In the face of the COVID-19 outbreak, military healthcare teams were deployed to London to assist the London Ambulance Service t transfer ventilated patients between medical facilities. This paper describes the preparation and activity of these military teams, records the lessons identified (LI) and reviews the complications encountered’. The teams each had two members. A consultant or registrar in emergency medicine (EM) and pre-hospitalemergency medicine (PHEM)E or anaesthesia and an emergency nurse or paramedic. Following a period of training, the teams undertook 52 transfers over a 14-day period. LI centred around minimising both interruption to ventilation and risk of aerosolisation of infectious particles and thus the risk of transmission of COVID-19 to the treating clinicians. Three patient-related complications (6% of all transfers) were identified. This was the first occasion on which the Defence Medical Services (DMS) were the main focus of a large-scale clinical military aid to the civil authorities. It demonstrated that DMS personnel have the flexibility to deliver a novel effect and the ability to seamlessly and rapidly integrate with a civilian organisation. It highlighted some clinical lessons that may be useful for future prehospital emergency care taskings where patients may have a transmissible respiratory pathogen. It also showed that clinicians from different backgrounds are able to safely undertake secondary transfer of ventilated patients. This approacmay enhance flexibility in future operational patient care pathways.

Background With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH.

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Research Objectives: To evaluate and compare static and dynamic balance as well as a gait in individuals with and without diabetic neuropathy.Design: Case-control study design. Setting: University setting. Participants: The study included a convenience sample of 13 individuals with type 2 DM (7 males, 6 females) with a mean age of 62.77AE11.9 years. Participants were grouped as neuropathy group (NG) (nZ6) or non-neuropathy group (NNG) (nZ7) based on 10-gram Semmes monofilament test results. Interventions: No intervention. Main Outcome Measures: Center of Pressure (COP) sway using a force plate in normal stance and Romberg stance, with eyes open and closed conditions. Clinically balance was assessed using the Mini-BESTest (anticipatory, reactive, sensory orientation, and dynamic gait). Gait parameters (velocity, stride, and step length) were assessed using the GAITRite. Results: Significant condition effects were found for total displacement (F Z9.14, pZ.006), amplitude anterior/posterior (F Z9.01, pZ.007), amplitude medial/lateral (F Z10.49, pZ.004), area (F Z19.24, p < 001), velocity anterior/posterior (F Z11.12, pZ.003) and velocity medial/lateral ((F Z13.03, pZ.002) for Romberg stance eyes closed condition in Neuropathy group. No significant group effect, condition effect, and interaction were found in the normal width stance. The Mini-BESTest components and gait parameters did not have any significant difference between the groups. There were no significant differences between the self-reported activity levels of the NG and NNG participants (UZ14.5; pZ.30). NG participants had significantly higher weight (pZ .035) than the NNG participants.Conclusions: This study demonstrates the importance of visual compensation for participants with neuropathy in a narrow stance as reflected through COP sway in Romberg's stance with eyes closed. Though the neuropathy group can maintain a similar level of gait and balance, when the base of support decreased, they need to rely on visual compensatory strategies. The neuropathy group had higher weights than the non-neuropathy participants even with similar activity levels. In addition to rehabilitative measures, there is a need for teaching visual compensatory strategies and weight reduction program for patients with diabetic neuropathy.