Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team

Abstract

Background The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. Methods Retrospective review of air critical care transfer service set up and case review of first 50 transfers. Results We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29–83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149–440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31–158). The mean transfer transit time between referring and receiving units was 72 min (9–182). Conclusion Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.

Burden of hospital admissions and resulting patient interhospital transports during the 2020/2021 SARS-CoV-2 pandemic in Saxony, Germany

“…The SARS-CoV-2 pandemic caused congestion in health care systems across Europe, and alternative transportation options were developed to relieve regional hospitals (i.e. ambulance bus in the Netherlands 28 or transport by civilian helicopter emergency medical service (HEMS, UK) 29 .…”

Developments in adult critical care transfer in England: a positive legacy of the COVID‐19 pandemic

“…Capacity transfers, previously termed ‘non‐clinical’, have long been presumed to be associated with risk and harm [ 9 ] as well as being used as a metric of an underperforming critical care unit or system [ 10 ]. The reasons for this are multiple, but it was accepted they would only occur when a critical care unit was under extreme pressure or unable to cope with the case‐load it faced.…”

“…The paper by Huq et al. [ 8 ] is one of a series from around the world [ 9 , 10 , 11 ] which have variably assessed the efficacy, physiological effects and outcomes of patients requiring critical care transfer during the pandemic. Evidence published before 2020 has long suggested that critical care transfer can be carried out safely by dedicated transfer and retrieval teams [ 1 ], with the best evidence from countries with well‐developed systems such as Australia.…”

Trends in Patient Transfers From Overall and Caseload-Strained US Hospitals During the COVID-19 Pandemic

“…Evidence on acute hospital transfers during the pandemic has been limited to local or narrative reports, surveys, specific patient cohorts (eg, those with stroke or ST-elevation myocardial infarction), and non-US studies. 6,[12][13][14][15][16][17] Most US states have not reported their experience with transfers to date, and among the few that have, the ability to transfer patients appeared to vary substantially across individual US state-based transfer coordination enters. 17,18 Furthermore, there were media reports of US hospitals making multiple unsuccessful attempts to move patients to other hospitals.…”