Prehospital high acuity transport by air rescue has the capability to deliver the sickest of patients to high quality, advanced care, and support. However, now all patients are transferred. Why? Per Bredmose tells the tale of Emma. Emma is a 12-year-old girl who developed a cough. She is admitted to local peripheral hospital, correctly diagnosed with pneumonia, and treated with IV antibiotics. Emma continues to deteriorate and is transferred to an ICU where she fails a trial of BiPAP and is intubated. She continues to deteriorate. She requires high pressure ventilation and vasopressor support – advanced, high end, specialist interventions. The truth… this never happened. This talk from Per is about all the future Emma’s. Someone in the hospital system (either the sending or receiving hospital) decided that Emma was too sick to be retrieved. Per challenges this notion of “Too sick to be retrieved”. He says it is rather a case of being in the wrong place at the wrong time. Or getting the wrong disease in the wrong place. Patients will inevitably be in hospitals that lack essential equipment or knowledge for a given condition. Small hospitals do have some deficiencies. Per advocates for the development of retrieval medicine teams and systems that can assist these patients and bring them to centres that can provide the best care. This requires a team including paramedics, pilots, flight nurses and yes, retrieval doctors who have high end specialist training and experience. The teams need to understand the system, the equipment and be able to calculate the risk-benefit ratio of retrievals. They need access to hardware – whether this be ambulances, planes, or infusion hardware. And they must be able to work within the system in which they are operating. Per advocates for a strong retrieval system, comprised of well support and trained happy teams. This leads to safe retrieval and transport and better outcomes for patients.

1. Never too sick to be
retrieved
Per P. Bredmose
Director of training
Air Ambulance Department
Oslo University Hospital @VikingOne_

2. Wrong place at the wrong time

4. With the wrong disease

5. Lack of ...
Medical equipment
Skills
Experience
Volume of “big sick” patients
Knowledge of specific situation
Staff
BASICALLY – NO OTHER OPTION !

7. crew

8. TEAM
Flight Nurse

12. X

15. Logistics
Team work
Communication
Organisation
Effects of
altitude
Human factors
CRM
Equipment
Planes
Ambulances
Helicopters
I:E ratio
Rise Time
Plateau
Pressure
Inspiratory
Pause
Peak Pressure
Vasopressin
Dobutamine
VV vs VA ECMO
Milrinone
Relaxation
Sedation
Congenital
heart
ICU care
24/7
Patient centered treatment 24 / 7

16. ?
7 yrs
12 yrs
15 yrs
Relevant Experience

17. One size doesn’t fit all..

18. hardware

23. This patient is too
sick to get an RSI !!
This patient is too
sick to be moved !!

24. This patient is too sick
to be moved..
Let’s bring in the
right TEAM to move
him...
If he is not moved,
he will die here !

26. The retrieval physician shall always be involved
in desicions regarding transports of “big sick”
patients
Never too sick to be
retrieved
(especially if someone else has judged
the patient not to be transportable)

28. Go home and make sure that you have a
system that is tuned in for this...
Skills - Team - Competance
Never too sick to be
retrieved

29. Happy Team = Safe Transport

30. ?

31. There will always be children to be retrieved –
despite all good intentions………