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Potin M, Carron PN, Genton B. Injuries and medical emergencies among international travellers. J Travel Med 2024; 31:taad088. [PMID: 37405992 DOI: 10.1093/jtm/taad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings. METHODS We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled). RESULTS All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur. CONCLUSIONS Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.
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Affiliation(s)
- Mathieu Potin
- ISTM CTH (Certificate of Travel Health), Chemin des Croix-Rouges 12, Lausanne CH-1007, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
| | - Blaise Genton
- Policlinic of Tropical, Travel Medicine and Vaccination, Centre for Primary Care and Public Health, Unisanté, University of Lausanne, Rue du Bugnon 44, Lausanne CH-1011, Switzerland
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2
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Veldman A, Krummer S, Schwabe D, Diefenbach M, Fischer D, Schmitt-Kästner S, Rohrbeck C, Pannu R. Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance. J Pediatr Intensive Care 2023; 12:235-242. [PMID: 37565016 PMCID: PMC10411161 DOI: 10.1055/s-0041-1731681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 08/12/2023] Open
Abstract
In cases of critical injury or illness abroad, fixed-wing air ambulance aircraft is employed to repatriate children to their home country. Air ambulance aircraft also transport children to foreign countries for treatment not locally available and newborns back home that have been born prematurely abroad. In this retrospective observational study, we investigated demographics, feasibility, and safety and outcomes of long-distance and international aeromedical transport of neonates and children. The study included 167 pediatric patients, 56 of those preterm neonates. A total of 41 patients were ventilated, 45 requiring oxygen prior to the transport, 57 transferred from an intensive care unit (ICU), and 48 to an ICU. Patients were transported by using Learjet 31A, Learjet 45, Learjet 55, and Bombardier Challenger 604, with a median transport distance of 1,008 nautical miles (NM), median transport time of 04:45 hours (median flight time = 03:00 hours), flight time ≥8 hours in 15 flights, and transport time ≥8 hours in 29 missions. All transports were accompanied by a pediatric physician/nurse team. An increase in FiO 2 during the transport was documented in 47/167 patients (28%). Therapy escalation (other than increased oxygen) was reported in 18 patients, and technical adverse events in 3 patients. No patient required CPR or died during the transport. Clinical transport outcome was rated by the accompanying physician as unchanged in 163 transports, improved in 4, and deteriorated in none. In summary, international, long-distance transport of neonatal and pediatric patients performed by experienced and well-equipped transport teams is feasible. Neither major adverse events nor physician-rated clinical deteriorations were observed in this group of patients.
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Affiliation(s)
- Alex Veldman
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stefanie Krummer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
| | | | | | - Doris Fischer
- Jetcall Air Ambulance, Idstein, Germany
- Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
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3
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Yorulmaz Ş, Gökçe A. Transport of Trauma Patients by Airway: Turkish Experience. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2022.91069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Vlot JA, van Steenbergen JE. Hospital-based care and/or death followed by repatriation in Dutch travelers: The HAZARD study. Travel Med Infect Dis 2022; 49:102329. [PMID: 35460875 DOI: 10.1016/j.tmaid.2022.102329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Travelers can experience health problems while abroad. This descriptive study aimed to quantify the disease burden leading to hospital-based care, repatriation or death in Dutch travelers during a stay in a foreign country, including Europe. METHODS Retrospective study of demographic and clinical data from three medical assistance centers (MACs) and the Dutch Ministry of Foreign Affairs on Dutch travelers receiving hospital-based care or who died abroad in the years 2010-2014. Diagnoses were coded according to the International Classification of Diseases (ICD) and classified using the Global Burden of Disease tool. RESULTS Data was available for 77,741 travelers' incidents: 75,385 medical consultations and 2356 deaths. Four in five travelers received inpatient care, of which 36% concerned older travelers (65+) who had significantly longer hospital stays. Overall the top three diagnoses were: injuries (29%), infectious diseases (17%), and cardiovascular diseases (17%). Mental illness was reported in nearly 1.5% of the travelers. Incidence proportions were highest in South-Eastern Asia, with enteric infections as most common diagnosis. Injuries and communicable diseases occurred most often in South-Eastern Asia, while non-communicable diseases were mostly reported in South America. One in five travelers who consulted a physician was repatriated back home, mostly on a scheduled flight with or without medical escort. Cardiovascular diseases and injuries were the leading causes of death. CONCLUSIONS Not only communicable diseases, but also injuries and chronic diseases (in particular cardiovascular diseases) frequently affected travelers' health while staying abroad and frequently necessitated hospital-based care. This should be addressed during the pre-travel counseling.
