No abstract

Critical care transport organizations are nimble, operationally focused institutions that can aid in managing crises. Ornge provides air ambulance and critical care transport services to Ontario. From 12 bases, Ornge operates four PC-12 Next Generation fixed wing (FW) aircraft, eight AW-139 rotary wing (RW) aircraft, and four critical care land ambulances (CCLA) on a 24/7 basis. Ornge also contracts with private air carriers to provide lower acuity air ambulance services. Ornge performs over 20,000 patient-related transports annually. We discuss Ornge's approach to preparing for the coronavirus disease 2019 (COVID-19) pandemic, and identify potential unconventional roles.

Objectives: The 12-lead electrocardiogram (ECG) can capture valuable information in the prehospital setting. By the time patients are assessed by an emergency department (ED) physician, their symptoms and any ECG changes may have resolved. We sought to determine whether the prehospital electrocardiogram (pECG) could influence ED management and how often the pECG was available to and reviewed by the ED physician. Methods: A retrospective medical record review was conducted on a random sample of patients $ 18 years who had a prehospital 12-lead ECG and were transported to one of two tertiary care centres. Data were recorded onto a standardized data extraction tool. Three investigators independently compared the pECG to the first ECG obtained in the ED after patient arrival at the hospital. Any abnormalities not present on the ED ECG were adjudicated to ascertain whether they had the potential to change ED management. Results: Of 115 ambulance runs selected, 47 had no pECG attached to the ambulance call record (ACR) and another 5 were excluded (one ST elevation myocardial infarction, one cardiac arrest, three ACR missing). Of the 63 pECGs reviewed, 16 (25%) showed changes not apparent on the initial ED ECG (k 5 0.83; 95% CI 0.74-0.93), of which 12 had differences that might influence ED management (k 5 0.76; 95% CI 0.72-0.82). Only one hospital record contained a copy of the pECG, despite the current protocol that paramedics print two copies of the pECG on arrival in the ED (one copy for the ACR and one to be handed to the medical personnel). None of 110 ED charts documented that the pECG was reviewed by the ED physician. Conclusion: The pECG has the potential to influence ED management. Improvement in paramedic and physician documentation and a formal pECG handover process appear necessary. RÉ SUMÉObjectifs : L'é lectrocardiogramme (ECG) à 12 dé rivations peut fournir des renseignements pré cieux en contexte de pré hospitalisation. En effet, avant que les patients n'aient é té é valué s par un mé decin du service des urgences (SU), leurs symptô mes et toute modification de l'ECG pourraient avoir é té dé jà ré solus. Nous cherchions donc à dé terminer si l'é lectrocardiogramme en pré hospitalisation (ECGp) pouvait influencer la prise en charge du patient au SU et à quelle fré quence il é tait mis à la disponibilité du mé decin du SU afin qu'il puisse l'é tudier. Mé thodes : Un examen ré trospectif des dossiers mé dicaux a é té mené sur un é chantillon alé atoire de patients de plus de 18 ans soumis à un ECG à 12 dé rivations et transporté s dans un des deux centres de soins tertiaires. Les donné es ont é té consigné es sur un instrument normalisé d'extraction de donné es. Trois chercheurs ont comparé sé paré ment l'ECGp avec le premier ECG obtenu au SU aprè s l'arrivé e du patient à l'hô pital. Toute anomalie absente de l'ECG du SU a é té examiné e afin de vé rifier si elle pouvait avoir modifié la prise en charge du patient par le SU. Ré sultats : Pour 115 transports par ambulance sé lectionné s, il n'y av...

LA calls are associated with short-term morbidity and mortality. Patient age was found to be associated with these outcomes. These calls may be early indicators of problems requiring comprehensive medical evaluation and thus further factors associated with poor outcomes should be determined.