Update from the Netherlands

By May 18, 2020 May 25th, 2020 2 Comments

Video interview with Dr. Ellen Weelink, HEMS physician and Medical Director of the Groningen HEMS base, one of four bases in the Netherlands.

Google Maps. Gruningen is under the red spot.

Another interview in our series with colleagues around the world involved HEMS, where we ask about the corona situation.

This time it is Ellen Weelink, anesthesiologist, HEMS physician and Medical Director of the Groningen HEMS base, one of four bases in the Netherlands.

She is interviewed by Hans Morten Lossius, General Secretary NAAF (Norwegian Air Ambulance Foundation).

– What is the situation in the Netherlands right now?

– Thank you for inviting me for this interview! Right now, the situation is a little bit quieter than when we started two months ago. The ICU commitments are easing down, so it is a little bit more back to normal.

Weeling continues:

– In the HEMS operations we started to take precautions almost immediately when the corona infection became apparent. We did every aerosol generating procedure (AGP) in full protection: FFP2-masks and full goggles to protect ourselves from possible contamination. In the HEMS (patient) population you don’t know which patients that may have contracted corona virus or not. Therefore, we started early to protect ourselves fully in the operation.

Waiting game

Weelink tells that up until now, nobody got sick from HEMS missions.

– Furthermore, we have the luxury that we don’t always need to transport the patient, because we are a quite small country. We decided to transport less patients to minimize the risk of infecting the crew. And we started wearing protective personal equipment, because in a helicopter we are close to each other in a small space. In almost every situation we are using surgical face masks. Both when we are in flight or in ambulances on the ground.

Weelink says that at the moment they are getting a little bit looser in the everyday life in the Netherlands, and also in the precautions they have taken to protect themselves from infection.

– At the moment we are waiting to see whether we get more infections or not, so it is a waiting game – to see what happens.

She thinks it is the same in all the European countries – what will happen next with the corona virus.

ICU patients flown from the south to the north

In the meantime, the HEMS physicians and crews from to bases in the northern and eastern parts of the Netherlands, got a new task:

– We had to transport Covid-patients from ICU in one part of the Netherlands, to the other part, because the ICU’s in the southern parts were overflowed with corona patients.

They had hot spots in one region, and still had room in the ICU’s in the northern parts.

– We transported Covid-patients from the south to the north.

 Has there been any discussions whether the physicians should be withdrawn from HEMS to work in the ICU’s because of lack of physicians?

– Not in our station or other stations in the Netherlands. They made a strict separation between the people who were working out of hospital and inside of the hospitals. The people working outside stayed out of the hospital, people working inside stayed inside.

Weelink continues:

– We had to upscale all ICU beds, and all the hospitals operating rooms were downscaled, so anesthesiologists became free to work in the ICU’s. HEMS stayed pre-hospital, but we did get the extra task of transporting ICU Covid-patients.

Special ventilation

– Can you tell us about your experiences clinically with the Covid-19-patients? The ones you transported to the ICU’s?

– What first became apparent, what that is was mostly male patients. They were younger than expected, around 60-70 years old, and some were also in their 50’s, quite young. About half of them needed to be transported in the prone position (on their belly), because of the ventilation. They all needed high concentrations of oxygen and high peep to be able to oxygenate and ventilate a little bit. They also had very high end-tidal CO2 levels. It is a special way of ventilating these patients, they are not “normal” ICU-patients when it comes to ventilation.

– Have you done a lot of pre-hospital advanced airway management?

– Most of these patients were transported to the hospital before they became respiratory troubled, and before they needed intubation. The pre-hospital intubations we do are on the normal HEMS population, not the Covid-population.

20 percent decrease in missions

– Has there been any changes in the regular HEMS patient groups? Do you have the same amount of trauma patients and coronary patients? Has there been any shifts?

– Yes, it is quite remarkable. We had a 20 percent decrease of HEMS missions in April. We still received the same patients in HEMS, but the ground ambulances saw fewer coronary patients and less anxiety patients, who called because they had chest pain. The real HEMS population stayed about the same, but a little bit reduced. Because everybody stays at home, there is less traffic, people don’t do sports outside, people stay inside and do less dangerous stuff.

Wake-up call

– In the future, is there anything you have learned from this situation that will change the service for the future? Or do you think it will return back to the same procedures, and that we will carry on as we did before?

– I think that at least until there are vaccines, and the corona virus is staying with us for a long time, there will be changes. This is a kind of wake-up call. We have been quite careless in protecting ourselves from getting infections from patients. I think we will be far more careful and protect ourselves from infections compared to how we operated before the corona virus.

Weelink think that masks and goggles will stay for a long time, maybe even permanently in the missions.

– When you clean the helicopters after the missions. Do you have any special decontaminating procedures?

– The helicopters can’t be cleaned easily, because the normal disinfectants are not certified for helicopters. We must use disinfectants that are suitable for the helicopters, and it has drying time. We have to spray everything, and it takes about 15 minutes to dry out, before everything is disinfected. It really slows you down in the operations. If you transport a patient with Covid, you need to clean everything thoroughly afterwards. We disinfect all the medical equipment with 70 percent alcohol. It is not very good for all the wires and things, but it kills the corona virus. The helicopters are cleaned with certified things.

– Have you considered installing incubators?

– Our HEMS operations are flown with EC135, and incubators can’t be used there because they are too big, but we also have EC145, where it fits, and it is tested there.

See more video interviews: