Psychological impact of medical evacuation for ICU saturation in Covid-19-related ARDS patients

PURPOSE

Psychological impact of Medical Evacuation (MEDEVAC) in Covid-19 patients is undetermined. The objectives were to evaluate: Post-traumatic Stress Disorder (PTSD) in MEDEVAC patients hospitalized in ICU for Covid-19-related acute respiratory distress syndrome (ARDS) compared to control group; anxiety, depression rates and outcomes in patients and PTSD in relatives.

MATERIAL AND METHODS

This is a retrospective multicentric 1/1 paired cohort performed in 10 ICUs in the West of France. Evaluation was performed 18 months after discharge. Patients and closest relatives performed IES-R (Impact and Event Scale-Revised) and/or HADS (Hospital Anxiety and Depression Scale) scales.

RESULTS

Twenty-six patients were included in each group. Patients were 64 ± 11 years old, with 83% male. We report 12 vs 20% of PTSD in control vs MEDEVAC groups (p = 0.7). Anxiety disorder affected 43.5 vs 28.0% (p = 0.26) and depression 12.5 vs 14.3% (p > 0.99) in control vs MEDEVAC groups. PTSD affects 33.3 vs 42.1% of closest relatives (p = 0.55). Ways of communication were adapted: video calls were more frequent in MEDEVAC patients (8.7 vs 60.9%, p < 0.01) whereas physical visits concerned more control group (45.8 vs 13.0%, p = 0.01).

CONCLUSIONS

PTSD rate were similar between groups. Adaptive ways of communication, restricted visits and global uncertainties could explain the absence of differences.

Stranded abroad: a travel medicine approach to psychiatric repatriation

BACKGROUND

The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches.

METHODS

Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems.

RESULTS

Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place.

CONCLUSIONS

Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.

Non-clinical determinants of Medevacs in Nunavut: perspectives from northern health service providers and decision-makers

A medevac involves the transport of a critically ill patient, usually by plane or helicopter, to access necessary and at times life-saving care, most often only accessible in urban centres. Medevacs are commonly used in resource-limited and geographically isolated areas in Canada.

The objective of this study was to explore the determinants of medevac decision-making from the perspective of frontline care providers and decision-makers in Nunavut. For this purpose, we conducted a secondary analysis of 90 in-depth interviews.

Findings indicate that medevacs can be the result of a number of intersecting factors, including the referring and receiving provider’s experience, insufficient staffing in health centres, lack of access to diagnostic or treatment-related, and challenges related to recruitment and retention. An expanded scope of practice for frontline care providers, and a related lack of training and/or confidence in skills, only add to these challenges.

Medevacs play an important role related to managing shifting community nursing workloads, which expands and contracts in response to local needs. Attention to structural issues, putting in place virtual peer support systems, resolving vacancies left by the lag between attrition and recruitment, increasing access to training, and local diagnostic and treatment equipment, might decrease reliance of medevacs.

[Four years after the Ebola crisis : Challenges, experiences, and implications in the German public health context]

The Ebola virus disease outbreak in West Africa in 2014/2015 was by far the biggest, most prolonged, and geographically most widespread outbreak of this disease since the discovery of the Ebola virus in 1976. Although no cases of Ebola virus disease were confirmed in Germany, a number of crisis management activities were initiated.Based on a combination of local, national, and international lessons learned, literature research, and a large number of discussions among German colleagues as well as German and foreign colleagues, the experiences of selected German public health actors as well as implications for health protection activities in Germany are presented.On the one hand, preparedness for managing unusual high consequence health events-caused by rare, highly pathogenic biological agents-including the provision of adequate material and personnel resources remains important in Germany. On the other hand, more German engagement in global health is necessary, because the dividing line between global health and local health is increasingly disappearing.

Transport While on Extracorporeal Membrane Oxygenation Support

Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports.

