Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-23T22:27:52.662Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  22 September 2021

David C. Leisten ,
Jennifer Wheeler ,
James Boomhower ,
Michael A. Frakes ,
Todd Denison ,
Jason E. Cohen  and
Susan R. Wilcox Open the ORCID record for Susan R. Wilcox [Opens in a new window]
David C. Leisten
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Department of Emergency Medicine, Lahey Hospital and Medical Center, Burlington, MassachusettsUSA
Jennifer Wheeler
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
James Boomhower
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Michael A. Frakes
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Todd Denison
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA
Jason E. Cohen
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Department of Surgery, Brigham and Women’s Hospital, Boston, MassachusettsUSA
Susan R. Wilcox*
Affiliation:
Boston MedFlight, Bedford, MassachusettsUSA Department of Emergency Medicine, Heart Center ICU, Massachusetts General Hospital, Boston, MassachusettsUSA
*
Correspondence: Susan R. Wilcox, MD Massachusetts General Hospital 55 Fruit Street Boston, Massachusetts02114, USA E-mail: swilcox1@partners.org
Get access Rights & Permissions [Opens in a new window]

Abstract

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). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.

Keywords

clinical operationsCOVID-19PPEresource utilizationtransport of patients
Type
Research Report
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 6 , December 2021 , pp. 762 - 766
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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.)

References

Paul, V, Patel, S, Royse, M, et al. Proning in non-intubated (PINI) in times of COVID-19: case series and a review. J Intensive Care Med. 2020;35(8):818–824.CrossRefGoogle ScholarPubMed
Wilcox, SR, Condella, A. Emergency department management of severe hypoxemic respiratory failure in adults with COVID-19. J Emerg Med. 2021;60(6):729–742.CrossRefGoogle ScholarPubMed
Jagan, N, Morrow, LE, Walters, RW, et al. The POSITIONED Study: prone positioning in nonventilated coronavirus disease 2019 patients—a retrospective analysis. Crit Care Explor. 2020;2(10):e0229.CrossRefGoogle ScholarPubMed
Padrão, EM, Valente, FS, Besen, BA, et al. Awake prone positioning in COVID-19 hypoxemic respiratory failure: exploratory findings in a single-center retrospective cohort study. Acad Emerg Med. 2020;27(12):1249–1259.CrossRefGoogle Scholar
Boomhower, J, Noland, HE, Frakes, MA, et al. Transport of a non-intubated prone patient with severe hypoxemic respiratory failure due to COVID-19. Prehosp Emerg Care. 2020;25(1):55–58.CrossRefGoogle ScholarPubMed
Sivaloganathan, AA, Nasim-Mohi, M, Brown, MM, et al. Noninvasive ventilation for COVID-19-associated acute hypoxemic respiratory failure: experience from a single center. Br J Anaesth. 2020;125(4):e368–e371.CrossRefGoogle Scholar
Mukhtar, A, Lotfy, A, Hasanin, A, et al. Outcome of non-invasive ventilation in COVID-19 critically ill patients: a retrospective observational study. Anaesth Crit Care Pain Med. 2020;39(5):579–580.CrossRefGoogle ScholarPubMed
Brown, CA, Mosier, JM, Carlson, JN, et al. Pragmatic recommendations for intubating critically ill patients with suspected COVID-19. J Am Coll Emerg Physicians Open. 2020;1(2):80–84.CrossRefGoogle Scholar
Moss, M, Huang, DT, Brower, RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med. 2019;380(21):1997–2008.Google ScholarPubMed
Cornejo, RA, Diaz, JC, Tobar, EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013;188(4):440–448.CrossRefGoogle ScholarPubMed
Guérin, C, Reignier, J, Richard, JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–2168.CrossRefGoogle ScholarPubMed
Taccone, P, Pesenti, A, Latini, R, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized control trial. JAMA. 2009;302(18):1977–1984.CrossRefGoogle Scholar
Seethala, RR, Frakes, MA, Cocchi, MN, et al. Feasibility and safety of prone position transport for severe hypoxemic respiratory failure due to coronavirus disease 2019. Crit Care Explor. 2020;2(12):e0293.CrossRefGoogle ScholarPubMed
Foster, C, Frakes, MA, Puopolo, E, et al. Inhaled epoprostenol to facilitate safe transport in Legionnaires’ disease. Prehosp Disaster Med. 2020;35(1):109–114.CrossRefGoogle ScholarPubMed
Richards, JB, Frakes, M, Saia, MS, et al. Changes in oxygen saturation and mean arterial pressure with inhaled epoprostenol in transport. J Intensive Care Med. 2020;36(7):758–765.CrossRefGoogle ScholarPubMed