Case Reports

First transport with EpiShuttle by dedicated team from 330 Squadron

By April 3, 2020 No Comments

Authors: Lene Pedersen, Stig Arild Stenersen, Trond Elden

Presentation of Case No. 1

The incubation team was ready and prepared to conduct a full-scale exercise when local dispatch sent a primary mission request to transport a patient with positive covid-19 and increasing respiratory distress.

The patient was isolated at home and the ambulance was on its way to the patient but expected a 2 ½ – 3-hour transport to the hospital.

The incubation team dispatched with the on-call crew at the 330 Squadron and arrived at the patient’s home after approx. 30 minutes. While the incubator team was preparing the transport, the emergency crew was prepared for other missions that might emerge.

The ambulance team had arranged for a garage near the residence to prepare the incubator.

After preparation of the infusion and oxygen port, applying the incubation drape and protective clothing on the two doctors in the incubation team, they went to the patient followed by a paramedic. The patient had speech dyspnea, was alert and cooperative, and received oxygen via a nasal catheter. The skin was dry, but cold peripheral and respiratory rate was 25-30. The patient was informed about the use of the incubator and related procedures and then walked out into the garage by himself, only with the support of a doctor. The distance from the house to the garage was approx. 20 meters.

In the garage, the patient was wrapped in disposable sheets and bubble wrap underneath. Oxygen treatment was continued, monitoring was established and infusion with Ringer Acetat established. The patient received a small dose of diazepam for known claustrophobia. Prior to sealing, a disposable bag with mask and PEEP valve, iGel and a sick bag was placed in the incubator. The lid was then applied and sealed, and the surrounding edges disinfected. After this, the doctors could remove the protective clothing. The transport to the hospital took approx. 45 minutes and the patient was delivered to a dedicated Corona ward at the receiving hospital.

Important learning points

It took 90 minutes from the team landed to the helicopter transport started. Some fogging on the inside of the incubator occurred, which most likely was due to cold weather during the preparation in the garage and the difference in temperature between the garage and the helicopter. Moreover, the bubble wrap initially covered the filter outlet at the foot end inside the incubator.

As others have reported from covid-19 patients with respiratory failure, this patient was also marginal. The walk from the house to the garage was quite exhausting and had to stop several times. There was no other area to place the incubator, but the patient should have been carried in a sling or similar. Transports that last more than an hour may be demanding to carry out with spontaneously breathing patients, especially with concurrent issues such as claustrophobia, turbulence and respiratory failure. There should be a low threshold for intubation. The rescue paramedic acted in this case as logistics manager, verified that we went through the checklists that were prepared, and made sure that the doctors performed the protective clothing procedures and disinfection routines correctly.