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Affiliation(s)
- Jessica A Vlot
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - Jim E van Steenbergen
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Center for Infectious Disease Control, Netherlands Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
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5
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Araiza A, Duran M, Surani S, Varon J. Aeromedical Transport of Critically Ill Patients: A Literature Review. Cureus 2021; 13:e14889. [PMID: 34109078 PMCID: PMC8180199 DOI: 10.7759/cureus.14889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aeromedical transport of critically ill patients has become an integral part of practicing medicine on a global scale. The development of reliable portable medical equipment allows physicians, emergency medical technicians, and nurses to transport wounded and diseased patients under constant critical care attention. Air transportation involves utilizing a fixed-wing (airplane) or rotor-wing (helicopter) aircraft to accomplish different types of transports ranging from scene responses to international transfers. The proper preparation and management of patients undergoing aeromedical transport require a basic understanding of the physiological changes and unique challenges encountered within the aircraft environment at 8,000 ft above sea level. The purpose of this paper is to review the literature and provide guidelines for approaching the aeromedical transportation of critically ill patients.
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Affiliation(s)
- Alan Araiza
- Critical Care, United Memorial Medical Center, Houston, USA.,Centro Universitario Médico Asistencial y de Investigación (CUMAI), Universidad Autónoma de Baja California, Tijuana, MEX.,Internal Medicine, Dorrington Medical Associates, Houston, USA
| | - Melanie Duran
- Critical Care, United Memorial Medical Center, Houston, USA.,Internal Medicine, Dorrington Medical Associates, Houston, USA
| | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
| | - Joseph Varon
- Critical Care, United Memorial Medical Center, Houston, USA.,Critical Care, University of Texas Health Science Center at Houston, Houston, USA.,Critical Care, United General Hospital, Houston, USA
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6
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Luft A, Corcostegui SP, Millet M, Gillard J, Boissier J, Rondy P, Bancarel J, Carfantan C. Aeromedical Evacuations Within the French Armed Forces: Analysis of 2,129 Patients. Mil Med 2021; 185:468-476. [PMID: 31642486 DOI: 10.1093/milmed/usz268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The doctrine of medical support during French military operations is based on a triptych: forward medical stabilization, forward damage control surgery, and early strategic aeromedical evacuation (Strategic-AE). The aim of this study was to describe the last piece, the evacuation process of the French Strategic-AE. METHODS We conducted a retrospective cohort analysis using patient records from 2015 to 2017. All French service members requiring an air evacuation from a foreign country to a homeland medical facility were included. Data collected included age, medical diagnosis, priority categorization, boarding location, distance from Paris, type of plane and flight, medical team composition, timeline, and dispatch at arrival. RESULTS We analyzed 2,129 patients evacuated from 71 countries, most from Africa (1,256), the Middle East (382), and South America (175). Most patients (1,958) were not severely injured, although some considered priority (103) or urgent (68). Diagnoses included disease (48.6%), nonbattle injuries (43%), battle stress (5.3%), and battle injuries (3%). 246 Strategic-AE used medical teams in flight, 136 of them in a dedicated Falcon aircraft. The main etiologies for those evacuations were battle injuries (24%), cardiovascular (15.4%), infections (8%), and neurologic (7.3%). The median time of management for urgent patients was about 16 hours but longer for priority patients (26 hours). Once in France, 1,146 patients were admitted to a surgery department and 96 to an intensive care unit. CONCLUSION This is the first study to analyze the French Strategic-AE system, which is doctrinally unique when compared to its North Atlantic Treaty Organization allies. North Atlantic Treaty Organization allies favor care in the theatre in place of the French early Strategic-AE. However, in the event of a high intensity conflict, a combination of these two doctrines could be useful.
