Transport Team Research Articles

Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

<h3>Objective</h3> There are limited studies on the safety and efficacy of high flow nasal cannula (HFNC) utilization in pediatric critical care transport (CCT). This 15-month retrospective study was designed to describe HFNC utilization by our transport team and to track escalations in respiratory support within 24 hours of hospital admission including increased liter flow, non-invasive ventilation (NIV), or intubation. <h3>Methods</h3> This study was conducted at a large quaternary free standing children's hospital with a dedicated pediatric transport team that completes an average of 5,500 transports per year. Data was collected from January 1, 2019, to March 31, 2020. A total of 6,279 pediatric transports were completed during the study period. Inclusion criteria: >30 days and <18 years old, required HFNC ≥4 L/min during transport, and admitted to our pediatric facility. Our institutions HFNC pediatric floor (Peds) criteria: <2 years of age, no comorbidities, suspected respiratory viral illness, max 2 L/kg and/or 15 L/min, ≤40% FiO2. All patients used the standard HFNC equipment in our department. No new equipment was trialed during this study. We did not include SARS-COVID-19 patients given the initial variability in non-invasive respiratory support. <h3>Results</h3> A total of 382 charts reviewed; 358 patients met inclusion criteria. Median age 0.7 years old, with an interquartile range (IQR) of 0.3-1 year of age. Median weight 8.4 kilograms (kg), IQR 6.2-11 kg. Median transport time 80 minutes (min), IQR 69-115 min. Most of our HFNC volume was initiated by the referral (279, 78%) and we initiated the remainder (79, 22%). The majority of our HFNC patients were transported from the (ER) (184, 51%) and Peds (119, 33%) with the remainder being from urgent care (UC) (42, 12%), and Pediatric Intensive Care Unit (PICU) (13, 4%). We transported (210, 41%) back to the PICU versus (148, 41%) to Peds. Of the 279 patients that were on HFNC started by the referral, 42 (15%) had their flow weaned by the transport team. Median HFNC 10 L/min with an IQR of 6-15 L/min appreciated at drop-off regardless of HFNC status (initiated by transport, weaned by transport, or continued referral settings) (p-value 0.122). Escalations of care were tracked up to 24 hours after patient drop-off. A total of 118 patients (33%) had an escalation of care; 90 (76%) required an increase in flow, 28 (24%) required NIV, and 0 (0%) required intubation within 24 hours. Escalations of care typically occurred within the first 6 hours after patient drop-off, 96 (27%), with a median HFNC 10.25 L/min, IQR 8-14 L/min (p-value range ≤0.310). <h3>Conclusion</h3> Our data suggests HFNC utilization in pediatric patients during CCT is a safe modality for non-invasive oxygen delivery with minimal risk of escalation requirement and no need for intubation. The number of escalations in liter flow after patient drop-off (∼25% of high flow volume) was likely due to inpatient protocol to place all HFNC patients on 2 L/kg or max of 15 L/min. In the future, we plan to implement a HFNC protocol for management guidelines during CCT while conducting further research and review.

A Review of Patient Population Requiring Novel Critical Care Pediatric Transport Stroke Clinical Practice Guideline: A Three Year Single Site Analysis

<h3>Objectives</h3> 1. To identify patients transported by a pediatric critical care transport team for suspected or confirmed acute ischemic stroke who met qualifications of stroke activation. 2. Retrospective calculation of Large Vessel Occlusion (LVO) score of patients meeting criteria for transport stroke protocol activation. <h3>Background</h3> There are many pre-hospital Emergency Medical Service (EMS) and transport protocols as well as Large Vessel Occlusion (LVO) screening tools that exist for rapid transport of an adult patient with suspected or confirmed acute ischemic stroke to the nearest stroke center for rapid diagnosis. These screening algorithms aid in identifying adult patients who benefit from transport directly to an adult comprehensive stroke center. No data has been published on pre-hospital and transport evaluation and treatment algorithms for suspected acute ischemic stroke in children. Our institution created and implemented a transport stroke clinical practice guideline specific to pediatric stroke to improve recognition and management of patients with suspected stroke by our interfacility critical care transport team. <h3>Methods</h3> A retrospective chart review of patients transported by our institution's critical care transport teams from September 1, 2016 and March 1, 2020 meeting institutional criteria for stroke activation. LVO scores were calculated retrospectively based on clinical information documented within the transport medical record. <h3>Results</h3> Of the 17,244 patients transported by our institution's critical care transport, 17 patients met criteria during the defined study period. Average/median age was 173 months, or 14.4 years old. 4 of 17 had radiographic evidence of thrombus with 3 of those 4 underwent definitive management with tPA or endovascular retrieval. Hemiplegia is the most common presenting symptom with confirmed stroke in this population. The confirmed stroke group scored significantly lower on Glasgow Coma Scale (median of 8 vs. 15, p = 0.014), significantly higher on the LAMS LVO score (median 4 vs. 0, p = 0.021) and significantly higher on the RACE LVO (median 4 vs. 0, p = 0.036). <h3>Conclusion</h3> Acute ischemic stroke is a rare occurrence in pediatric patients. A standardized clinical practice guideline for transport can facilitate early recognition, appropriate management, and transport to a pediatric specific stroke care for timely diagnosis and intervention. LVO scores designed for adult population have not been validated for use in pediatric patients for suspected stroke, but may be useful in triage of pediatric patients with stroke-like symptoms to a stroke center with specialized care in pediatric stroke.

