Interview with Dr. Ivo Breitenmoser, Senior HEMS Physician
COVID-19 Transport
The first video interview in a series of interviews with medical leaders and doctors working in the air ambulance in Europe, and throughout the world. The purpose of the interview is to discuss experiences with Covid-19-transports.
– What is the situation now? How do you prepare? Morten Lossius, General Secretary in the Norwegian Air Ambulance Foundation (NAAF), asks.
– In Switzerland we are one of the hot spots of corona. Very early we started to set up plans and scenarios on how we could deal with the situation. It is hard to prepare for something where you really don’t know what to expect, but basically, we decided that it is only a transmittable disease, and mainly transmittable by droplets. So that is how we wanted to handle it. Our helicopters are quite small, so there is no way we can keep a two meters distance, and that meant we had to protect ourselves.
When Breitenmoser is interviewed in the beginning of April, they have had 58 transports of Covid-patients. Initially they had some problems with the lack of protective gear, such as gowns, but it has been better for two weeks now.
Checklists and challenges
– We have seen that our checklists work well and are suitable for that sort of operations, but with some uncertainties. We have seen that the transfers of the patients, and the hand over in the hospitals that we get the patients from, are not the same as we are used to.
Breitenmoser describes that the rooms are very often small, there is not much space to work in. The ICU-personnel is not the same as before.
– Very often there are people that are not used to working in the ICU and they are not used to hand over patients to our service, that makes it a bit more challenging for our teams.
They have to talk through the whole process, which is complicated anyway.
– That makes it necessary to work with checklists. Without checklists it is almost impossible not to make mistakes during the process. Even with checklists it is hard!
– How do you transport the patient? How do you protect yourselves and the patient?
– All patients get facial masks, so a surgical mask to start with. It doesn’t matter if it is confirmed or suspected corona, or a broken leg up in the mountain. It is for our protection.
No gowns
The teams always wear facial masks, most of the time they wear goggles, and they always wear gloves when they work on the patient.
– Inside the helicopters we don’t wear gowns. It is too difficult. The gowns are a bit too loose, they touch everything and is hard to control. So, it is better to work without gowns in the helicopter.
If they do secondary missions from the ICU bed, over to stretcher and back to the ICU bed, then they wear gowns, but otherwise not.
– We always try to separate between clean sections and contaminated sections. It is not a very sharp line, but we try to keep most of the gear, at least the monitoring gear, clean. We will never touch our respirator with dirty hands.
They first disinfect their hands, then they can adjust the ventilator.
– It makes a lot of changes necessary. We have to put on gloves, take off gloves, disinfect, which makes the process very annoying, so it is hard to do that. Everything takes at least twice as much time compared to before corona.
– How have you managed to educate the doctors?
– First, we had a long discussion about how we wanted to do it. Did we want to dedicate two helicopters to transfers of corona-patients – or did we want to train the whole fleet?
They decided that it was impossible to dedicate only two helicopters.
How they did the training
– You can always get in contact with corona-patients wherever you are. So, it doesn’t make sense to have only two helicopters doing this job.
They have 130 doctors on 12 different bases. First, they did digital lessons. They made small instruction videos. They put up checklists. First the teams had to train themselves.
– Secondly, we sent instructors on every base, and did a remake of the training, and had a look on how they performed. We got very important feedback from these teams.
Even after over 50 cases, they still get useful information back from the teams, and from this feedback they have made changes and implemented them on the checklists.
Close to the peak
– Have you had any of the crews getting ill themselves?
– We have been very lucky. We haven’t had any of the crew, pilots or doctors that are infected. I don’t know if it is only good luck or good performance of the teams. We hope it will stay like that! In Switzerland we are close to the peak now, so we hope we are over the peak in two-three weeks. Then we can start to get back to normal.
Breitenmoser tells that they are not very restrictive in Switzerland, quarantine-wise. They can still go out around the base and do outdoor sports.
– Even the crews can go out of the base and to sports lessons. But of course, we have to restrict contacts of people visiting the bases, but otherwise it is not so different from before.
Almost the same cleaning
– How do you clean the helicopters?
– We do swipes with disinfectants, and not much more than we did before actually. We know more or less where we have touched in the helicopter. Then we clean all these areas with just swipes. All the patients are wrapped into drapes and blankets.
They use regular clothing on the crews, nothing more. Since it is quite warm, they try to wear uniforms with bare arms and gloves.
– It is easier to disinfect your arm than your clothing! So far, we have had no problems with that. If you take care and don’t touch too much with your arms, that is quite well containable.
– Have you discussed implementing an incubator?
– We could do that if we wanted to. Rega has constructed a patient isolation unit which is transportable with fixed wing. We can actually load it into our helicopters, but I think there is no need to transport these patients under these conditions.
As long as they take care and don’t touch too many things, it shouldn’t be a problem, Breitenmoser reasons. They have had no problems so far.
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