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Affiliation(s)
- Antoine Luft
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Simon-Pierre Corcostegui
- Special Medical Unit of Satory, French Military Medical Service, Camp des matelots, CS 10702, Versailles Cedex 78013, France
| | - Marianne Millet
- Paris Fire Brigade, French Military Medical Service, 47 rue Saint Fargeau, Paris 75020, France
| | - Jonathan Gillard
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jerome Boissier
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Patrick Rondy
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
| | - Jérôme Bancarel
- Medical Center of Rochefort, French Military Medical Service, BA 721 r Bois Bernard, Rochefort Air 17133, France
| | - Cyril Carfantan
- Department of Defense, Operational headquarters, French Military Medical Service, 60 boulevard du Général Valin CS 21623, Paris Cedex 15 75509, France
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Duchateau FX, Ramin G, Castro MT, Lepetit A. COVID-19: From the short term crisis mode to a long term maintainance mode, International Medical Assistance to reinvent? Air Med J 2020; 39:310. [PMID: 33012460 PMCID: PMC7287455 DOI: 10.1016/j.amj.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- François-Xavier Duchateau
- Allianz Partners Medical Global Competency Center Europe Brussels, Brussels, Belgium; Allianz Partners Group Medical Operations, Paris, France
| | - Geoffrey Ramin
- Allianz Partners Medical Global Competency Center Asia Pacific, Brisbane, Australia
| | | | - Anne Lepetit
- Allianz Partners Group Medical Operations, Paris, France
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Felkai PP, Marcolongo T, Van Aswegen M. Stranded abroad: a travel medicine approach to psychiatric repatriation. J Travel Med 2020; 27:5719611. [PMID: 32010953 DOI: 10.1093/jtm/taaa013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/12/2010] [Accepted: 01/30/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches. METHODS Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems. RESULTS Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place. CONCLUSIONS Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.
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Affiliation(s)
- Peter P Felkai
- Travel Medicine Faculty Group, Internal Medicine Chair, Medical Faculty, Debrecen University, 1039 Debrecen, Hungary
| | - Tullia Marcolongo
- International Association for Medical Assistance to Travellers, Toronto, ON, ON M6K 3E3 Canada
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9
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Liew CH, Flaherty GT. Experiences and Attitudes of International Travelers with Cardiovascular Disease: A Qualitative Analysis. Am J Trop Med Hyg 2020; 102:689-697. [DOI: 10.4269/ajtmh.19-0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chee Hwui Liew
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard Thomas Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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10
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Aeromedical Transport in Children: A Descriptive Analysis of 96 Cases. Pediatr Emerg Care 2020; 36:31-33. [PMID: 29112540 DOI: 10.1097/pec.0000000000001308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric aeromedical transport (AT) is highly challenging. We aim to describe a series of 96 cases of children requiring medical transport in terms of the indication, modalities, and related adverse events. METHODS In this single-center retrospective study, we included air-transported patients less than 18 years old. RESULTS During the study period, 96 patients, with median age of 120 months (range, 0-204), were air transported. The reason for AT was repatriation to the home country from another hospital in 65 (67.7%), whereas for 31 (32.3%) patients, it was for transport from a hospital to another for a special procedure. The main diagnosis was trauma surgery (n = 38; 39.5%). Fifteen (15.6%) patients were mechanically ventilated. No patient sustained serious adverse events during the flight. Patients were transported by an air ambulance or by a scheduled aircraft in 55.2% and 44.8%, respectively. The median flight distance was 822 km (range, 277-9878), and most of the ATs were intra-European (n = 41; 42.7%). CONCLUSION This study describes an international experience in providing AT services for pediatric clinical cases. Among pediatric patients, the younger ones constitute a specific population, and most of them require mechanical ventilation. Therefore, the transport of these patients seems to be more appropriate in a dedicated air ambulance.
