Mr Stephen Colman1, Mr Ryan Matthews2, Associate Professor Kareemah Najaar2, Mr Benjamin De Waal2
1Otago Southland Rescue Helicopter, 2Cape Peninsula University of Technology
Biography:
Stephen previously worked in Cape Town, South Africa at the Red Cross Air Mercy Service (AMS) as an Emergency Care Practitioner. His professional interests are focused on HEMS operations and critical care. Currently, he is completing a master’s dissertation with a focus on sedation and analgesia in the aeromedical setting. Stephen now resides in New Zealand, where he works as a Critical Care Paramedic for Southland Otago Rescue Helicopter.
Abstract:
Background
Aeromedical transport is used regularly to transfer critical patients from rural facilities to tertiary hospitals in the metropole. Currently, the adverse event rate is largely unknown or undocumented in this cohort of patients in the Western Cape.
Aim
The aim of this research was to determine the adverse event rate among mechanically ventilated patients undergoing aeromedical transfer, to describe the types of adverse events, and determine any relationships in the data.
Methods
A retrospective chart review of patient care records (PCRs) at an aeromedical service in the Western Cape was conducted. Patients >18 years old who were mechanically ventilated during transfer were sampled. A subgroup analysis of adverse events (AEs) was performed during review. Data was analysed by a statistician with SPSS®.
Results
A sample of 158 patient care records was reviewed from rotor and fixed wing platforms.
Most AEs occurred at the referring facility (49%), 19.6% occurred during loading into the aircraft, and 17.6% during flight. 2% of AEs occurred during handover, and 11.8% took place at multiple points during transfer.
Overall, 51 patients experienced adverse events (32.27%). The most common adverse event was hypotension (21.52%, n=158). Hypoxia was the second most common event (12.03%). Cardiac arrest occurred in one patient (0.63%).
Patients on the rotor wing platform were at higher risk of adverse events than those transported by fixed wing (OR 2.167 [95% CI 1.208-3.887]; Χ2=8.01; p=0.005). Patients with traumatic injury had a higher risk of an adverse event (OR 1.7 [95% CI 1.077- 2.683]; Χ2=5.33; p=0.021). Those receiving vasopressors had a greater risk of an adverse event (OR 2.784 [95% CI 1.852-4.184]; Χ2=21.312; p<0.001).
Conclusion
This small study at a single service shows that the adverse event rate is high among mechanically ventilated patients undergoing aeromedical transport. Hypotension and hypoxia were the most common AEs recorded.