As healthcare systems across Europe emerge from the chaos of the pandemic, there is a new challenge every provider in the transport medicine is about to face. Just as we had to resort to a learning-by-doing philosophy, when it all started during the spring of 2020, there is yet another concept to familiarise ourselves with.
We are experiencing an ever-growing number of requests for the transport of patients who, although they have overcome the worst part of the symptoms caused by Covid-19, remain in severe respiratory failure for a prolonged time after being infected by the virus. These cases often get the label of ‘post-Covid’ by customers and are expected to be treated similarly to our previous, ‘sterile’ missions. While there are well-defined guidelines in existence based on scientific evidence that help to identify which patients present a low-enough risk of being infectious, in order to discontinue airborne precautions (i.e., to transport them without a portable medical isolation unit [PMIU]), the pre-assessment, organisation and execution of such missions still presents many challenges.
Clearing up some misconceptions
First of all, there might be a misconception regarding the terminology. ‘Covid-19’ is the name of the illness, and the patients in question do have this diagnosis. What could be confusing is that there is no clear definition of a patient being ‘postCovid’, other than being completely healed and symptom-free (not to mention the emergence of ‘long Covid’, a term which is actually being used synonymously with post-Covid conditions, but in reality has a whole different meaning).
Secondly, even if employees at the treating hospital are aware of the above-mentioned preconditions of discontinuing airborne precautions or have already obtained negative PCR results, these patients often remain on Covid ICUs in a contaminated zone, until they are weaned off the respirator. That means medical transport crews have to use full-spectrum PPE for their own protection when carrying out bed-to-bed missions just to perform the handover, even though the patient is not considered infectious anymore. The situation is quite similar at the receiving facilities, patients are often placed in the red zones.
Last but not least, these patients are often in very severe respiratory failure, requiring aggressive ventilation strategies, resulting in an oxygen consumption of unprecedented amounts. Due to the limited supply that is possible to be placed onboard, connecting missions are, more often than not, impossible.
‘Covid is a game-changer’ – goes the saying, rightfully so. There is a whole array of new strategies to be developed and tailored to everyday use, and these cases, although often referred to as ‘post-Covid’ cases, are indeed a lot closer to active Covid missions in terms of required planning, costs, human resources and consumption of medical supplies.