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11
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Flaherty GT, Geoghegan R, Brown IG, Finucane FM. Severe obesity as a barrier to international travel: a qualitative analysis. J Travel Med 2019; 26:5373174. [PMID: 30855079 DOI: 10.1093/jtm/taz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is unknown whether obesity is a barrier to international travel. The purpose of this qualitative study was to describe the travel experiences of a cohort of severely obese individuals attending a hospital-based bariatric service, to identify their perceived barriers to travel and to generate recommendations that address the needs of severely obese individuals. METHODS Semi-structured interviews were conducted with severely obese patients attending a regional, structured, multidisciplinary lifestyle modification programme. Coding and thematic analysis of the transcripts were completed by three independent researchers. A thematic analysis was performed based on examination of the transcribed interviews. Demographic and clinical data such as gender, age and body mass index were also recorded. RESULTS Twelve patients (six males), with a mean age of 54 ± 5.98 years and a mean body mass index of 46.2 ± 8.2 kg/m2, agreed to semi-structured interviews (14-52-minute duration). The principal themes emerging from the interviews included obese air traveller embarrassment, physical discomfort on commercial flights, perceived weight bias, challenges in accessing hotel rooms, heat intolerance in warm climates, restricted leisure travel activities and medical co-morbidities. Most of the interviewees perceived a health benefit to travel but regarded obesity as a significant barrier to international travel. CONCLUSION These findings highlight the limitations experienced by obese travellers when engaging in international travel. Our results may inform the pre-travel health advice given to obese travellers. They might also serve to raise awareness among operators within the travel industry of the difficulties travellers with severe obesity face.
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Affiliation(s)
- Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Rosemary Geoghegan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Francis M Finucane
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Bariatric Medicine Service, Galway Diabetes Research Centre and Health Research Board Clinical Research Facility, Galway, Ireland
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Ravi P, Joshi MC, Dhawan M, Sud S, Vijai MN. Critical care air transport team and patient transfer unit: A decade of experience of a zonal hospital. JOURNAL OF MARINE MEDICAL SOCIETY 2019. [DOI: 10.4103/jmms.jmms_35_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Guilavogui T, Camara A, Diallo EM, Koïvogui A, Barry A, Zoumanigui K, Diallo AA, Delamou A, Koulibaly M. Organisational framework and outputs of International medical evacuation in Guinea: A need for change. Int J Health Plann Manage 2018; 33:614-626. [PMID: 29446151 DOI: 10.1002/hpm.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
The study aims to describe the organizational framework of International Medical Evacuation (IME), the profile of persons evacuated, and the associated cost of IME in Guinea. This was a descriptive study of IME policy in Guinea. We described the politico-structural organization of IME and the profile of patient accessing IME through the Ministry of Health (MOH: 2001-2015) and through the National Social Security Fund (NSSF: 2011-2015). From 1958 to 1992 since the health system was restricted, the country negotiated the free medical treatment with Socialist countries. Since 1992, a medical assistance line was included in the sector budgets, and IME was officially managed by the MOH and with a parallel system existing at the NSSF. With an average cost of US $34 251 per case, cardiovascular diseases (20%), Traumatology/Orthopedic diseases (20%), and Neurologic/neurosurgery diseases (12.5%) have motivated more than half of 2445 IME supported by the MOH between 2001 and 2015. With a diagnostic exploration (38.7%) as main motivation, the majority of the IMEs (80.0%) endorsed by the NSSF (2011-2015) concerned their employees/workers or those of the NSSF's supervisory ministry and their families. Despite a strict regulatory framework, the emergence and sustainability of parallel IME systems in other departments with different procedures than MOH's procedure represent a major weakness/deficiency. The new prospects for the free medical treatment of state employees could eventually lead to an effective correction of this structural failure if efficiently managed.
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Affiliation(s)
- Timothé Guilavogui
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
- Programme National de Lutte contre le Paludisme, Conakry, Guinée
| | - Alioune Camara
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
- Programme National de Lutte contre le Paludisme, Conakry, Guinée
| | - Elhadj Marouf Diallo
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Akoï Koïvogui
- Comité Départemental des Cancers (CDC93), Bondy, France
| | | | | | - Alpha Ahmadou Diallo
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Alexandre Delamou
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Moussa Koulibaly
- CHU De Conakry, Hôpital National Ignace Deen, Direction Générale, Conakry, Guinea
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire d'Anatomo-Pathologie, Université de Conakry, Conakry, Guinée
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Chen LH, Leder K, Barbre KA, Schlagenhauf P, Libman M, Keystone J, Mendelson M, Gautret P, Schwartz E, Shaw M, MacDonald S, McCarthy A, Connor BA, Esposito DH, Hamer D, Wilson ME. Business travel-associated illness: a GeoSentinel analysis. J Travel Med 2018; 25:4841826. [PMID: 29462444 PMCID: PMC5824651 DOI: 10.1093/jtm/tax097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Background Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 through 31 December 2014. Results Among 12 203 business travelers seen 1997-2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20-64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess. Conclusions Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.
