Timing of Transport of Patients with COVID-19.

Rationale: The objective of this study was to evaluate the risk of mortality or ECMO cannulation for patients with confirmed or suspected COVID-19 transferred from sending hospitals to receiving tertiary care centers as a function of the duration of time at the sending hospital.

Objective: To determine outcomes of critically ill patients with COVID-19 who were transferred to tertiary or quarternary care medical centers.

Materials And Methods: Retrospective cohort study of critical care transports of patients to one of seven consortium tertiary care centers from March 1, 2020, through September 4, 2020.

Ventilator Management in Metformin-Associated Lactic Acidosis: A Case Report.

The initiation of mechanical ventilation in the setting of profound metabolic acidosis can be a particular challenge in the transport environment. The classic teaching is that patients with severe acidemia should not be intubated, if possible, because they are often able to better maintain their own compensatory minute ventilation compared with clinician management with the mechanical ventilator. In this case, a patient had profound metformin-associated lactic acidosis with a pH of 6.

Interfacility Transport of Critically Ill Patients.

Objectives: To assess recent advances in interfacility critical care transport.

Data Sources: PubMed English language publications plus chapters and professional organization publications.

Study Selection: Manuscripts including practice manuals and standard (1990-2021) focused on interfacility transport of critically ill patients.

Operational Policies and Procedures for Critical Care Transport During a Respiratory Pandemic.

The severe acute respiratory syndrome coronavirus 2 pandemic of 2020 to 2021 created unprecedented challenges for health care organizations, including those in the critical care transport sector. Critical care transport services had to rapidly adjust to changing patient demographics, distribution of diagnoses, and transport utilization stratagem. To evolve with the pandemic, organizations developed new protocols and guidelines in rapid succession.

Air Versus Ground Transport Times in an Urban Center.

Purpose: Given that the benefits of helicopter transport vary with geography and healthcare systems, we assessed transport times for rotor wing versus ground transport over a 10 year period in an urban setting.

Materials And Methods: All completed transports from 153 sending hospitals in New England from 2009 through 2018 to 8 local tertiary care centers were extracted from an administrative database. The primary outcome of interest was patient-loaded transport time for rotor wing versus ground transports.

Clinical Policies and Procedures for Critical Care Transport during a Respiratory Pandemic.

The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19).

Critical Care Transport of Patients With COVID-19.

Purpose: Critical care transport is associated with a high rate of adverse events, and the risks and outcomes of transporting critically ill patients during the COVID-19 pandemic have not been previously described.

Materials And Methods: We performed a retrospective review of transports of subjects with suspected or confirmed COVID-19 from sending hospitals to tertiary care hospitals in Boston. Follow-up data were obtained for patients transported between March 1st and April 20th, 2020.

Feasibility and Safety of Prone Position Transport for Severe Hypoxemic Respiratory Failure Due to Coronavirus Disease 2019.

Objectives: To assess the safety and feasibility of a new protocol for interhospital critical care transport of mechanically ventilated patients in the prone position during the coronavirus disease 2019 pandemic by nurse and paramedic critical care transport teams.

Design: Retrospective observational study.

Setting: Single critical care transport agency serving multiple centers in the greater Boston area.

ECMO Transport without Physicians or Additional Clinicians.

Background: Extracorporeal membrane oxygenation (ECMO) has accelerated rapidly for patients in severe cardiac or respiratory failure. As a result, ECMO networks are being developed across the world using a "hub and spoke" model. Current guidelines call for all patients transported on ECMO to be accompanied by a physician during transport.

Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19.

With the COVID-19 pandemic, healthcare systems have been facing an unprecedented, large-scale respiratory disaster. Prone positioning improves mortality in severe hypoxemic respiratory failure, including COVID-19. While this is effective for intubated patients with moderate-to-severe ARDS, it has also been shown to be beneficial for non-intubated patients.

The Effect of Lights and Sirens on Critical Care Transport Time.

Background: In the prehospital setting, the use of ambulance lights and sirens (L&S) has been found to result in minor decreases in transport times, but has not been studied in interfacility transportation.

Objective: The objective of this study was to evaluate the indications for L&S and the impact of L&S on transport times in interfacility critical care transport.

Methods: We performed a retrospective analysis using administrative data from a large, urban critical care transportation organization.

Inhaled Epoprostenol to Facilitate Safe Transport in Legionnaires' Disease.

Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important.

Management of suspected myocarditis during critical-care transport.

Myocarditis and malignant dysrhythmias are unusual presentations in pediatric patients. We report a series of 4 patients with myocarditis and arrhythmia who presented to community emergency departments and were transported to a pediatric tertiary-care center. Three of the patients required extracorporeal life support.

Factors associated with unoffered trauma analgesia in critical care transport.

Objective: Pain relief is a key out-of-hospital patient care outcome measure, yet many trauma patients do not receive prompt analgesia. Although specialty critical care transport (CCT) teams provide analgesia frequently, successfully, and safely, there is still a population of CCT patients to whom analgesia is not offered. We report the factors associated with non-administration of analgesia and with analgesic effect in trauma patients cared for by CCT teams.

Effectiveness of a challenge-and-respond checklist in ensuring safety behavior compliance by medical team members at a rotor-wing air medical program.

Introduction: Checklists are a frequently recommended strategy for minimizing human error in both the aviation and medical industries, yet checklist noncompliance is sometimes cited as a factor in untoward incidents. We evaluate the use of a challenge-and-respond checklist designed to ensure compliance with basic pre-departure safety preparations by medical personnel at a helicopter air medical program.

Methods: The studied helicopter air medical transport program uses an interactive, challenge-and-respond checklist prior to departure to verify completion of four operational safety items.

Defibrillator availability on rotor-wing critical care transports.

Introduction: Defibrillation is a time-critical and life-saving intervention for patients in ventricular fibrillation or ventricular tachycardia. The preparation of rotor-wing critical care transport teams to manage such arrhythmias out of the transport vehicle is unclear.

Methods: A mail and telephone survey of 230 rotor-wing critical care transport programs.

A survey of adherence to community-generated safety guidelines in rotor-wing air medical programs.

Introduction: Operational safety, both crash prevention and improved crash survival, is a central concern in the air medical community. Professional organizations have published operational safety guidelines, but the extent to which those guidelines are followed is unclear. We report the results of a survey of adherence with selected safe practice recommendations.

Sleep debt and outside employment patterns in helicopter air medical staff working 24-hour shifts.

Introduction: Twenty-four hour availability creates physiological and psychological challenges for air medical teams. The 24-hour shift (24H) is a common staffing pattern in the air medical community. We report sleep dept and pre-duty activity patterns for 24H medical staff members at helicopter air medical transport programs.