Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

Abstract

Background Little is known on the trends of aeromedical retrieval during social isolation. Objectives To compare the pre, lockdown, and post‐lockdown aeromedical retrieval (AR) patient characteristics during a period of Coronavirus 2019 (COVID‐19) social isolation. Methods An observational study with retrospective data collection, consisting of AR between 26 January and 23 June 2020. Results There were 16981 ARs consisting of 1983 (11.7%) primary evacuations (PEs) and 14998 (88.3%) inter‐hospital transfers (IHTs), with a population median age of 52 years (interquartile range [IQR] 29.0–69.0), with 49.0% (n= 8283) of the cohort being male and 38.0% (n= 6399) being female. There were six confirmed and 230 suspected cases of COVID‐19, with the majority of cases (n=134; 58.3%) in the social isolation period. As compared to pre‐restriction, the odds of retrieval for the restriction and post‐restriction period differed across time between the major diagnostic groups. This included, an increase in cardiovascular retrieval for both restriction and post‐restriction periods (OR 1.12 95% CI 1.02‐1.24 and OR 1.18 95% CI 1.08‐1.30 respectively), increases in neoplasm in the post restriction period (OR 1.31 95% CI 1.04‐1.64), and increases for congenital conditions in the restriction period (OR 2.56 95% CI 1.39‐4.71). Cardiovascular and congenital conditions had increased rates of priority 1 patients in the restriction and post restriction periods. There was a decrease in endocrine and metabolic disease retrievals in the restriction period (OR 0.72 95% CI 0.53‐0.98). There were lower odds during the post‐restriction period for a retrievals of the respiratory system (OR 0.78 95% CI 0.67‐0.93), and disease of the skin (OR 0.78 95% CI 0.6‐1.0). Distribution between the 2019 and 2020 time periods differed (p<0.05), with the lockdown period resulting in a significant reduction in activity. Conclusion The lockdown period resulted in increased AR rates of circulatory and congenital conditions. This article is protected by copyright. All rights reserved.

Hospital in the air: Royal Flying Doctor Service retrievals and challenges before, during and after, Australia's COVID‐19 lockdown in 2020

“…Fortunately the RFDS experienced substantial reduction in acute coronary syndrome (ACS) transfers during the restriction. This demand rebounded soon afterward 1 . Similarly, the Feedback Intervention and Treatment Times in ST‐Elevation Myocardial Infarction (FITT‐STEMI) study observed a worrying 12.6% decrease in STEMI presentations and interhospital transfers during the pandemic peak in regional Germany 7 .…”

“…In this issue of the Internal Medicine Journal , Gardiner et al 1 . offer valuable lessons from their considered and comprehensive analyses of aeromedical retrieval patterns for the whole Royal Flying Doctor Service (RFDS) network during the 7 weeks before, during and after, Australia's COVID‐19 restrictions imposed between 16 March and 4 May 2020.…”

“…The RFDS transported six confirmed and 230 suspected COVID‐19 cases during the whole study period. No confirmed, and 13 and 4 suspected COVID‐19 patients, respectively, required intubation and non‐invasive ventilation during the study period 1 . Long periods of encasement in PPE inflicts fatigue, heat stress, degrades cognitive performance, hinders life‐saving medical procedures and interpersonal communication in a constrained, noisy and vibrating aircraft cabin 5,6 …”

“…Doctors, nurses, air‐crew and clinical coordination staff and their patients, some of whom required medical escorts for critical illness or severe injury, 1 together braved the COVID‐19 head‐wind of potentially reduced access to on‐scene resuscitation and time‐critical transfer for percutaneous coronary intervention and stroke reperfusion. Some staff would require isolation, and aircraft would need COVID‐19 disinfection 3–6 …”

“…Retrievals for cerebrovascular disease remained stable through the three study periods. One‐quarter to one‐third of these cases were assigned high acuity requiring P1 medical escort 1 …”