Care of the Injured Patients at Nursing Stations and during Air Medical Transport

Nolan, Brodie; Ackery, Alun; Mamakwa, Sol; Glenn, Shari; VanderBurgh, David; Orkin, Aaron; Kirlew, Michael; Dell, Evelyn M; Tien, Homer

doi:10.1016/j.amj.2017.11.013

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…The patient population requiring OHT might be as diverse as a patient with trauma transported via a 30-minute flight from the scene of an accident to the nearest trauma centre, a patient with a perioperative major hemorrhage in a smaller hospital requiring a 90-minute interfacility transfer to the nearest tertiary care centre, or a patient with postpartum hemorrhage in a remote nursing station with no access to blood products or laboratory testing, and transport time exceeding 2 hours. 11 , 30 We believe that this expert consensus document can help to overcome such challenges through a nationwide approach to OHT protocols that provides specific guidance while taking into account the variability in geography, patient factors, in-hospital and prehospital blood product availability, and other available resources.…”

Section: Discussionmentioning

confidence: 99%

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Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

Vopelius-Feldt

Lockwood

Mal

et al. 2023

cmajo

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Background: Early resuscitation with blood components or products is emerging as best practice in selected patients with trauma and medical patients; as a result, out-of-hospital transfusion (OHT) programs are being developed based on limited and often conflicting evidence. This study aimed to provide guidance to Canadian critical care transport organizations on the development of OHT protocols. Methods: The study period was July 2021 to June 2022. We used a modified RAND Delphi process to achieve consensus on statements created by the study team guiding various aspects of OHT in the context of critical care transport. Purposive sampling ensured representative distribution of participants in regard to geography and relevant clinical specialties. We conducted 2 written survey Delphi rounds, followed by a virtual panel discussion (round 3). Consensus was defined as a median score of at least 6 on a Likert scale ranging from 1 (“Definitely should not include”) to 7 (“Definitely should include”). Statements that did not achieve consensus in the first 2 rounds were discussed and voted on during the panel discussion. Results: Seventeen subject experts participated in the study, all of whom completed the 3 Delphi rounds. After the study process was completed, a total of 39 statements were agreed on, covering the following domains: general oversight and clinical governance, storage and transport of blood components and products, initiation of OHT, types of blood components and products, delivery and monitoring of OHT, indications for and use of hemostatic adjuncts, and resuscitation targets of OHT. Interpretation: This expert consensus document provides guidance on OHT best practices. The consensus statements should support efficient and safe OHT in national and international critical care transport programs.

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Section: Discussionmentioning

confidence: 99%

“…This is particularly relevant in countries like Canada, with long transport times to tertiary care centres, and remote communities that have limited or no access to physicians or blood components and products at their local health care facilities. 11 …”

mentioning

confidence: 99%

Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

Vopelius-Feldt

Lockwood

Mal

et al. 2023

cmajo

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“…Closures to hospitals in Eastern and Northern Ontario led to much larger decreases in the proportion of people with potential access, which is highlighted in both the overall and monthly analysis. This is further complicated as much of Northern Ontario relies on air ambulance to provide transport to the closest ED with transport times of multiple hours for some communities [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

A system in crisis: exploring how recent emergency department closures influence potential access to emergency care in Ontario

2023

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Objectives Access to emergency medical care in Ontario has been under stress, mainly due to a lack of human resources (staffing of nurses and doctors). Over the past year, several emergency departments in Ontario have closed. Some of these closures are nightly, while others have closed for weeks at a time, leaving Ontario residents without access to emergency medical care which can lead to poor or more severe outcomes. The purpose of this paper was to examine how closures of ED’s in Ontario have influenced potential access to emergency medical care. Methods We performed population-level geographic information systems (GIS)-based analysis of potential access to ED hospitals in Ontario. The number of people with access to an ED was calculated when all ED’s in Ontario were open, then recalculated with the 14 ED closures. Access was defined by ground travel with 30 min, 45 min, and 60 min travel times used for analysis. Differences in the number of people at the census block level who potentially lost access were compiled and examined by census subdivision. Results If all 14 ED’s had closed at the same time, there would be 35,808 people at 30 min, 15,018 at 45 min, and 12,131 at 60 min travel times in Ontario who lost access to ED care. Certain areas of the province saw more significant decreases in ED access. At 45 min travel times, nearly 2000 people in Central Frontenac lost access (44% of population), while 7298 people in Cochrane (North Part) lost access (20% of population). Conclusions ED closures have led to decreases in potential access to emergency care for predominantly rural populations. Health human resource recovery strategies must focus on areas where lack of overlap exists. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-023-00460-y.

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“…Canada is the second largest country in the world, spanning nearly 10 million sq/km of access- and weather- challenged geography, with most of the population concentrated along the southern border. 7 , 8 In Canada, healthcare is largely regionalised, with secondary, tertiary- and quaternary-level care concentrated into regional hubs. While early hemostatic resuscitation is emerging as best practice in select trauma and medical patients, the timely provision of blood components and products during primary (prehospital) and secondary (interfacility) critical care transport (CCT) can significantly impact clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

A descriptive analysis of the Canadian prehospital and transport transfusion (CAN-PATT) network

et al. 2023

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Care of the Injured Patients at Nursing Stations and during Air Medical Transport

Cited by 7 publications

References 17 publications

Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

A system in crisis: exploring how recent emergency department closures influence potential access to emergency care in Ontario

A descriptive analysis of the Canadian prehospital and transport transfusion (CAN-PATT) network

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