Interview with Dr. Maurizio Menarini, Director of HEMS in Ravenna, Romagna Region , Italy.
Italy has been harshly struck by the Covid-19 epidemic.
Hans Morten Lossius, General Secretary of the Norwegian Air Ambulance Foundation (NAAF) interviews Dr. Maurizio Menarini, Director of HEMS in Ravenna, Italy about the situation in Italy and their experiences so far. The Interview was done in early April.
– What is the situation in your area now? Lossius asks.
– It is better than last week. We have a reduction of cases and patients in the hospitals, and even some ICU-beds are available. It is a good situation compared to last week, Menarini says.
– What part has HEMS played?
– The lock down has reduced primary missions considerably, so the helicopters have been dedicated to transfer of teams.
Menarini tells that they have transferred 70 patients from full ICU’s to other ICU’s, but the helicopters in Ravenna were not used.
– Unfortunately, we cannot transfer Covid-patients as the helicopters are not made for these types of transport, because we must avoid contact with the pilot and other technicians. There is no division between the cockpit and the back of the helicopter. But HEMS has been useful because we have had the possibility to reduce time for transfer of equipment and teams.
In other regions of Italy, they have transferred Covid-patients by helicopters, especially in Lombardia.
– It was a dramatic situation with a lot of patients without ICU-beds, so they had to transfer them to other regions. Some patients were transferred to Germany.
– Have you had any primary missions to Covid-patients or suspected Covid-patients?
– No, for Covid suspect cases we use ambulances, and maybe teams from the helicopter for medical interventions, but these missions are done with ambulances.
– What about other activities? Trauma patients and other HEMS patients?
– These missions have fallen about 30 percent below normal levels. There are no traumas because there is no traffic and no working activities. Strangely enough there has been a reduction of acute myocardial infarcts and strokes as well. I don’t know why but we have had a reduction of 30-40 percent. So, the helicopters are dedicated to secondary transfers.
– What kind of gear do you use for protection on the HEMS missions? Do you anything particular for the Covid patients?
– We use level 3 protection, especially for invasive maneuvers, intubation for example. Fortunately, in our region, we have few cases of contaminated physicians. In Lombardia there have been many, many physicians who are contaminated. So for any mission we have to consider that the patient can be Covid positive.
– How do you clean the helicopters afterwards?
– We have specific procedures with ozone, and we almost empty the helicopters, leaving only multimonitors, ventilators and a limited part of the equipment, so it is easy to clean the helicopter. We do normal de-sanitizing and ozone. Has there been any need for prehospital RSI (Rapid Sequence Intubation) and securing of airways?
– In this period, we have had patients brought to the hospital in an early phase of infection, so in general we have had patients with slight dyspnea and cough, but in no need of intubation. We have had a few cases with CPAP, but 95 percent of the patients don’t require invasive maneuvers.
In their experience the patient’s problems starts four-five days after the onset of fever.
– Our policy is to transfer the patient to hospital if they have had four days of fever without any improvement, and if the patient is slightly dyspneic.
– When this is over, what is the most important message?
– To be prepared for a pandemic from now. In the future, I think we that we possibly will have the same problem again. We need to change the culture of our personnel. We will deal with more than catastrophic emergencies, multi-trauma and cardiac arrests. We have to treat the patients with infections, and develop ways of transfer.
Menarini also thinks that to transfer the patients to hospital is not the solution to all problems.
– I think the solution and prevention of epidemics in the future will be on the street and in the homes. We have to think that helicopter teams are an instrument to have better care in the first phases of this infection. In our country it will be important to revise completely the policy of health care in many regions.