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Affiliation(s)
- Lin H. Chen
- Mount Auburn Hospital, Cambridge, Massachusetts, and Harvard Medical School, Boston, MA, USA
| | - Karin Leder
- Royal Melbourne Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kira A. Barbre
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Michael Libman
- Montreal General Hospital and McGill University, Montreal, Quebec, Canada
| | - Jay Keystone
- Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Philippe Gautret
- Aix Marseille Université, IHU—Méditerranée Infection, Marseille, France
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine Tel-Aviv University, Israel
| | - Marc Shaw
- Worldwise Travellers Health Centres New Zealand and James Cook University, Australia
| | - Sue MacDonald
- Medicine and Quality, Interior Health, and University of British Columbia, Kelowna, British Columbia, Canada
| | - Anne McCarthy
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Bradley A. Connor
- The New York Center for Travel and Tropical Medicine and Weill Medical College of Cornell University, New York, NY, USA
| | - Douglas H. Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Davidson Hamer
- Center for Global Health and Development, Boston University School of Public Health, and Boston University School of Medicine, Boston, MA, USA
| | - Mary E. Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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15
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Delorenzo AJ, Abetz JW, Andrew E, de Wit A, Williams B, Smith K. Characteristics of Fixed Wing Air Ambulance Transports in Victoria, Australia. Air Med J 2017; 36:173-178. [PMID: 28739238 DOI: 10.1016/j.amj.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/04/2017] [Accepted: 02/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Air medical transport is important for the transfer of patients in the prehospital and interhospital environment. Few studies have described the services provided by fixed wing ambulances or the broader clinical profiles of patients they transport. Such information may be useful for the planning and allocation of resources, assistance with training, and refining clinical protocols. We sought to describe the characteristics of patients transported by fixed wing aircraft at Air Ambulance Victoria (AAV) and the service AAV provides in Victoria, Australia. METHODS A retrospective data review of patients transported by AAV fixed wing aircraft between January 1, 2011, and June 30, 2015, was performed. Data were sourced from the Ambulance Victoria data warehouse. Retrievals involving physicians were excluded. RESULTS A total of 16,579 patients were transported during the study period, with a median age of 66 years. Most patients were male (58.7%), and cardiovascular/hematologic conditions (27.2%) were most common. Overall, 51.7% of cases were prebooked routine transfers, 47.4% were interhospital routine transfers, and 0.9% were primary responses. Caseloads were largest in the regions furthest from the capital city. CONCLUSION The AAV fixed wing service in Victoria enables regional and remote patients to be transported to definitive care without major disruption to ground ambulances.
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Affiliation(s)
- Ashleigh J Delorenzo
- Research Assistant, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia.
| | - Jeremy W Abetz
- Medical Student, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Emily Andrew
- Research Governance Manager, Ambulance Victoria, Victoria, Australia
| | - Anthony de Wit
- Air Operations Manager, Ambulance Victoria, Victoria, Australia
| | - Brett Williams
- Head of Department, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Karen Smith
- Adjunct Professor, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Manager of Research and Evaluation, Ambulance Victoria, Victoria, Australia; Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Adjunct Professor, Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
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16
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Allyn J, Angue M, Corradi L, Traversier N, Belmonte O, Belghiti M, Allou N. Epidemiology of 62 patients admitted to the intensive care unit after returning from Madagascar. J Travel Med 2016; 23:taw023. [PMID: 27147730 DOI: 10.1093/jtm/taw023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND To our knowledge, there is no data on the epidemiology of patients hospitalized in intensive care unit (ICU) after a stay in Madagascar or other low-income countries. It is possible that such data may improve transfer delays and care quality for these patients. METHODS In a retrospective study, we reviewed the charts of all patients admitted to ICU of the Reunion Island Felix Guyon University Hospital from January 2011 through July 2013. We identified all patients who had stayed in Madagascar during the 6 months prior to ICU admission. RESULTS Of 1842 ICU patients, 62 (3.4%) had stayed in Madagascar during the 6 months prior to ICU admission. Patients were 76% male and the median age was 60.5 (48.25-64.75) years; patients were more frequently residents of Madagascar than travellers (56.5%). In most cases, patients were not hospitalized or given antibiotics in Madagascar. The most frequent causes of hospitalization were infections including malaria (21%) and lower respiratory infection (11%). Carriage and infection with multidrug resistant (MDR) bacteria on ICU admission were frequent (37% and 9.7%, respectively). The mortality rate in ICU was 21%, and severity acute physiological Score II was 53.5 (37-68). CONCLUSIONS Patients admitted to ICU after a stay to Madagascar are mainly elderly patients with chronic illnesses, and often foreign residents. The admission causes are specific of the country like malaria, or specific to the population concerned such as cardiovascular accidents that could be prevented.