Non-battle injuries among U.S. Army soldiers deployed to Afghanistan and Iraq, 2001-2013

INTRODUCTION

Many non-battle injuries among deployed soldiers are due to occupational-related tasks. Given that non-battle injuries are a significant cause of morbidity and mortality, occupational safety and health are of great concern to the military. Some of the leading causes of non-battle injuries in the military are also common in non-military occupational settings. Nationally, falls and motor-vehicle accidents are leading causes of non-fatal occupational injuries in the civilian workforce. The objective of this research is to identify the leading causes, types, and anatomic locations of non-fatal non-battle injuries in Afghanistan and Iraq.

METHODS

Non-battle injuries were identified from medical air evacuation records. Causes of air evacuated injuries were identified and coded using the diagnosis and narrative patient history in the air evacuation records. Descriptive statistics were used to report the air evacuated non-battle injury rates, causes, injury types, and anatomic locations.

RESULTS

Between 2001 and 2013, there were 68,349 medical air evacuations from Afghanistan and Iraq. Non-battle injuries accounted for 31% of air evacuations from Afghanistan and 34% from Iraq. These injuries were the leading diagnosis category for air evacuations. The three leading causes of injury for Afghanistan and Iraq, respectively, were sports/physical training (23% and 24%), falls/jumps (19% and 16%), and military vehicle-related accidents (8% and 11%). The leading injury types were fractures (21%), overuse pain and inflammation (16%), and dislocations (11%).

PRACTICAL APPLICATIONS

Given that over 30% of medical evacuations of soldiers result from non-battle injuries, prevention of such conditions would substantially enhance military readiness during combat.

High rate of multidrug-resistant organism colonization among patients hospitalized overseas highlights the need for preemptive infection control

We performed 4 years of active screening for multidrug resistant organism (MDRO) colonization among patients with a history of overseas hospitalization. Thirteen (56.5%) of 23 cases were positive for MDROs, which highlights the importance of preemptive infection control to prevent the spread of MDROs in this population.

Unpredictable, unpreventable and impersonal medicine: global disaster response in the 21st century

The United Nations has recognized the devastating consequences of “unpredictable, unpreventable and impersonal” disasters—at least US $2 trillion in economic damage and more than 1.3 million lives lost from natural disasters in the last two decades alone. In many disasters (both natural and man-made) hundreds—and in major earthquakes, thousands—of lives are lost in the first days following the event because of the lack of medical/surgical facilities to treat those with potentially survivable injuries. Disasters disrupt and destroy not only medical facilities in the disaster zone but also infrastructure (roads, airports, electricity) and potentially local healthcare personnel as well. To minimize morbidity and mortality from disasters, medical treatment must begin immediately, within minutes ideally, but certainly within 24 h (not the days to weeks currently seen in medical response to disasters). This requires that all resources—medical equipment and support, and healthcare personnel—be portable and readily available; transport to the disaster site will usually require helicopters, as military medical response teams in developed countries have demonstrated. Some of the resources available and in development for immediate medical response for disasters—from portable CT scanners to telesurgical capabilities—are described. For immediate deployment, these resources—medical equipment and personnel—must be ready for deployment on a moment’s notice and not require administrative approvals or bureaucratic authorizations from numerous national and international agencies, as is presently the case. Following the “trauma center/stroke center” model, disaster response incorporating “disaster response centers” would be seamlessly integrated into the ongoing daily healthcare delivery systems worldwide, from medical education and specialty training (resident/registrar) to acute and subacute intensive care to long-term rehabilitation. The benefits of such a global disaster response network extend far beyond the lives saved: universal standards for medical education and healthcare delivery, as well as the global development of medical equipment and infrastructure, would follow. Capitalizing on the humanitarian nature of disaster response—with its suspension of the cultural, socioeconomic and political barriers that often paralyze international cooperation and development—disaster response can be predictable, loss of life can be preventable and benefits can be both personal and societal.

Development and application of triage and medical evacuation system for casualties at sea

Traditional triage could not meet the needs of battlefield casualties' care in modern warfare. This paper designs of triage and medical evacuation system for casualties at sea that can quickly address mass-casualty triage, and store and transmit medical information during battlefield treatment and medical evacuation. This system consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.