A feasibility study of teledermatology was undertaken in Groningen. Six general practitioners (GPs) sent digital images by email, along with relevant patient information, to dermatologists at the Martini Ziekenhuis Groningen, a general non-academic hospital. The dermatologists returned their responses by email. A total of 89 cases were dealt with in this way. On average, the GPs took three photographs per patient. The time taken by the GP to produce and transmit the images, and to implement the telemedicine advice received from the dermatologist, was 9 min and 3 min, respectively. The time spent on diagnosis, provision of advice and response by email amounted to 10 min for the dermatologist. It was concluded that teleconsultations by email are feasible in the daily practice of GPs and dermatologists in a general non-academic hospital. Generally, GPs, dermatologists and patients were satisfied with teleconsultations. Furthermore, GPs reported that 63% of the teleconsultations were of educational value.
Background
As part of the humanitarian response to the COVID-19 pandemic, the German and French Armed Forces provided air transport for patients from overwhelmed regional hospitals in Italy and France. The objective of this study is to analyse the characteristics of the missions and the medical conditions of COVID-19 patients transported during an aeromedical evacuation on fixed-wing aircraft in March and April 2020.
Method
Retrospective analysis of transport records as well as other documents for 58 COVID-19 patients requiring artificial ventilation.
Results
The age of the transported patients was in median 61.5 years and 61 % of them had pre-existing medical conditions. They had been ventilated for a median of 5 days and experienced the first symptoms of 18 days before transport. The patients flown out of France had less days of ventilation before flight, a lower end-tidal CO
2
at the beginning of the flight and a lower Charlson Comobidity Index. There were also some differences between the ventilation and the flight-level flown by the two air forces.
Conclusion
The intensive care transport of ventilated COVID-19 patients requires highly qualified personnel and appropriate equipment and should be planned appropriately.
Zusammenfassung
Hintergrund Im Rahmen der humanitären Hilfeleistung während der COVID-19-Pandemie flog die Bundeswehr Patienten zur Entlastung der überfüllten regionalen Krankenhäuser aus Italien und Frankreich nach Deutschland aus. Diese Hilfeleistung umfasste bis dato insgesamt 22 italienische und 2 französische Staatsbürger. Ziel der vorliegenden Studie ist es, im Rahmen eines Prä-post-Vergleichs die Veränderungen der Vitalparameter, insbesondere der Beatmungssituation der transportierten Patienten zu analysieren und Schlüsse für zukünftige luftgestützte Transporte mit Flächenflugzeugen für Patienten mit COVID-19 zu erlangen.
Methoden Retrospektive Analyse der Intensivtransport-Protokolle sowie weiterer vorliegender Dokumente (Patient Movement Request, Verlegungsbriefe, Flugzeiten) der insgesamt 24 Patienten, die an COVID-19 erkrankt und beatmungspflichtig waren.
Ergebnisse Bei den Patienten (Median Alter: 59,1 Jahre) lagen in 63% Vorerkrankungen vor und sie waren im Median seit 10,0 (3 – 28) Tagen künstlich beatmet, erste Beschwerden aufgrund COVID-19 lagen im Median 17,5 (6 – 35) Tage vor dem Transport. Eine Verschlechterung der Vitalparameter und der Beatmungssituation während des Transports konnte nicht festgestellt werden. Jedoch war eine Vertiefung der Narkose und die vermehrte Gabe von Katecholaminen während der Transportbedingungen notwendig.
Schlussfolgerung Der Intensivtransport von beatmeten COVID-19-Patienten benötigt ein hohes Maß an Qualifikation des Personals und eine geeignete Ausstattung, kann jedoch unter Berücksichtigung der Rahmenbedingungen geplant durchgeführt werden.
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