Interhospital Aircraft/Ground Extracorporeal Membrane Oxygenation Transportation by a Mobile Extracorporeal Membrane Oxygenation Team: First Turkish Pediatric Case Series.

Extracorporeal membrane oxygenation is a life-saving treatment for patients with circulatory and respiratory failure refractory to standard therapy. However, safe and timely patient transport to the referral extracorporeal membrane oxygenation center is critical for better patient outcomes in patients with acute cardiogenic shock. This study aimed to describe children's features who were transferred to our center under extracorporeal membrane oxygenation by aircraft/ground vehicle and demonstrated the importance of extracorporeal cardiopulmonary resuscitation for transported children. We report the first Turkish pediatric case series of patients with acute cardiogenic shock transported by aircraft and ground ambulances on extracorporeal membrane oxygenation support to a referral extracorporeal membrane oxygenation center between January 2016 and January 2021. Overall, 6 patients on venoarterial extracorporeal membrane oxygenation support were transported by aircraft and ground vehicles to our pediatric intensive care unit. Transport was achieved by fixed-wing aircraft in 5 patients and commercial aircraft in 1. Our mobile extracorporeal membrane oxygenation team cannulated 3 patients, and 3 patients were cannulated by the team at the hospital they applied to. The median age was 112 (range: 14-204) months and the median weight was 28.6 kg (range: 8.6-57.2 kg). The etiology of acute cardiogenic shock was fulminant myocarditis in 4 patients, dilated cardiomyopathy in 1, and transposition of great arteries and atrial flutter in 1. The median distance of travel for the patients to our hospital was 618 (407-955) km. No adverse events were detected during aircraft or ground vehicle transport. Mobile pediatric extracorporeal membrane oxygenation transport teams may provide safe aircraft and ground vehicle transportation in high-risk patients with acute cardiogenic shock bridging to survival or long-term circulatory support.

ОЦЕНКА ЭКОНОМИЧЕСКОЙ ЭФФЕКТИВНОСТИ ТРАНСПОРТНОГО ПЛАНИРОВАНИЯ В ГРАФАХ ВОЗДЕЛЫВАНИЯ ОЗИМОЙ ПШЕНИЦЫ

The article analyzes the agricultural activity of the agro-industrial complex of the Volgograd region. A study of the value of the yield of winter wheat for a relatively long period from 1930 to 2021 was conducted. The transport component in the technological map of winter wheat cultivation has been determined. It is revealed that when harvesting grain, production transport and logistics systems with mass transportation chains at the micro, meso and macro levels arise. In the agro-industrial complex, it is imperative to work out technological schemes for cultivating agricultural crops and the correct organization of interaction between road transport and combine harvesters as part of harvesting and transport teams, based on modeling methods. The authors proposed to plan transport costs by constructing graphs at the micro–level "Sowing fields – district current", at the meso–level – using the graph "District current – district elevators", at the macro-level - using the graph "District elevators - port elevators". The effectiveness of the proposed measures is evaluated by economic methods. As a result, agricultural enterprises are able to plan their work taking into account new information technologies that ensure higher efficiency of their agricultural activities. The resulting economic effect is only for the individual links selected as an example of each of the levels of a large multimodal logistics system (at the micro level for the link (A_20–B_(1 )) – 61,660 rubles, at the meso level for the link (A_79–B_(33 )) – 625,833.3 rubles, at the macro level for the link (A_33–B_(2 )) – 10,923,680.6 rubles). It will reduce the transport component in the calculation of costs for the cultivation of winter wheat sold inside Russia and for export to Turkey and Iran.

