TRANSPORT ORGANISATION OF SPECIFIC PATIENT GROUPS DIAGNOSED WITH COVID-19 IN PRE-HOSPITAL EMERGENCY HEALTHCARE

Year 2022, Volume: 7 Issue: 3, 425 - 447, 01.01.2023

Şükran Balkaner Gül Özlem Yıldırım

https://doi.org/10.54409/hod.1070410

Abstract

Transport of critically ill patients is very risky and difficult. This situation becomes even more important in specific patient groups diagnosed with COVID-19. Transport of COVID-19 suspected/diagnosed patients should be performed in accordance with “transport principles of critical patient” with infectious disease. It has become even more important than before the pandemic that the parties involved in the patient transport process draw clear road maps, accurately identify suspected/diagnosed COVID-19 cases, use existing resources in the most effective way, and reduce the risks to pre-hospital emergency health personnel. During transportation, continuous monitoring of the vital functions of critically ill patients, organization of the necessary equipment and personnel to intervene in risky situations, provision of personal protective equipment to the personnel, disinfection and decontamination of the ambulance are of great importance for the safety of patients and pre-hospital emergency health personnel. In this review, it is focused on how to transfer special patient groups with COVID-19 and what to pay attention to.

Keywords

Covid-19, Patient Transport, Pre-hospital, İnfectious Disease

HASTANE ÖNCESİ ACİL SAĞLIK HİZMETLERİNDE COVID-19 TANILI ÖZELLİKLİ HASTA GRUPLARININ NAKİL ORGANİZASYONU

Abstract

Kritik hasta nakli oldukça riskli ve zordur. COVID-19 tanılı özellikli hasta gruplarında bu durum daha da önem kazanmaktadır. COVID-19 şüpheli/tanılı hastaların nakilleri, bulaşıcı hastalığı olan “kritik hasta nakil ilkelerine” uyularak yapılmalıdır. Hasta nakli sürecinde görev alan tarafların net yol haritaları çizmesi, şüpheli/tanılı COVID-19 vakalarının doğru bir şekilde tespit edilmesi, var olan kaynakların en etkin şekilde yönetilerek kullanılması ve hastane öncesi acil sağlık personeline yönelik risklerin azaltılması salgın öncesine göre daha da önemli hale gelmiştir. Nakil sırasında, kritik hastalığı olan özellikli hastaların hayati fonksiyonlarının sürekli izlenmesi, riskli durumlarda müdahalenin yapılabilmesi için gerekli ekipman ve personelin organizasyonun yapılması, personele kişisel koruyucu ekipmanın sağlanması, ambulansın dezenfeksiyon ve dekontaminasyonu hasta ve hastane öncesi acil sağlık çalışanlarının güvenliği açısından büyük önem taşır. Bu derlemede, COVID-19’lu özellikli hasta gruplarının nakillerinin nasıl yapılması ve nelere dikkat edilmesi gerektiği üzerinde durulmuştur.