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Affiliation(s)
| | | | | | - Nicolas Traversier
- Bacteriology laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France
| | - Olivier Belmonte
- Bacteriology laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France
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17
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Abstract
OBJECTIVE To identify factors affecting the likelihood of requiring medical services during international business trips. METHODS Data from more than 800,000 international trips and medical assistance cases provided to 48 multinational corporations in 2009. Travel destination countries were grouped into four a priori risk-related categories. RESULTS Travel to "low" medical risk countries in aggregate accounted for more hospitalizations and medical evacuations than travel to "high" medical risk countries. Nevertheless, the risk per trip was much higher for travel to higher medical risk countries. CONCLUSIONS Corporations with employees on international travel should allocate sufficient resources to manage and ideally prevent medical issues during business travel. Travel medicine must focus on more than infectious diseases, and programs are necessary for both high- and low-risk regions. Improved understanding of travel-related needs determines resource allocation and risk mitigation efforts.
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18
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Duchateau FX, Burnod A, Josseaume J. Évacuation sanitaire aérienne et rapatriement. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Liu X, Liu Y, Zhang L, Liang W, Zhu Z, Shen Y, Kang P, Liu Z. Mass Aeromedical Evacuation of Patients in an Emergency: Experience Following the 2010 Yushu Earthquake. J Emerg Med 2013; 45:865-71. [DOI: 10.1016/j.jemermed.2013.05.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/13/2012] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
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20
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Tursch M, Kvam AM, Meyer M, Veldman A, Diefenbach M. Stratification of patients in long-distance, international, fixed-wing aircraft. Air Med J 2013; 32:164-169. [PMID: 23632226 DOI: 10.1016/j.amj.2012.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 08/19/2012] [Accepted: 10/21/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION A growing number of individuals with significant medical histories travel for business and holidays. Precise anticipation and stratification of transport-relevant illness severity in the planning stage of an air medical evacuation is crucial for mission success and patient safety. METHODS We developed a staging system (ie, Stratification of Air Medical Transport by Expression of Symptoms in Patients [STEP]) and applied it to 356 patients transported by a fixed wing aircraft between January 2010 and June 2011. Patients were stratified before transport, and the transport team performed independent staging of each patient during the actual transport. Data on transport modes, transport time, age, sex, diagnosis, the need for mechanical ventilation, and transport-related complications were collected. Data were analyzed for significant differences in STEP categories between operations staging and staging by the flight crew and for the correlation between operations STEP staging and actual transport acuity. RESULTS Complete datasets were available in 353 of 356 patients. Differences between staging by operations and flight crew were documented in 31 cases (P = .809); in 18 of them, the flight crew considered the patient to be more severely affected than previously estimated. Decisions for specific transport mode and configuration were found to be adequate in all but 3 cases (99.15%). CONCLUSION STEP is a useful tool to assess patient's illness/injury severity in the planning stage of a long distance, international, air ambulance transport and assists in choosing the appropriate mode and configuration of transport.