Rare Cause of Arrhythmia and Seizures in a Late-Preterm Newborn

Rare Cause of Arrhythmia and Seizures in a Late-Preterm Newborn

Application of quality function deployment technology in extracorporeal membrane oxygenation treatment of patients with critical cardiopulmonary disease

To accurately and effectively identify the most critical needs of extracorporeal membrane oxygenation (ECMO) treatment for patients with severe cardiopulmonary diseases, and to better carry out continuous improvement of medical service quality an patients' satisfaction. Patients who underwent ECMO and transferred from 56 medical institutions in the Henan Provincial People's Hospital Critical Care Medicine Specialist Alliance [the patients who were transported before applying quality function deployment (QFD) from June 2017 to May 2018 were enrolled as the control group, and patients who were transported after applying QFD from June 2018 to May 2019 were the observation group], medical staff in the alliance hospitals, ECMO transfer teams and transfer driver teams were enrolled as the subjects of the survey. QFD was applied to convert the collected requirements into quality improvement elements for targeted improvement measures. A total of 125 questionnaires were distributed in this survey, and 116 valid questionnaires were collected, including 91 from patients (including 27 from the control group and 64 from the observation group), 10 from the medical staff of the alliance hospitals, 10 from the ECMO transport teams and 5 from the transport driver teams. The questionnaire recovery rate was 92.8%. The improvement elements of ECMO treatment for patients with critical cardiopulmonary diseases were ranked according to the importance, and the top five were as follows: the accuracy of the first diagnosis, the specialization of ECMO team, the guarantee of vehicle safety, the seamless responses, and the smooth coordinated rescue protocol. The top five improvement elements should be prioritized in ECMO treatment of patients with critical cardiopulmonary disease in all hospitals of the Alliance to ensure more accurate and timely treatment.

275 Prothrombin Complex Concentrate Use in a Rural Health Care Network

Study ObjectivesReversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal.MethodsThis was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups.ResultsAfter data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups.ConclusionIn rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.No, authors do not have interests to disclose Study ObjectivesReversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal. Reversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods such as fresh frozen plasma (FFP). In many rural facilities the availability of PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal. MethodsThis was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups. This was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) from outside hospital admission. Active warfarin prescription, EMS transfer to the tertiary facility, and receipt of anticoagulation reversal between January 2012 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Time to event analysis was conducted to compare mean INR reversal times. Propensity score matching was used to match patients in each arm and Chi-square analysis compared variables across groups. ResultsAfter data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups. After data collection and review, 165 patients were analyzed. There were 44 patients transferred before implementation of the PCC4 exchange program and 121 after. The mean duration to INR reversal was significantly shorter for patients post-exchange (19.03 hours) compared to pre-exchange (38.98 hours) (p=0.0104). There was no significant difference in 30-day mortality between the groups. ConclusionIn rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.No, authors do not have interests to disclose In rural hospitals, increasing availability of PCC4 using a medication exchange program significantly reduces time to INR reversal in warfarin patients.

A Retrospective Cohort Study of Burn Casualties Transported by the US Army Burn Flight Team and US Air Force Critical Care Air Transport Teams.