Keywords

Covid-19, Hasta Nakli, Hastane Öncesi, Bulaşıcı Hastalık

References

• AWMF. (2017). S3-Leitlinie Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz. AWMF Leitlinien RegisterNr.001/021
• Alhazzani, W, Møller, MH, Arabi, YM, Loeb, M, Gong, MN, Fan, E, Oczkowski, S, Levy, MM, Derde, L, Dzierba, A, Du, B, Aboodi, M, Wunsch, H, Cecconi, M, Koh, Y, Chertow, DS, Maitland, K, Alshamsi, F, Belley-Cote, E, Greco, M, Rhodes, A. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive care medicine, 46(5), 854–887. https://doi.org/10.1007/s00134-020-06022-5
• Bellini, C. (2021). COVID-19 outbreak impact on neonatal emergency transport. Pediatric research, 89(5), 1044–1045. https://doi.org/10.1038/s41390-020-1027-y
• Bellini, C, & Gente, M. (2020). Neonatal Transport and COVID-19 outbreak. Air medical journal, 39(3), 154–155. https://doi.org/10.1016/j.amj.2020.03.003
• Boomhower, J, Noland, HE, Frakes, MA, Seethala, RR, Cohen, JE, & Wilcox, SR. (2021). Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19. Prehospital emergency care, 25(1), 55–58. https://doi.org/10.1080/10903127.2020.1819492
• Bozan, Ö. (2020). ARDS hastalarında Prone pozisyonu. Acilci.net. https://acilci.net/ards-hastalarinda-prone-pozisyonu/, 24.06.2021.
• Bredmose, PP, Diczbalis, M, Butterfield, E. et al. (2020). Decision support tool and suggestions for the development of guidelines for the helicopter transport of patients with COVID-19. Scand J Trauma Resusc Emerg Med 28, 43. https://doi.org/10.1186/s13049-020-00736-7
• Bulbul, A, Agirgol, E, Uslu, S, Elitok, GK, Tellioglu, A, Avsar, H, Divarci, A, Bas, EK, & Unal, ET. (2020). COVID-19 Management in Newborn Babies in the Light of Recent Data: Breastfeeding, Rooming-in and Clinical Symptoms. Sisli Etfal Hastanesi tip bulteni, 54(3),261–270. https://doi.org/10.14744/SEMB.2020.90267
• Cavicchiolo, ME, Doglioni, N, Ventola, MA, Biban, P, Baraldi, E, & Trevisanuto, D. (2021). Neonatal emergency transport system during COVID-19 pandemic in the Veneto Region: proposal for standard operating procedures. Pediatric research, 89(3), 399–401. https://doi.org/10.1038/s41390-020-0937-z
• Cook, TM, El-Boghdadly, K, McGuire, B, McNarry, AF, Patel, A, & Higgs, A. (2020). Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia, 75(6), 785–799. https://doi.org/10.1111/anae.15054
• Çelik, S. (2018). Mekanik Ventilasyonda Prone Pozisyonunun Yönetimi. Yoğun Bakım Hemşireliği Dergisi, 22(2), 80-87. Retrieved from https://dergipark.org.tr/tr/pub/ybhd/issue/42048/506094
• Çiftçi, E, Özen, S. (2020). Gebelerde ve Yenidoğanlarda COVID-19 (Editör; Memikoğlu O, Genç V.). COVID-19. 1.Basım. Ankara Üniversitesi Basımevi; 137-143. http://www.medicine.ankara.edu.tr/wp-content/uploads/sites/121/2020/05/COVID-19-Kitap.pdf , 10.05.2021.
• DellaVolpe, JD, Lovett, J, Martin-Gill, C, & Guyette, FX. (2016). Transport of Mechanically Ventilated Patients in the Prone Position. Prehospital emergency care, 20(5), 643–647. https://doi.org/10.3109/10903127.2016.1162888
• Dong, Y, Mo, X, Hu, Y, Qi, X, Jiang, F, Jiang, Z, & Tong, S. (2020). Epidemiology of COVID-19 Among Children in China. Pediatrics, 145(6), e20200702. https://doi.org/10.1542/peds.2020-0702
• Ergin, M, Özel, G, Taze, Ö. (2020). Pandemi Sırasında Hastane Öncesi Acil Sağlık Hizmetleri. Oğuztürk H, Editör. Koronavirüs Hastalığı (COVID19) ve Acil Tıp 2020. Ankara: Türkiye Klinikleri. 47-53.
