Helicopter Emergency Medical Services Transport of COVID-19 Patients in the "First Wave": A National Survey

Study objectives Helicopter emergency medical services (HEMS) providers have had to adjust to transporting patients with a novel, highly infectious pathogen. This study describes how HEMS organizations in the USA approached the coronavirus disease 2019 (COVID-19) pandemic in its first wave. Methods A survey was distributed via REDCap™ to HEMS organizations in May of 2020 using a national database. Data were collected regarding agency demographics and COVID-19 practices, including education, risk assessment, protective measures, equipment use, and decontamination practices. These were analyzed for qualitative observations and program attributes for COVID transport. Results A total of 68/287 (24%) organizations responded and completed the survey. Eighty-five percent (85%) of responding programs reported that they chose to transport known or suspected COVID-19 patients by air medical transport. Of responding programs, 93% provided education to their providers regarding COVID-19 and 100% conducted a COVID-19 risk analysis for patient transports. Of agencies transporting known or suspected COVID-19 patients, 77% required the use of N95 filtering facepiece respirators (N95) or powered air-purifying respirators (PAPR) for crewmembers during known or suspected COVID-19 patient transfers and 95% provided N95 respirators for pilots during transport. Five percent of responding programs utilized portable negative pressure isolation units. For COVID-19 transporting and non-transporting agencies, when transporting non-COVID-19 known or suspected patients, personal protective equipment (PPE) practice varied but tended to be more relaxed. Some services separated pilots from providers even during downtime (29%). Among services transporting known or suspected COVID-19 patients, the most common decontamination practice was manual wipe-down of all surfaces for a downtime of less than two hours. Conclusion The majority of survey respondents report that their programs chose to transport patients with known or suspected COVID-19 by air medical transport. However, there was high variability in practices regarding the transport of known or suspected COVID-19 as well as that of non-COVID-19 known or suspected patients by air during the initial outbreak of the pandemic. The HEMS industry may benefit from further research and standardization of airborne highly infectious disease transport practices in preparation for the next respiratory virus pandemic.