The US Army Burn Center, the only burn center in the Department of Defense provides comprehensive burn care. The Burn Flight Team (BFT) provides specialized burn care during transcontinental evacuation. During Operations Iraqi and Enduring Freedom, burn injuries accounted for approximately 5% of all injuries in military personnel. To augment BFT capacity, US Air Force Critical Care Air Transport Teams (CCATTs) mobilized to transport burn patients. The purpose of this study was to describe critically ill, burn injured patients transported to the US Army Burn Center by BFT or CCATT, to compare and contrast characteristics, evacuation procedures, in-flight treatments, patient injuries/illnesses, and outcomes between the two groups. We conducted a retrospective cohort study of CCATT and BFT patients, admitted to the burn ICU between January 1, 2001 and September 30, 2018. Patients with total body surface area burned (TBSA) >30% were evacuated by BFT, while CCATT evacuated patients with ≤ 30% TBSA. Ninety-seven patients met inclusion criteria for this study. Of these, 40 (41%) were transported by the BFT and 57 (59%) were transported by CCATTs. Compared with patients transported by CCATTs, patients transferred by the BFT had higher median TBSA and full-thickness burn size, higher prevalence of chest, back and groin burns, and higher prevalence of inhalation injury. BFT patients had increased hospital days (62 vs. 37; P = .08), ICU days (29 vs. 12; P = .003) and ventilator days (14 vs. 6; P < .001). TBSA was the only variable significantly associated with ARDS (aOR = 1.04; 95% CI: 1.01, 1.08; P = 0.04), renal failure (aOR = 1.07; 95% CI: 1.03, 1.11; P = .002), and mortality (aOR = 1.08; 95% CI: 1.03, 1.13; P = .001). Evacuation by the BFT was associated with increased ICU and ventilator days, increased mortality, and a greater risk for developing renal failure. The severity of injury/TBSA likely accounted for most of these differences.

French national survey on simulation-based neonatology education of pediatric residents

The French Society of Neonatology (SFN) conducted a national questionnaire survey on the simulation-based education neonatal curriculum for pediatric residents. The response rate was 93% for the pediatric curriculum coordinators and 97% for the neonatal intensive care unit medical directors and neonatal transport teams. The average hourly volume during the curriculum was 21 ± 17 h. Overall, 89% of regional pediatric curricula offered at least one simulation session. Each simulation program involved newborn resuscitation in the delivery room but often lacked a formalized program. Additionally, half of the neonatology departments provided simulation-based education. Simulation education is now common for training pediatric residents in neonatology in France but it is heterogeneous in the French territory.

Predictive value of the clinical scale for assessment of premature newborns during pre-transport preparation of newborns

Purpose. This study is aimed at determining the predictive value of the clinical assessment scale for premature newborns during pre-transport preparation in relation to the outcomes of treatment of newborns.Materials and methods. The cohort study included data from 604 visits of the neonatal transport team to the newborn children hospitalized in the medical centers of the Sverdlovsk region from August 1, 2017, to December 31, 2018. Median birth weight [IQR] 2515 [1600; 3275] grams, median gestational age [IQR] 36 [32; 38] weeks. Primary medical documentation was used for scale assessment. Descriptive statistics tools: median and interquartile range, fraction, 95% CI for the proportion, error of the proportion, calculation of the area under the ROC curve, calculation of sensitivity, specificity, cut-off level, positive (PPV) and negative predictive value (NPV). The correlation analysis of quantitative data with an abnormal distribution is performed by Spearman’s test.Results. The scale demonstrated a high predictive value for lethal outcome (AUC = 0.803 (0.734–0.872)), 7-day mortality (AUC = 0.821 (0.743–0.899)), late neonatal sepsis (AUC = 0.763 (0.697–0.830)), severe intraventricular hemorrhage (AUC = 0.784 (0.729–0.838)), and occlusive hydrocephalus (AUC = 0.802 (0.725–0.878)) in the total sample of newborns (fullterm and premature). The negative predictive value significantly prevails over the positive predictive value. Weak correlations were found between the score and the duration of intensive care (r = 0.305, p &lt; 0.0001), duration of ventilation (r = 0.221, p &gt;&lt; 0.0001), duration of nCPAP (r = 0.214, p = 0.001), and hospitalization (r = 0.214, p &gt;&lt; 0.0001), both in the general sample and among the survivors. Conclusion. The scale has a high predictive value in relation to the outcomes of the hospital stage in newborns, but a weak correlation with quantitative outcomes. Key words: Newborns, interhospital transportation of newborns, neonatal transfer, severity assessment, tactical decision.&gt;˂ 0.0001), duration of ventilation (r = 0.221, p ˂ 0.0001), duration of nCPAP (r = 0.214, p = 0.001), and hospitalization (r = 0.214, p ˂ 0.0001), both in the general sample and among the survivors.Conclusion. The scale has a high predictive value in relation to the outcomes of the hospital stage in newborns, but a weak correlation with quantitative outcomes.

