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      Interhospitaler Intensivtransport Translated title: Interhospital critical care transport

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          Abstract

          Kritisch kranke Patienten, die spezialisierte diagnostische oder therapeutische Verfahren benötigen, jedoch in einem Krankenhaus ohne diesbezügliche Ausstattung versorgt werden, müssen unter Fortführung intensivmedizinischer Maßnahmen zu geeigneten Zentren transportiert werden. Solche Transporte sind herausfordernde Einsätze mit hohem Ressourcenbedarf und logistischem Aufwand, die durch ein spezialisiertes Team bewältigt werden müssen. Hierzu ist neben einem effizienten Crew Resource Management eine gute Planung des Einsatzes notwendig. Bei adäquater Vorbereitung sind solche Einsätze für den Patienten sicher und komplikationsarm durchführbar. Neben Routineintensivtransporten gibt es Sondereinsätze (z. B. isolationspflichtiger Patienten oder Patienten mit extrakorporaler Organunterstützung), die eine Anpassung des Teams oder des vorgehaltenen Materials erfordern. Dieser Beitrag beschreibt die Grundlagen des interhospitalen Intensivtransportes, seine Phasen und Sonderfälle.

          Translated abstract

          Critically ill patients in need of specialized diagnostic or therapeutic procedures, but are being cared for in a hospital without such equipment, have to be transferred to appropriate centers without discontinuation of current critical care (interhospital critical care transfer). These transfers are resource intensive, challenging, and require high logistical effort, which must be managed by a specialized and highly trained team, predeployment planning and efficient crew–resource management strategies. If planned adequately, interhospital critical care transfers can be performed safely without frequent adverse events. Beside routine interhospital critical care transfers, there are special missions (e.g., for patients in quarantine or supported by extracorporeal organ support) that might require adaption of the team composition or standard equipment. This article describes interhospital critical care transport missions including their different phases and special circumstances.

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          Most cited references12

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          Teamwork as an essential component of high-reliability organizations.

          Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. High-reliability organizations (HROs) are those that exist in such hazardous environments where the consequences of errors are high, but the occurrence of error is extremely low. In this article, we argue that teamwork is an essential component of achieving high reliability particularly in health care organizations. We describe the fundamental characteristics of teams, review strategies in team training, demonstrate the criticality of teamwork in HROs and finally, identify specific challenges the health care community must address to improve teamwork and enhance reliability.
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            The checklist--a tool for error management and performance improvement.

            Levels of cognitive function are often compromised with increasing levels of stress and fatigue, as is often the norm in certain complex, high-intensity fields of work. Aviation, aeronautics, and product manufacturing have come to rely heavily on checklists to aid in reducing human error. The checklist is an important tool in error management across all these fields, contributing significantly to reductions in the risk of costly mistakes and improving overall outcomes. Such benefits also translate to improving the delivery of patient care. Despite demonstrated benefits of checklists in medicine and critical care, the integration of checklists into practice has not been as rapid and widespread as with other fields. This narrative is a guide to the evolution of medical and critical care checklists, and a discussion of the barriers and risks to the implementation of checklists.
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              Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study

              Introduction Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients undergoing aeromedical transport are unknown. Methods We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university hospital during 2001 to 2003. All patients receiving mechanical ventilation via endotracheal tube or tracheostomy were included; trauma, scene flights, and fixed transports were excluded. Data were abstracted from patient flight and hospital records. Adverse events were classified as either major (death, arrest, pneumothorax, or seizure) or minor (physiologic decompensation, new arrhythmia, or requirement for new sedation/paralysis). Bivariate associations between hospital and flight characteristics and the presence of adverse events were examined. Results Six hundred eighty-two interfacility flights occurred during the period of review, with 191 patients receiving mechanical ventilation. Fifty-eight different hospitals transferred patients, with diagnoses that were primarily cardiopulmonary (45%) and neurologic (37%). Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively. No major adverse events occurred during flight. Forty patients (22%) experienced a minor physiologic adverse event. Vasopressor requirement prior to flight and flight distance were associated with the presence of adverse events in-flight (P < 0.05). Patient demographics, time of day, season, transferring hospital characteristics, and ventilator settings before and during flight were not associated with adverse events. Conclusion Major adverse events are rare during interfacility, rotary-wing transfer of critically ill, mechanically ventilated patients. Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight.
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                Author and article information

                Contributors
                philipp.lepper@uks.eu
                Journal
                Med Klin Intensivmed Notfmed
                Med Klin Intensivmed Notfmed
                Medizinische Klinik, Intensivmedizin Und Notfallmedizin
                Springer Medizin (Heidelberg )
                2193-6218
                2193-6226
                12 December 2022
                : 1-11
                Affiliations
                [1 ]GRID grid.415600.6, ISNI 0000 0004 0592 9783, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, , Bundeswehrkrankenhaus Ulm, ; Ulm, Deutschland
                [2 ]GRID grid.411937.9, Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, , Universitätsklinikum des Saarlandes, ; Kirrberger Str. 100, 66421 Homburg/Saar, Deutschland
                [3 ]GRID grid.412468.d, ISNI 0000 0004 0646 2097, Klinik für Anästhesiologie und Operative Intensivmedizin, Campus Kiel, , Universitätsklinikum Schleswig-Holstein, ; Kiel, Deutschland
                [4 ]GRID grid.416653.3, ISNI 0000 0004 0450 5663, Dept. of Pneumology, Critical Care and Sleep Medicine, , Brooke Army Medical Center, ; San Antonio, TX USA
                [5 ]GRID grid.419824.2, ISNI 0000 0004 0625 3279, Klinik für Anästhesiologie, Notfallmedizin, Schmerz- und Intensivmedizin, , Klinikum Kassel, ; Kassel, Deutschland
                [6 ]GRID grid.411937.9, Zentrale Notaufnahme und Klinik für Anästhesiologie, Schmerz- und Intensivmedizin, , Universitätskliniken des Saarlandes, ; Homburg, Deutschland
                Author notes
                [Wissenschaftliche Leitung]

                Uwe Janssens, Eschweiler

                Michael Joannidis, Innsbruck

                Konstantin Mayer, Karlsruhe

                Guido Michels, Eschweiler

                Author information
                http://orcid.org/0000-0003-3620-0912
                Article
                973
                10.1007/s00063-022-00973-x
                9744043
                36507960
                b57ff7ec-efa1-4028-bab0-dd6e8a70e0ed
                © The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2022

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 12 July 2022
                : 14 September 2022
                : 20 September 2022
                Categories
                CME

                intensivmedizin,rettungsdienst,patiententransport,rettungswagen,crew ressource management,critical care,emergency medical services,transportation of patients,ambulances

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