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Gautret P, Gaudart J, Leder K, Schwartz E, Castelli F, Lim PL, Murphy H, Keystone J, Cramer J, Shaw M, Boddaert J, von Sonnenburg F, Parola P. Travel-associated illness in older adults (>60 y). J Travel Med 2012; 19:169-77. [PMID: 22530824 DOI: 10.1111/j.1708-8305.2012.00613.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older individuals represent a substantial proportion of international travelers. Because of physiological changes and the increased probability of underlying medical conditions, older travelers might be at higher risk for at least some travel-associated diseases. METHODS With the aim of describing the epidemiology of travel-associated diseases in older adults, medical data were prospectively collected on ill international travelers presenting to GeoSentinel sites from 1997 to 2009. Seven thousand thirty-four patients aged 60 years and over were identified as older travelers and were compared to 56,042 patients aged 18-45 years, who were used as the young adult reference population. RESULTS The proportionate morbidity of several etiological diagnoses was higher in older ill travelers compared to younger ill, including notably lower respiratory tract infections, high-altitude pulmonary edema, phlebitis and pulmonary embolism, arthropod bites, severe malaria, rickettsiosis, gastritis, peptic ulcers, esophagitis and gastroesophageal reflux disease, trauma and injuries, urinary tract infections, heart disease, and death. In contrast, acute diarrhea, upper respiratory tract infections, flu and flu-like illnesses, malaria, dengue, genital infections, sexually transmitted diseases, and schistosomiasis proportionate morbidities were lower among the older group. CONCLUSION Older ill travelers are more likely to suffer from certain life-threatening diseases and would benefit from reinforcement of specific preventive measures including use of anti-thrombosis compression stockings and sufficient hydration and exercises during long-distance flights, hand hygiene, use of disposable handkerchiefs, consideration of face-masks in crowded conditions, influenza and pneumococcal vaccines, progressive acclimatization to altitude, consideration of acetazolamide, and use of repellents and mosquito nets. Antibiotics for the presumptive treatment of respiratory and urinary tract infections may be considered, as well as antacid medications. At-risk patients should be referred to a specialist for medical evaluation before departing, and optimal control of co-morbidities such as cardiovascular and chronic obstructive pulmonary diseases should be achieved, particularly for high-altitude travel.
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Affiliation(s)
- Philippe Gautret
- Infectious Diseases and Tropical Medicine Unit, North University Hospital, AP-HM, Marseille, France.
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Hussenet C, Jauréguiberry S, Robert J, Rouby JJ, Bricaire F, Caumes E. Multidrug-resistant Acinetobacter baumannii infections in three returning travelers evacuated from Algeria, Thailand, and Turkey after hospitalization in local intensive care units. J Travel Med 2011; 18:358-60. [PMID: 21896102 DOI: 10.1111/j.1708-8305.2011.00546.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report three cases of returning travelers evacuated from Algeria, Thailand, and Turkey by aero-medical repatriation, following overseas hospitalization in local intensive care units for accidental injuries or medical problems. All three patients presented with imipenem-resistant Acinetobacter baumannii infections. One died whereas two recovered.
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Affiliation(s)
- Claire Hussenet
- Department of Infectious and Tropical Diseases, Pitié Salpêtrière Hospital, Université Pierre et Marie Curie, APHP, Paris, France
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Ting JY. Letter to the editors: the potential role for prehospital thrombolysis and time-critical stroke transfers in the northern Norway aeromedical retrieval system; In response to: Norum J, Elsbak TM: Air ambulance services in the Arctic: a Norwegian study. Int J Emerg Med 2011, 4:1. Int J Emerg Med 2011; 4:45. [PMID: 21791086 PMCID: PMC3158421 DOI: 10.1186/1865-1380-4-45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/26/2011] [Indexed: 11/12/2022] Open
Abstract
The role for prehospital thrombolysis for ST-elevation acute myocardial infarction and time-critical stroke transfers in the northern Norway aeromedical retrieval system as well as the aero-evacuation impact of increased Arctic expedition tourism could benefit from further discussion by Norum and Elsbak. Close ECG surveillance for ST elevation and retrieval thrombolysis en route to the accepting hospital could be of benefit for acute coronary syndrome patients in northern Norway who require prolonged aeromedical transfer. For patients who remain within a reasonable time frame for stroke thrombolysis (up to 4.5 h after symptom onset), expedited transfer for neuroimaging to determine eligibility is recommended.
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Affiliation(s)
- Joseph Y Ting
- Careflight Medical Services, Brisbane 4000, Australia.
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