Neonatal Vital Sign Trajectories and Risk Factors During Transport Within a Regional Care Network

ObjectiveThe aim of this study was to characterize vital sign abnormalities, trajectories, and related risk factors during neonatal transport. MethodsWe performed a retrospective analysis of neonates transported within a US regional care network in 2020 to 2021. Demographic and clinical data were collected from electronic records. Group-based trajectory modeling was applied to identify groups of neonates who followed distinct vital sign trajectories during transport. Patients with conditions likely to impact the assessed vital were excluded. Risk factors for trajectories were examined using modified Poisson regression models. ResultsOf the 620 neonates in the study, 92% had one abnormal systolic blood pressure (SBP) measure, approximately half had an abnormal heart rate (47%) or temperature (56%), and 28% had an abnormal oxygen saturation measure during transport. Over half (53%) were in a low and decreasing SBP trajectory, and 36% were in a high and increasing heart rate trajectory. Most infants ≤ 28 weeks postmenstrual age had 2 or more concerning vital sign trajectories during transport. ConclusionAbnormal vital signs were common during neonatal transport, and potentially negative trajectories in heart rate and SBP were more common than temperature or oxygen saturation. Transport teams should be trained and equipped to detect concerning trends and respond appropriately while en route.

Neonatal Transport Ventilation: Simulation to Improve Knowledge and Skills.

IntroductionNeonatal transport is a frequent activity in most tertiary and regional perinatal centers. Neonatal transport teams serve as mobile intensive care units and are equipped with specialized incubators that have built-in ventilators that can provide several levels of support. In our institution, we aim to educate all neonatal transport providers, including neonatal-perinatal fellows, neonatal intensive care unit–dedicated advanced practice providers, and neonatal intensive care unit–dedicated registered respiratory therapists, on transport ventilation management and troubleshooting, utilizing simulation to optimize patient care during transport.MethodsWe developed scenarios based on the equipment used at our institution: an AirBorne Voyager transport incubator with a built-in Crossvent 2i+ infant ventilator, AirBorne TXP-2D high-frequency ventilator, and AeroNOx inhaled nitric oxide system (International Biomedical). Equipment and troubleshooting knowledge were assessed via knowledge tests prior to and at intervals after simulation scenario completion. We performed paired t tests to analyze change in test scores at each time point postsimulation compared to presimulation. Facilitated debriefing and a survey elicited feedback on learner confidence and comfort.ResultsTen learners participated in the simulations and completed the knowledge assessments. At all postsimulation time points, mean knowledge scores showed statistically significant improvements compared to presimulation scores. Feedback from learners on confidence in their skills and comfort with the equipment was positive.DiscussionNeonatal transport team ventilator knowledge and troubleshooting skills have improved after instituting this semiannual simulation training.

Transport of the patient with trauma: a narrative review.

Trauma and injury place a significant burden on healthcare systems. In most high-income countries, well-developed acute pre-hospital and trauma care systems have been established. In Europe, mobile physician-staffed medical teams are available for the most severely injured patients and apply a wide variety of lifesaving interventions at the same time as ensuring patient comfort. In trauma systems providing pre-hospital care, medical interventions are performed earlier in the patient journey and do not affect time to definite care. The mode of transport from the accident scene depends on the organisation of the healthcare system and the level of hospital care to which the patient is transported. This varies from 'scoop and run' to a basic community care setting, to advanced helicopter emergency medical service transport to a level 4 trauma centre. Secondary transport of trauma patients to a higher level of care should be avoided and may lead to a delay in definitive care. Critically injured patients must be accompanied by at least two healthcare professionals, one of whom must be skilled in cardiopulmonary resuscitation and advanced airway management techniques. Ideally, the standard of care provided during transport, including the level of monitoring, should mirror hospital care. Pre-hospital care focuses on the critical care patient, but the majority of injured patients need only close observation and pain management during transport. Providing comfort and preventing additional injury is the responsibility of the whole transport team.

Interfacility Transport of Critically Ill Patients.

To assess recent advances in interfacility critical care transport. PubMed English language publications plus chapters and professional organization publications. Manuscripts including practice manuals and standard (1990-2021) focused on interfacility transport of critically ill patients. Review of society guidelines, legislative requirements, objective measures of outcomes, and transport practice standards occurred in work groups assessing definitions and foundations of interfacility transport, transport team composition, and transport specific considerations. Qualitative analysis was performed to characterize current science regarding interfacility transport. The Task Force conducted an integrative review of 496 manuscripts combined with 120 from the authors' collections including nonpeer reviewed publications. After title and abstract screening, 40 underwent full-text review, of which 21 remained for qualitative synthesis. Since 2004, there have been numerous advances in critical care interfacility transport. Clinical deterioration may be mitigated by appropriate patient selection, pretransport optimization, and transport by a well-resourced team and vehicle. There remains a dearth of high-quality controlled studies, but notable advances in monitoring, en route management, transport modality (air vs ground), as well as team composition and training serve as foundations for future inquiry. Guidance from professional organizations remains uncoupled from enforceable regulations, impeding standardization of transport program quality assessment and verification.

