in the management of prehospital respiratory distress. NAEMSP recommends:NIV should be used in the management of prehospital patients with respiratory failure, such as those with chronic obstructive pulmonary disease, asthma, and pulmonary edema.NIV is a safe intervention for use by Emergency Medical Technicians.Medical directors must assure adequate training in NIV, including appropriate patient selection, NIV system operation, administration of adjunctive medications, and assessment of clinical response.Medical directors must implement quality assessment and improvement programs to assure optimal application of and outcomes from NIV.Novel NIV methods such as high-flow nasal cannula and helmet ventilation may have a role in prehospital care.