• Grasselli, G, Zangrillo, A, Zanella, A, Antonelli, M, Cabrini, L, Castelli, A, Cereda, D, Coluccello, A, Foti, G, Fumagalli, R, Iotti, G, Latronico, N, Lorini, L, Merler, S, Natalini, G, Piatti, A, Ranieri, MV, Scandroglio, AM, Storti, E, Cecconi, M, COVID-19 Lombardy ICU Network (2020). Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA, 323(16), 1574–1581. https://doi.org/10.1001/jama.2020.5394
• Guérin, C, Reignier, J, Richard, JC, Beuret, P, Gacouin, A, Boulain, T, Mercier, E, Badet, M, Mercat, A, Baudin, O, Clavel, M, Chatellier, D, Jaber, S, Rosselli, S, Mancebo, J, Sirodot, M, Hilbert, G, Bengler, C, Richecoeur, J, Gainnier, M, PROSEVA Study Group (2013). Prone positioning in severe acute respiratory distress syndrome. The New England journal of medicine, 368(23),2159–2168. https://doi.org/10.1056/NEJMoa1214103
• Heightmant, AJ. (2020). The EMS Today Show: Prone Positioning of Patients Found to be Beneficial to COVID-19 Patient Care. https://www.jems.com/podcasts/the-ems-today-show-prone-positioning-of-patients-found-to-be-beneficial-to-covid-19-patient-care/, 21.04.2021.
• Huang, C, Wang, Y, Li, X, Ren, L, Zhao, J, Hu, Y, Zhang, L, Fan, G, Xu, J, Gu, X, Cheng, Z, Yu, T, Xia, J, Wei, Y, Wu, W, Xie, X, Yin, W, Li, H, Liu, M, Xiao, Y, Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England), 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
• Ing, EB, Xu, QA, Salimi, A, & Torun, N. (2020). Physician deaths from corona virus (COVID-19) disease. Occupational medicine (Oxford, England), 70(5), 370–374. https://doi.org/10.1093/occmed/kqaa088
• Jahn, N, Voelker, MT, Bercker, S, Kaisers, U, & Laudi, S. (2017). Interhospitaltransport von Patienten mit ARDS [Interhospital transport of patients with ARDS]. Der Anaesthesist, 66(8), 604–613. https://doi.org/10.1007/s00101-017-0296-2
• Kucharski, AJ, Russell, TW, Diamond, C, Liu, Y, Edmunds, J, Funk, S, Eggo, RM, & Centre for Mathematical Modelling of Infectious Diseases COVID-19 working group (2020). Early dynamics of transmission and control of COVID-19: a mathematical modelling study. The Lancet. Infectious diseases, 20(5), 553–558. https://doi.org/10.1016/S1473-3099(20)30144-4
• Liew, M.F, Siow, WT, Yau, YW, & See, KC. (2020). Safe patient transport for COVID-19. Critical care (London, England), 24(1), 94. https://doi.org/10.1186/s13054-020-2828-4
• Lu, R, Zhao, X, Li, J, Niu, P, Yang, B, Wu, H, Wang, W, Song, H, Huang, B, Zhu, N, Bi, Y, Ma, X, Zhan, F, Wang, L, Hu, T, Zhou, H, Hu, Z, Zhou, W, Zhao, L, Chen, J, Tan, W. (2020). Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet (London, England), 395(10224), 565–574. https://doi.org/10.1016/S0140-6736(20)30251-8
• Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. (2020). The epidemiological characteristics of an outbreak of 2019 novel Coronavirus diseases (COVID-19)—China, 2020. Zhonghua Liu Xing Bing Xue Za Zhi 2:113–122. https://doi.org/10.46234/ccdcw2020.032
• Oxford-Horrey, C, Savage, M, Prabhu, M, Abramovitz, S, Griffin, K, LaFond, E, Riley, L, & Easter, SR. (2020). Putting It All Together: Clinical Considerations in the Care of Critically Ill Obstetric Patients with COVID-19. American journal of perinatology, 37(10), 1044–1051. https://doi.org/10.1055/s-0040-1713121
• Ozbek, AE, Sanci, E, & Halhalli, HC. (2021). Effect of using barrier devices on intubation times and performance—a randomized, prospective, crossover manikin study. Notfall Rettungsmed. https://doi.org/10.1007/s10049-021-00860-6
• Özbilen, F, Altunkan, AA. (2020). COVID-19 ve Uyanık Prone Pozisyon. Turk J Intensive Care 2020;18:50-56 DOI: 10.4274/tybd.galenos.2020.51422
• Painvin, B, Messet, H, Rodriguez, M, Lebouvier, T, Chatellier, D, Soulat, L, Ehrmann, S, Thille, AW, Gacouin, A, & Tadie, JM. (2021). Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France. Annals of intensive care, 11(1), 54. https://doi.org/10.1186/s13613-021-00841-5
