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B-19 Air rescue coordination centres
B-19 AIR RESCUE COORDINATION CENTRES Peter Vonmoos, Robert Hurter, Medicall Ruchstuckstrasse 12, CH-8306 Bruttisellen/Zurich. Medicall is an alarm- and emergency centre, operating 24 hours a day as a link between insurance companies and health care organizations on one hand, and ambulance jet services, helicopter and ground rescue services on the other. As partner and representative of costbearing organizations Medicall organizes and carries out the transport of patients in a medically correct way and in the best interest of the patient. Some insurance companies have alarm centres of their own. Unfortunately, these centres often lack properly qualified and multilingual staff. They are rarely or never used to full capacity, and as a consequence, they lack the indispensable practical experience. Their efficacityand practical value is bound to be limited, and rather nominal than factual. This solution cannot be reconTnended. But, satisfactory service can be expected from fully-fledged rescue organizations with proper alarm centres and adequate means of transport of their own. The great disadvantage of this solution lies in the fact that such ccnm~rcially-minded organizations are pressed to operate at the highest possible rentability. Consequently, their decisions will be coloured by their own interest rather than by the desire to avoid unnecessary expenses for the costbearing insurance companies. These considerations suggest the following guidelines for the organization of alarm centres: i. The centres should operate independently of the insurance companies AND of the carriers. 2. Staff training must focus on the medical aspects and include insurancerelated concerns. 3. Alarm centres must be financed independently of the number or the type of services or missions carried out.
B-20 AEROMEDICAL TRANSPORT OF PATIENTS WITH RECENT MYOCARDIAL INFARCTION
S e r g e I v a n o f f , M i c h a e l Rapp, C h r i s t i a n L a r a t t e . Europ A s s i s t a n c e M e d i c a l D e p a r t m e n t , 23 Rue C h a p t a l , 75009 P a r i s , France. I n t r o / M e t h o d s . From a s e r i e s o f 300 cases of recent myocardial infarction o v e r s i x y e a r s we s t u d i e d t h e r i s k o f aeromedical transport, the risk being a p p r e c i a t e d i n r e t r o s p e c t by t h e r a p e u t i c a c t i o n s begun d u r i n g t r a n s p o r t . We evaluated whether delay before transport, symptom complex, and i n t i a l t r e a t m e n t influenced the risk of transport. R e s u l t s . The p a t i e n t ~ , whose i n f a r c t s d a t e d from l e s s than 5 d a y s , remained s t a b l e in f l i g h t when t h e i n i t i a l t r e a t m e n t had e f f e c t i v e l y stabilized the p a t i e n t . They improved when t h e t r a n s p o r t p e r m i t t e d t h e b e g i n n i n g or t h e c o m p l e t i o n of insufficient treatment with coronary d i l a t o r s or a n t i a r r h y t h m i c s . A n t i c o a g u l a n t s were u s e d r o u t i n e l y . T h e r e was no c a s e where d e f i b r i l l a t i o n was r e q u i r e d . A l l c a s e s were t r a n s p o r t e d under ECG m o n i t o r i n g and IV i n f u s i o ~ w i t h a pump t o r e g u l a t e . 8Z o f t h e s t a b l e infarct patients needed treatment f o r a n g i n a , a l t e r a t i o n o f b l o o d p r e s s u r e , or e x t r a s y s t o l e s . These p r o b l e m s o c c u r r e d as u n e x p e c t e d l y in t h e s e c o n d week o f e v o l u t i o n as in t h e 4 t h week and in patients with uncomplicated infarctions initially considered without risk. C o n c l u s i o n . The 92% o f s t a b l e i n f a r c t s which d e s p i t e t h e s t r e s s o f a i r voyage d i d n o t e x p e r i e n c e c o m p l i c a t i o n s in ~ , l ~ shc~s . . . . ~ir transport even early, in the overwhelming number of cases, is not dangerous. Nevertheless, the experience with the remaining 8Z, for whom a problem in transport developed which was not predictable, j u s t i f i e s ECG monitoring and medical escort (physician 85% -nurse 15 %), with available resuscitation medications and equipment, as in the case of an unstable or acute infarct patient. We conclude from our experience t h a t medically escorted aeromedical transport of stable patients with recent myocardial infarction can be done safely afld is at least no more dangerous than convalescence without observation in a hotel room.
AMJ SEPTEMBER/OCTOBER1988 55
B-20 AEROMEDICAL TRANSPORT OF PATIENTS WITH RECENT MYOCARDIAL INFARCTION
S e r g e I v a n o f f , M i c h a e l Rapp, C h r i s t i a n L a r a t t e . Europ A s s i s t a n c e M e d i c a l D e p a r t m e n t , 23 Rue C h a p t a l , 75009 P a r i s , France. I n t r o / M e t h o d s . From a s e r i e s o f 300 cases of recent myocardial infarction o v e r s i x y e a r s we s t u d i e d t h e r i s k o f aeromedical transport, the risk being a p p r e c i a t e d i n r e t r o s p e c t by t h e r a p e u t i c a c t i o n s begun d u r i n g t r a n s p o r t . We evaluated whether delay before transport, symptom complex, and i n t i a l t r e a t m e n t influenced the risk of transport. R e s u l t s . The p a t i e n t ~ , whose i n f a r c t s d a t e d from l e s s than 5 d a y s , remained s t a b l e in f l i g h t when t h e i n i t i a l t r e a t m e n t had e f f e c t i v e l y stabilized the p a t i e n t . They improved when t h e t r a n s p o r t p e r m i t t e d t h e b e g i n n i n g or t h e c o m p l e t i o n of insufficient treatment with coronary d i l a t o r s or a n t i a r r h y t h m i c s . A n t i c o a g u l a n t s were u s e d r o u t i n e l y . T h e r e was no c a s e where d e f i b r i l l a t i o n was r e q u i r e d . A l l c a s e s were t r a n s p o r t e d under ECG m o n i t o r i n g and IV i n f u s i o ~ w i t h a pump t o r e g u l a t e . 8Z o f t h e s t a b l e infarct patients needed treatment f o r a n g i n a , a l t e r a t i o n o f b l o o d p r e s s u r e , or e x t r a s y s t o l e s . These p r o b l e m s o c c u r r e d as u n e x p e c t e d l y in t h e s e c o n d week o f e v o l u t i o n as in t h e 4 t h week and in patients with uncomplicated infarctions initially considered without risk. C o n c l u s i o n . The 92% o f s t a b l e i n f a r c t s which d e s p i t e t h e s t r e s s o f a i r voyage d i d n o t e x p e r i e n c e c o m p l i c a t i o n s in ~ , l ~ shc~s . . . . ~ir transport even early, in the overwhelming number of cases, is not dangerous. Nevertheless, the experience with the remaining 8Z, for whom a problem in transport developed which was not predictable, j u s t i f i e s ECG monitoring and medical escort (physician 85% -nurse 15 %), with available resuscitation medications and equipment, as in the case of an unstable or acute infarct patient. We conclude from our experience t h a t medically escorted aeromedical transport of stable patients with recent myocardial infarction can be done safely afld is at least no more dangerous than convalescence without observation in a hotel room.
AMJ SEPTEMBER/OCTOBER1988 55