Challenges and Risks in Out-of-Hospital Transport of Patients During the Coronavirus Disease 2019 Pandemic

Objective: Norwegian critical care resources are regionalized making air ambulances transport of suspected or confirmed coronavirus disease 2019 (COVID-19)-positive patients a necessity. We prospectively observed pre- and interhospital transportation of patients with suspected or confirmed COVID-19 in our physician-manned emergency medical services. Methods: This was a prospective, observational quality assurance study of primary and secondary missions conducted by 2 Norwegian air ambulances during the COVID-19 pandemic. Results: Forty-one (24.1%) were primary missions, whereas 129 (75.9%) were interhospital transports. Most patients (158 [92.9%]) were transported with ground-based vehicles, and 12 (7.1%) were transported by rotor wing aircrafts. One hundred thirty-four of 170 patients (78.8%) were COVID-19 positive at the time of transportation. The median (interquartile range) fraction of inspired oxygen concentration was 0.60 (0.50-0.80), the positive end-expiratory pressure was 11 cm H(2)O (8-13.5 cm H(2)O), and the peak inspiratory pressure was 26 cm H(2)O (22-30 cm H(2)O). Some degree of elevated treatment challenge was reported in 157 (87.7%) transports, and in 139 (77.7%), the patient risk was considered elevated. The physician stated that some degree of elevated risk for the provider was elevated in 131 (73.2%) of the transports. Conclusion: The capacity of the physician-manned emergency medical services to safely transfer patients remains essential to maintain resilient critical care capacity, and the perceived elevated risks should be considered in capacity planning.