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Breath Circles: Industry Trends | Successful Experience of 13 Cases of Aviation Medical Rescue Patients Tells Us that Powerful Combination and Seamless Connection Are Key to Success of Air Transport
Source: Posted Date:01-29-2018

The convenience of aviation emergency medical assistance helps to facilitate the orderly referral of critically ill patients among the tertiary medical institutions and solve rescuing and treating difficulties due to traffic and geography. Professor Zhan Qingyuan from China-Japan Friendship Hospital(CJFH) ECMO Center, Director of CJFH Respiratory and Critical Care Medicine Department Ⅳ and V, concluded that powerful combination and seamless connection were the key points when talked about the aviation transport experience of critically ill patients.

[Aviation Lifelines] are opened in Red Cross Society of China, 999 and 120 Emergency Centers

In our country, the establishment of air transport system is quite late and it has not been completed yet. However, due to its high speed and super mobility, it has played a critical role in the evacuation of the injured during emergencies such as earthquake, snowstorm and group burns, saving lives of many wounded people for prompt treatment. At present, the Red Cross Society of China, 999 and 120 Emergency Centers establish " Aviation Lifelines ", are equipped with professional transport teams and found a diversified transport system (ambulances, helicopters, fixed-wing medical aircrafts, etc.), having possessed very rich aviation transport experience for the injured in emergencies and critically ill patients.
 
Wang Chen, Academician of Chinese Academy of Engineering and CJFH President pointed out that the blocking problem of ground transportation was the key issue hindering medical assistance. Therefore, the advancement of air transport is particularly important. However, aviation medical rescue is still a relatively new thing in China and it is still at the starting stage. CJFH is pretty honored to participate in the construction of aviation medical rescue relatively early. The basic facilities of CJFH have reached a relatively standardized level which lays a good foundation for carrying out formal aviation medical rescue. It is reported that since CJFH and the 999 first launch the aviation medical aid, they aim to establish an emergency medical rescue transport network especially centering on the Beijing-Tianjin-Hebei region and covering a surrounding area of 600 kilometers from the center Beijing. From November 2016, CJFH has successfully admitted and transported 13 cases of aviation medical rescue patients up to now, mainly from Chifeng, Zhangjiakou, Handan and other places.

Aviation emergency transport system begins from the First World War

At the [aviation medical rescue seminar] co-organized by CJFH and 999 Emergency Center, Professor Zhan Qingyuan introduced the international status of aviation emergency transport. It is reported that the aviation emergency transport system begins from the First World War and it is firstly used in the transfer of battlefield injuries. According to data of French, providing air transport to battlefield injuries could reduce the death rate from 60% to less than 10%. Aviation emergency transport was gradually extended to civilian use thereafter.

In the United States, the aviation emergency transport system has now become an inseparable part of its complete trauma emergency system. The first non-military air emergency station was established in Maryland in 1969. In 1991, it was estimated that there were totally 225 air emergency stations throughout the United States, of which 175 were attached to hospitals and the remaining were either independent pre-hospital emergency stations or attached to police fire-fighting system. Air emergency stations mainly use helicopters and small fixed-wing aircrafts,  usually 2 airplanes. The main advantage of air emergency transport is to reduce the pre-hospital transport time of critically ill patients and improve the stability of the transport process.

British air emergency transport system is also more mature. British air rescue aircrafts not only assume emergency medical service functions but also are responsible for patient transport among specialist treatment centers or participation of humanitarian relief.

In fact, all the global developed countries have formed a complete air emergency transport system. Establishing the air emergency transport system is a common trend of all countries in developing emergency service, an important part of improving national emergency system and also a necessary requirement for enhancing the medical level of critical diseases.

Powerful combination and seamless connection are successful experience

Professor Zhan Qingyuan mainly summed up the aviation transport experience of critical respiratory disease and pointed out that the key points were powerful combination and seamless connection. Firstly, judging from the cooperation between CJFH and 999, the critical disease transport team of 999 could well complete the transferring of critically ill patients in terms of hardware, team, experience and cooperation. Secondly, a complete acute and critical diseases treatment system such as the emergency system that can finish multiple trauma rescue and treatment and the ICU system including MICU, SICU and CCU should be established in the hospital. Various functional departments should be highly coordinated. This can also be attributed to the leading position of CJFH in critical respiratory disease in China: one is the visceral organ monitoring technology system such as respiratory mechanics, FRC, esophageal pressure, PICCO and the other is the visceral organ function supporting system including the respiratory supporting system (like HFNC、NPPV、IPPV、ECMO), CRRT, plasma exchange, bilirubin adsorption and the like.

Moreover, the high-level comprehensive medical treatment ability of hospitals also played a significant role. Professor Zhan Qingyuan introduced their two cases of critical diseases admitted by air transport. The successful treatment is also very much related to the high comprehensive treatment capacity of hospitals. One male patient in his 30’s was in suspect of having severe pneumonia and high white blood cells and was diagnosed as critical respiratory disease with the ventilator put on at a local hospital. The patient also had obesity problem and he was in light coma. After admission to CJFH, a diagnosis was made to consider whether the severe pneumonia leaded to ARDS. Later, it turned out that the patient had a six-month medical history after inquiry and the imaging showed that it should not be ARDS. Thus, it was suspected to be mitral valve sclerosis and reflux, overthrowing the local diagnosis and completely changing the treatment. After finishing the primary diagnosis at MICU, the respiratory support including mechanical ventilation and ECMO was given to the patient to control pulmonary infection, heart failure and respiratory failure; then he was transferred to a general ward of Respiratory Department II to control pulmonary infection as well as heart failure and complete the preoperative examination. The patient was cured by surgical Professor Liu Peng through operation.