Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-02T22:03:49.930Z Has data issue: false hasContentIssue false

Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic

Published online by Cambridge University Press:  05 September 2023

Riccardo Stucchi
Affiliation:
SSD AAT Milano, Agenzia Regionale Emergenza Urgenza (AREU), Dipartimento di Emergenza e Accettazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Alba Ripoll-Gallardo*
Affiliation:
SSD AAT Milano, Agenzia Regionale Emergenza Urgenza (AREU), Dipartimento di Emergenza e Accettazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Giuseppe Maria Sechi
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Eric S. Weinstein
Affiliation:
CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Guido Francesco Villa
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Cristina Frigerio
Affiliation:
Dipartimento di Anestesia e Rianimazione, ASST Melegnano Martesana, Cernusco sul Naviglio, Italy
Federico Federighi
Affiliation:
UOC Maxiemergenze e Grandi Eventi, ARES 118 Lazio, Italy
Giacomo Grasselli
Affiliation:
Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
Alberto Zoli
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Rodolfo Bonora
Affiliation:
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Roberto Fumagalli
Affiliation:
Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
*
Corresponding author: Alba Ripoll Gallardo; Email: alba.ripoll@med.uniupo.it.

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.

Type
Concepts in Disaster Medicine
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

AREU Crisis Unit: Enzo Albergoni RN3, Paolo Baldini RN10, Giuseppe Brambilla RN3, Gianluca Chiodini EMT3, Lucia Colombi RN3, Giovanni De Luca RN1, Roberto Di Silvestre MD3, Claudio Mare MD3, Maurizio Migliori MD3, Michele Pirovano RN3 and Fabrizio Polverini RN3

References

Coronavirus Disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update. World Health Organization (WHO). Published March 7, 2022. Accessed March 2022. https://covid19.who.int Google Scholar
Spina, S, Marrazzo, F, Migliari, M, et al. The response of Milan’s Emergency Medical System to the COVID-19 outbreak in Italy. Lancet. 2020;395:e49-e50.CrossRefGoogle Scholar
Koenig, KL, Schultz, CH, eds. Koenig and Schultz’s disaster medicine: comprehensive principles and practices. Cambridge University Press; 2010.Google Scholar
Grasselli, G, Pesenti, A, Cecconi, M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545-1546.CrossRefGoogle ScholarPubMed
King, MA, Niven, AS, Beninati, W, et al.; Task Force for Mass Critical Care. Evacuation of the ICU: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146:e44S-e60S.CrossRefGoogle ScholarPubMed
Cabrini, L, Caputo, P, de Blasio, E, et al. Raccomandazioni per i Trasferimenti Inter ed Intra Ospedalieri Gruppo di Studio SIAARTI Emergenza. Published October 31, 2012. Accessed March 2022. https://www.timeoutintensiva.it/tecne_data/8_1_linee_guida_file_42.pdf Google Scholar
Indicazioni ad interim per un utilizzo razionale delle protezioni per infezione da SARS-COV-2 nelle attività sanitarie e sociosanitarie nell’attuale scenario emergenziale SARS-COV-2. Istituto Superiore di Sanità. March 28, 2020. Accessed March 2022. https://www.iss.it/documents/20126/0/Rapporto+ISS+COVID+2_+Protezioni_REV.V6.pdf/740f7d89-6a28-0ca1-8f76-368ade332dae?t=1585569978473 Google Scholar
Ingravallo, F, Petrini, F, Zoia, R, et al. Decisioni per le cure intensive in caso di sproporzione tra necessità assistenziali e risorse disponibili in corso di pandemia di COVID-19. Published January 13, 2021. Accessed March 2022. https://www.siaarti.it/news/382977 Google Scholar
Vincent, JL, Creteur, J. Ethical aspects of the COVID-19 crisis: how to deal with an overwhelming shortage of acute beds. Eur Heart J Acute Cardiovasc Care. 2020;9:248-252.CrossRefGoogle ScholarPubMed
Sammito, S, Turc, J, Post, J, et al. Analysis of European air medical evacuation flights of coronavirus disease 2019 patients. Air Med J. 2021;40:211-215.CrossRefGoogle ScholarPubMed
Mazzoli, CA, Gamberini, L, Lupi, C, et al. Interhospital transfer of critically ill COVID-19 patients: preliminary considerations from the Emilia-Romagna experience. Air Med J. 2020;39:423-426.CrossRefGoogle Scholar
Berkeveld, E, Mikdad, S, Zandbergen, HR, et al. Experience of the coronavirus (COVID-19) patient care in the Amsterdam region: optimization of acute care organization. Disaster Med Public Health Prep. 2020;19:1-5 Google Scholar
Martinez, T, Simon, K, Lely, L, et al. Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study. BMJ Mil Health. Published online July 9, 2021.CrossRefGoogle Scholar
Turc, J, Dupré, HL, Beaussac, M, et al. Collective aeromedical transport of COVID-19 critically ill patients in Europe: a retrospective study. Anaesth Crit Care Pain Med. 2021;40(1):100786.CrossRefGoogle ScholarPubMed
Martin, DT. Fixed wing patient air transport during the COVID-19 pandemic. Air Med J. 2020;39:149-153.CrossRefGoogle ScholarPubMed
Albrecht, R, Knapp, J, Theiler, L, et al. Transport of COVID-19 and other highly contagious patients by helicopter and fixed-wing air ambulance: a narrative review and experience of the Swiss air rescue Rega. Scand J Trauma Resusc Emerg Med. 2020;28:40.CrossRefGoogle ScholarPubMed
Bredmose, PP, Diczbalis, M, Butterfield, E, et al. Decision support tool and suggestions for the development of guidelines for the helicopter transport of patients with COVID-19. Scand J Trauma Resusc Emerg Med. 2020;28(1):43.CrossRefGoogle ScholarPubMed
Hilbert-Carius, P, Braun, J, Abu-Zidan, F, et al. Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective. Scand J Trauma Resusc Emerg Med. 2020;28:94.CrossRefGoogle ScholarPubMed
Lemay, F, Vanderschuren, A, Alain, J. Aeromedical evacuations during the COVID-19 pandemic: practical considerations for patient transport. CJEM. 2020;22:584-586.CrossRefGoogle ScholarPubMed
Grasselli, G, Greco, M, Zanella, A, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-1355.CrossRefGoogle ScholarPubMed
Ciceri, F, Castagna, A, Rovere-Querini, P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol. 2020;217:108509.CrossRefGoogle ScholarPubMed
Beaussac, M, Boutonnet, M, Koch, L, et al. Oxygen management during collective aeromedical evacuation of 36 COVID-19 patients with ARDS. Mil Med. 2021;186:e667-e671.CrossRefGoogle ScholarPubMed
Quah, P, Li, A, Phua, J, Phua, J. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Crit Care. 2020;24:285.CrossRefGoogle ScholarPubMed
Karki, S, Sprinkle, DJ. Helicopter emergency medical services during coronavirus disease 2019 in Nepal. Air Med J. 2021;40:287-288.CrossRefGoogle ScholarPubMed
Ragazzoni, L, Barco, A, Echeverri, L, et al. Just-in-time training in a tertiary referral hospital during the COVID-19 pandemic in Italy. Acad Med. 2021;96:336-339.CrossRefGoogle Scholar