Adverse events during intra-hospital transport of critically ill patients: an observational study

Aim: This study aimed to describe adverse events occurring during intra-hospital transportation of adult patients from the emergency room to the intensive care unit and to analyze the associated risk factors. Design: This study uses a quantitative analytical observational design. Methods: In total, 151 critically ill patients out of 159 with indicated intra-hospital transportation participated in the study. Patients were transported from the emergency room to the intensive care unit in a class A general hospital in Central Java, Indonesia. The statistical analysis included descriptions of demographic, medication, monitoring, equipment, and clinical characteristics of the cohort, and identified risk factors for adverse events during transportation by univariate and multivariate logistic regression analyses. Results: The overall incidence of adverse events was 78.8%. Risk factors were: transport team, hemodynamic monitoring, equipment preparation, and patient&#8217;s condition, and were associated with adverse events (p &lt; 0.05). Multivariate analysis showed that equipment preparation was the factor most contributing to adverse events with Exp(B) = 22.6. Conclusion: This study showed that the incidence of adverse events during transportation of critically ill patients was high. We recommend that transports be performed by fully equipped teams of medical professionals. Monitoring of intra-hospital transportation-related events is also recommended to reduce frequency of adverse events.

Evaluation of the relevance of interhospital transfer medicalization in the suspicion of foreign body aspiration in children

IntroductionForeign body aspiration in preschool children is a common and potentially fatal event. Diagnostic confirmation requires tracheobronchoscopy. The current medical care in West Provence Alpes Cote d'Azur (PACA) is based on an inter-hospital transfer via the emergency medical services (EMS) to the pediatric ear–nose–throat (ENT) reference center in Marseille as quickly as possible. However, the intensive care pediatric transport team has only one vehicle, which is not always available. The issue of the real risk for the suspected patient when they are asymptomatic therefore arises, questioning the presence of a physician during these transports. Main objectiveWe aimed to describe our practice regarding suspected foreign body aspiration (FBA) and assess the relevance of medical transport for children with suspected FBA regardless of their clinical and/or radiological presentation. Material and methodsThis was a retrospective, single-center study at the Timone Children's Hospital, from January 1, 2016, to December 31, 2017. Clinical and radiological data were collected from pediatric emergency files and endoscopy reports. ResultsA total of 178 children were suspected of having FBA upon arrival at the Pediatric Emergency Department of La Timone Children's Hospital; 96 children were transferred from another hospital on pediatric ENT advice. Of these 96 children, 63 were asymptomatic. Of these asymptomatic children who were transferred, 11 did not undergo tracheobronchoscopy and four children presented with a foreign body at tracheobronchoscopy (6%). When transport-related data were available, no deterioration of the clinical condition was described in these patients during transport. ConclusionIn our retrospective study of the medical care for suspected FBA in children in the West PACA region, less than 10% of children who were asymptomatic but suspected of having FBA presented with a foreign body on endoscopy, which questions the relevance of physician presence during transport of these patients.

Helicopter versus ground ambulance transport for interfacility transfer of critically ill children