• Parhar, K, Zuege, DJ, Shariff, K, Knight, G, & Bagshaw, SM. (2021). Prone positioning for ARDS patients-tips for preparation and use during the COVID-19 pandemic. Positionnement ventral des patients atteints d’un SDRA — conseils pour la préparation et l’utilisation de cette modalité pendant la pandémie de COVID-19. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 68(4), 541–545. https://doi.org/10.1007/s12630-020-01885-0
• Phua, J, Weng, L, Ling, L, Egi, M, Lim, CM, Divatia, JV, Shrestha, BR, Arabi, YM, Ng, J, Gomersall, CD, Nishimura, M, Koh, Y, Du, B, & Asian Critical Care Clinical Trials Group (2020). Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. The Lancet. Respiratory medicine, 8(5), 506–517. https://doi.org/10.1016/S2213-2600(20)30161-2
• Rimensberger, PC, Kneyber, M, Deep, A, Bansal, M, Hoskote, A, Javouhey, E, Jourdain, G, Latten, L, MacLaren, G, Morin, L, Pons-Odena, M, Ricci, Z, Singh, Y, Schlapbach, LJ, Scholefield, BR, Terheggen, U, Tissières, P, Tume, LN, Verbruggen, S, Brierley, J, European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific Sections’ Collaborative Group (2021). Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 22(1), 56–67. https://doi.org/10.1097/PCC.0000000000002599
• Rollas, K, Şenoglu, N. (2020). Covid-19 Hastalarının yoğun bakım ünitesinde yönetimi. Tepecik Eğit. ve Araşt. Hast. Dergisi. 2020;30 (Ek sayı):142-55.
• Samanta, S, Samanta, S, Wig, J, Baronia, AK. (2014). How safe is the prone position in acute respiratory distress syndrome at late pregnancy? Am J Emerg Med. 2014;32(6):687.
• Schmiady, MO, Hofmann, M, Sromicki, J, Halbe, M, van Tilburg, K, Aser, R, Mestres, CA, Maisano, F, & Ferrari, E. (2021). Initiation of an inter-hospital extracorporeal membrane oxygenation transfer programme for critically ill patients with coronavirus disease 2019: bringing extracorporeal membrane oxygenation support to peripheral hospitals. Interactive cardiovascular and thoracic surgery, 32(5), 812–816. https://doi.org/10.1093/icvts/ivaa326
• Schellhaaß, A, Pöselt, S, Schwietring, J, Horter, J, & Münzberg, M. (2020). Luftgebundene Intensivverlegung in Bauchlage bei COVID-19-ARDS [Air ambulance intensive care transport in prone position for COVID-19 ARDS]. Notfall & rettungsmedizin, 1–5. Advance online publication. https://doi.org/10.1007/s10049-020-00798-1
• Scholten, EL, Beitler, JR., Prisk, GK, & Malhotra, A. (2017). Treatment of ARDS With Prone Positioning. Chest, 151(1), 215–224. https://doi.org/10.1016/j.chest.2016.06.032
• Seethala, RR, Frakes, MA, Cocchi, MN, Cohen, JE, Dargin, J, Friedman, F, Grant, C, Jr, Kaye, A, Wilcox, SR. (2020). Feasibility and Safety of Prone Position Transport for Severe Hypoxemic Respiratory Failure Due to Coronavirus Disease 2019. Critical care explorations, 2(12), e0293. https://doi.org/10.1097/CCE.0000000000000293
• Shekar, K, Badulak, J, Peek, G, Boeken, U, Dalton, HJ, Arora, L, Zakhary, B, Ramanathan, K, Starr, J, Akkanti, B, Antonini, MV, Ogino, MT, Raman, L, Barret, N, Brodie, D, Combes, A, Lorusso, R, MacLaren, G, Müller, T, Paden, M, ELSO Guideline Working Group (2020). Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO journal (American Society for Artificial Internal Organs, 66(7), 707–721. https://doi.org/10.1097/MAT.0000000000001193
• Sofuoğlu, T. (2020). Corona Virüs (COVID-19) ve Hastane Öncesi Acil Sağlık Hizmetleri, Afet Araştırmaları Derneği. https://www.afet.org.tr/corona-virus-covid-19-ve-hastane-oncesi-acil-saglik-hizmetleri/, 19.05.2020.
