Interview with Dr. Daniel Löfving, Medical Director of the HEMS Uppsala, Sweden.
In a series of interviews, medical leaders for helicopter emergency medical services (HEMS) around Europe talk about their experiences with the COVID-19 outbreak.
Dr. Daniel Löfving, medical director of HEMS Uppsala, that mainly do inter-hospital transfers, tells about their experiences so far.
Still a lot of patients
Löfving says that the number of Covid-patients in Uppsala area has stabilized, but at a fairly high level. In their area they have 20 ICU-patients and just above 100 patients hospitalized.
– We have about the same number of patients coming in, as patients that are dismissed and sent home. This is pretty much the case in the rest of Sweden as well. There is a lot of pressure everywhere. Especially in Stockholm.
Have you had many transfers by air, intensive care transports? Hans Morten Lossius, Secretary General of the Norwegian Air Ambulance Foundation (NAAF), asks.
– We thought there would be more. At the same time, when we planned a month ago, we thought that most people would be treated in the hospitals where the patient was first admitted, because of the risk of contamination. But then it seems that the need has grown. If some departments are full, then patients must be relocated.
Prefer to transfer by ground
They have had ten transfers so far, three by helicopter, four by air ambulance, two by car and one by a Swedish Armed Forces helicopter.
They want to use the helicopter as little as possible because of the risk of spreading Covid-19 and the time it takes to disinfect the helicopter afterwards.
– But if we have to move the patient over longer distances, then helicopter is the best option.
During these operations they try to empty the cabin as much as possible. The equipment is put in plastic bags that are only opened if necessary. The curtain between the cockpit and cabin is taped to protect the pilot. Normally the pilots help with the equipment, but not now.
Rejects incubators
Have you considered using an incubator?
– Yes, we did a test during the Ebola epidemic. We tried with a manikin how it worked, but it was difficult with intubated patients with all the tubes and equipment, so in practice it was almost impossible.
How do you disinfect after transfer of a Covid-patient?
– As we normally do, but we are more thorough. We regard the floor as dirty anyway, it is not possible to disinfect. We use personal protection equipment (PPE) with all the recommendations that exist.
Löfving also says that they follow checklists when the put on an take off PPE, when changing gloves and aprons at different stages of transport to keep it as clean as possible.
Do you test the personnel?
– Yes, I was tested last night because I had some symptoms. We test all personnel with symptoms. We have had two pilots who were positive, but they were probably not infected in the service, because this was quite early on.
Cooperation with the Swedish Armed Forces
They have established good cooperation with the Swedish Armed Forces, which assists with three military helicopters (Black Hawk or NH90) and is stationed in Luleå, Uppsala and Gothenburg.
– We bring our own equipment. They only have oxygen and electricity. There has only been one transport so far, so we are in a start-up phase.
Löfving says that intensive care nurses are involved in these missions.
Fewer assignments than normal
Is there any change in the number of missions otherwise?
– There are fewer secondary transports now and there is a tendency for a smaller portion of primary missions. People stay at home, so there are less accidents.
Sweden has chosen a different strategy than the rest of the world, do you discuss this?
– I’m just a layman in that regard, so I can not comment on that. The health service works, but it is under pressure, and the queues for operations are growing. I do not know how this will end, that will only be guessing.
Are there any experiences that you will take with you in the future?
– We have made a plan that we can use in the future. We have realized that we must have a larger amount of PPE and other equipment stored. As a patient category, these patients are special, everything takes more time. We use twice the time compared to regular missions, Löfving says.
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