Prehospital high acuity transport by air rescue / HEMS

Prehospital high acuity transport by air rescue has the capability to deliver the sickest of patients to high quality, advanced care, and support. However, not all patients are transferred. Why? Per Bredmose tells the tale of Emma. Emma is a 12-year-old girl who developed a cough. She is admitted to local peripheral hospital, correctly diagnosed with pneumonia, and treated with IV antibiotics. Emma continues to deteriorate and is transferred to an ICU where she fails a trial of BiPAP and is intubated. She continues to deteriorate. She requires high pressure ventilation and vasopressor support – advanced, high end, specialist interventions. The truth… this never happened. This talk from Per is about all the future Emma’s. Someone in the hospital system (either the sending or receiving hospital) decided that Emma was too sick to be retrieved. Per challenges this notion of “Too sick to be retrieved”. He says it is rather a case of being in the wrong place at the wrong time. Or getting the wrong disease in the wrong place. Patients will inevitably be in hospitals that lack essential equipment or knowledge for a given condition. Small hospitals do have some deficiencies. Per advocates for the development of retrieval medicine teams and systems that can assist these patients and bring them to centres that can provide the best care. This requires a team including paramedics, pilots, flight nurses and yes, retrieval doctors who have high end specialist training and experience. The teams need to understand the system, the equipment and be able to calculate the risk-benefit ratio of retrievals. They need access to hardware – whether this be ambulances, planes, or infusion hardware. And they must be able to work within the system in which they are operating. Per advocates for a strong retrieval system, comprised of well support and trained happy teams. This leads to safe retrieval and transport and better outcomes for patients.

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