Descriptive record of the activity of military critical care transfer teams deployed to London in April 2020 to undertake transfer of patients with COVID-19

Abstract

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.

Global key concepts of civil-military cooperation for disaster management in the COVID-19 pandemic – a qualitative phenomenological scoping review.

“…The following section reviews concrete CIMIC eld experiences or analyses of such (3,(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62). Because disaster management during COVID-19 was generally guided by national frameworks and policies, pertinent reports in this section are reviewed grouped by country of rst author in order to maintain this perspective (Figure 4), appearing geographically aggregated by continent and in descending order of overall numbers of reports per country.…”

“…An interesting example for enhancing crisis management capabilities in the public sector is the British stabilization unit, which facilitates cooperation between agencies, civilians and the military and could serve as a training and capacity building model (48). Ten military critical care transfer teams assisted the London Ambulance Service and transported 52 ventilated civilian patients during a COVID-19 patient surge in intensive care units in London, UK, during the last two weeks in April 2020 (49). Each twomember team was composed of 1) a consultant/registrar in emergency medicine and pre-hospital emergency medicine or anesthesia and 2) an emergency nurse or paramedic (49).…”

“…Ten military critical care transfer teams assisted the London Ambulance Service and transported 52 ventilated civilian patients during a COVID-19 patient surge in intensive care units in London, UK, during the last two weeks in April 2020 (49). Each twomember team was composed of 1) a consultant/registrar in emergency medicine and pre-hospital emergency medicine or anesthesia and 2) an emergency nurse or paramedic (49). Main lessons identi ed centered around overcoming technical issues with the ventilation and measures to avoid transmission SARS-CoV-2 to the staff (49).…”

“…Each twomember team was composed of 1) a consultant/registrar in emergency medicine and pre-hospital emergency medicine or anesthesia and 2) an emergency nurse or paramedic (49). Main lessons identi ed centered around overcoming technical issues with the ventilation and measures to avoid transmission SARS-CoV-2 to the staff (49).…”

Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

“…Indeed, ambulance services are overloaded by demands and rows of ambulances with COVID-19 patients waiting outside the emergency departments are reported with almost daily frequency in each country. Under certain emergency circumstances, even military healthcare teams have been deployed to assist the ambulance service [ 4 ]. Therefore, it frequently happens that intubated patients remain in the Emergency Department (ED) for several hours before the transfer can be accomplished.…”