BackgroundFollowing initial stabilization, critically ill children often require transfer to a specialized pediatric hospital. While the use of specialized pediatric transport teams has been associated with improved outcomes for these patients, the additional influence of transfer mode (helicopter or ground ambulance) on clinical outcomes remains unknown. MethodsWe investigated the association between transport mode and outcomes among critically ill children transferred to a single pediatric hospital via a specialized pediatric transport team. We designed a retrospective cohort study to reduce indication bias by limiting analysis to patients for whom a helicopter transport was initially requested. We compared outcomes for those who ultimately traveled via helicopter, and for those who ultimately traveled via ground ambulance due to non-clinical factors. ResultsWe compared transport times, in-hospital mortality, and hospital length of stay by transport mode. Transport time in minutes was shorter for helicopter transports (median = 143, interquartile range [IQR]: 118–184) compared to ground ambulance transports (median = 289, IQR: 213–258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In unadjusted analysis, helicopter transport was not associated with a difference in in-hospital mortality (helicopter = 6.0%, ground ambulance = 7.0%; 95% CI for difference: −6.6% to 3.3%; p = 0.64) but was associated with a statistically significant reduction in median hospital days (helicopter = 4, ground ambulance = 5; 95% CI -3 to 0; p = 0.04). In adjusted analyses, there were no statistically significant associations. These results were consistent across sensitivity analyses. ConclusionsAmong critically ill pediatric patients without traumatic injuries transported by a specialty team, those patients who would have been transferred by helicopter if available but were instead transferred by ground ambulance reached their site of definitive care approximately 2.5 h later. Helicopter transport for these patients was not associated with in-hospital mortality, but was potentially associated with reduced hospital length of stay.

Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows’ Performance and Confidence

ObjectivePediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows’ confidence and performance. MethodsThis was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed. ResultsThe participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement. ConclusionThe pediatric transport curriculum had a positive impact on PEM and PCCM fellows’ confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants’ real-life performance and patient care.

Medical evacuation of non-transportable newborns after re-evaluation

BACKGROUND: Early admission or birth in a high-level neonatal care facility is associated with lower morbidity in preterm infants. Assessment of transportability remains a problem of the pre-transport evaluation. The literature data lacks the possibility of subsequent evacuation of patients recognized as non-transportable at the first examination.&#x0D; AIM: This study compares intensive care during the first and second examinations of patients recognized as non-transportable and evacuated after re-departure.&#x0D; MATERIALS AND METHODS: The cohort study included data from patients recognized as non-transportable at the first examination and evacuated after the second examination (18 patients). Comparison of intensive care, assessments by scales, correction of intensive care by the transport team during the first and repeated examinations of the patient was performed. Descriptive statistics methods, Wilcoxons test, and McNemars test were applied.&#x0D; RESULTS: Patients evacuated on the second attempt had a birth weight of less than 1500 grams. The median birth weight was 1125 [7403240] grams. The patients were reliably more often on traditional mechanical ventilation and less on high-frequency ventilation at the second examination. The infusion of adrenaline and prostaglandins was more often performed. The average number of corrective actions per patient at the first examination was 1.33 (SD 0.77), at the second examination 0.5 (SD 0.62), p = 0.003. During the first attempt at evacuation, patients significantly more often required the administration or correction of the catecholamine dose, tracheal reintubation, and blood transfusion.&#x0D; CONCLUSION: The data obtained indicate the inadequacy of the therapy performed before the arrival of the transport team contributes to the decision on the patients non-transportability.

Transportability of newborns at the stage of pre-transport evaluation

with the necessary resources and technology to improve the level and quality of care remains one of the most important tasks of emergency neonatology. Deterioration on the road may be due to suboptimal stabilization, the severity of the patient's condition, and the transportation procedure itself. Assessment of transportability is one of the most important tasks in the pre-transport preparation phase. Materials and Methods. The cohort study included data from 604 resuscitation team visits. According to the tactical decision, the subgroups of the transportable (n = 497) and non-transportable (n = 46) patients were singled out. The anamnesis data, scores according to the KSHONN, NTISS, TRIPS threat scales, the volume of intensive care, pre-transport preparation, and the outcome of the hospital stage were analyzed. Results. Non-transportable patients had significantly higher scores on the examined threatometric scales. The need for high-frequency artificial lung ventilation was associated with patient nontransportability with a risk ratio of 10.1 [6.72 to 15.18], and dopamine and adrenaline infusion increased the likelihood of nontransportability with risk ratios of 5.85 [3.44 to 9.95] and 11.38 [8.09 to 16.01], respectively. The need for correction of intensive care is associated with nontransportability with a risk ratio of 3.44 [2.29 to 5.17]. The group of nontransportable patients was characterized by significantly higher mortality, 7-day mortality, frequency of late neonatal sepsis, and longer duration of ventilatory ventilation and intensive care. Discussion. The group of patients considered untransportable at the stage of pre-transport preparation is characterized by high morbidity, the need for intensive care, and the need to correct therapy, which is regarded by the transport team as an additional risk. Conclusion. Non-transportable patients are characterized by a significantly higher need for intensive care and amount of pre-transport preparation, high morbidity and mortality