• Şan, İ, Yıldırım, Ç, Bekgöz, B, & Gemcioğlu, E. (2020). Transport of awake hypoxemic probable COVID 19 patients in the prone position. The American journal of emergency medicine, S0735-6757(20)30932-3. Advance online publication. https://doi.org/10.1016/j.ajem.2020.10.036
• Çelik, SŞ, Özbaş, AA, Çelik, B, Karahan, A, Bulut, H, Koç, G, Özleyen, ÇÖ. (2020). COVID-19 Pandemi Süreci: Türk Hemşireler Derneği. Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi, 17(3), 279-283.
• T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Bulaşıcı Hastalıklar Dairesi Başkanlığı ve Acil Sağlık Hizmetleri Genel Müdürlüğü (2019). Hastane Öncesi Acil Sağlık Hizmetlerinde (HÖASH) Enfeksiyon Hastalıklarından Korunma Rehberi. https://acilafet.saglik.gov.tr/Eklenti/36327/0/hastane-oncesi-acil-saglik-hizmetleri-rehberipdf.pdf, 10.05.2021.
• Tezer, H, & Bedir Demirdağ, T. (2020). Novel coronavirus disease (COVID-19) in children. Turkish journal of medical sciences, 50(SI-1), 592–603. https://doi.org/10.3906/sag-2004-174
• The EMS Today Show: Prone Positioning of Patients Found to be Beneficial to COVID-19 Patient Care. (2021). https://www.jems.com/podcasts/the-ems-today-show-prone-positioning-of-patients-found-to-be-beneficial-to-covid-19-patient-care/ , 21.05.2021.
• Thompson, AE, Ranard, BL, Wei, Y, & Jelic, S. (2020). Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA internal medicine, 180(11), 1537–1539. https://doi.org/10.1001/jamainternmed.2020.3030
• Türk Neonataloji Derneği. (2021). Neonatal Transport. Türk Neonatoloji Derneği “COVID-19 (SARS-CoV2) Enfeksiyonu veya Şüphesi Olan Yenidoğan Bebeklere Perinatal ve Neonatal Dönemde Yaklaşım Önerileri v.3.” https://www.neonatology.org.tr/media/2021/01/YENI%CC%87-KAPAK-V3-2.-TASARIM_merged.pdf, 04.06.2021.
• Usul, AS. (2021). Sağlık Bakanlığınca acil sağlık hizmetine ihtiyaç duyan bebekler özel ambulanslarla taşınıyor. Anadolu Ajanjsı. https://www.aa.com.tr/tr/saglik/saglik-bakanliginca-acil-saglik-hizmetine-ihtiyac-duyan-bebekler-ozel-ambulanslarla-tasiniyor/2229216# , 04.06.2021.
• Usul, E, Korkut S. (2020) COVID-19 hastalarında taburculuk, izolasyon ve nakil kriterleri. Oğuztürk H, editör. Koronavirüs Hastalığı (COVID19) ve Acil Tıp 2020. 1. Baskı. Ankara: Türkiye Klinikleri. p.60-5.
• Uygur, Ö, Öncel, MY. (2020). Perinatal ve yenidoğan döneminde Covid-19 enfeksiyonu. Tepecik Eğit. ve Araşt. Hast. Dergisi. 2020;30(Ek sayı):63-9.
• Wang, D, Hu, B, Hu, C, Zhu, F, Liu, X, Zhang, J, Wang, B, Xiang, H, Cheng, Z, Xiong, Y, Zhao, Y, Li, Y, Wang, X, & Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 323(11), 1061–1069. https://doi.org/10.1001/jama.2020.1585
• Wax, RS, & Christian, MD. (2020). Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Directives concrètes à l’intention des équipes de soins intensifs et d’anesthésiologie prenant soin de patients atteints du coronavirus 2019-nCoV. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 67(5), 568–576. https://doi.org/10.1007/s12630-020-01591-x
• Wu, Z, & McGoogan, JM. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA, 323(13), 1239–1242. https://doi.org/10.1001/jama.2020.2648
• Vogt, BT, Sensen, B, Kluge, S. (2019). Bauchlagerung bei Beatmung – Schritt für Schritt. Dtsch Med Wochenschr 144:978–981.
• Zaretsky, J, Corcoran, JR, Savage, E, Berke, J, Herbsman, J, Fischer, M, Kmita, D, Laverty, P, Sweeney, G, & Horwitz, LI. (2022). Increasing Rates of Prone Positioning in Acute Care Patients with COVID-19. Joint Commission journal on quality and patient safety, 48(1), 53–60. https://doi.org/10.1016/j.jcjq.2021.09.005