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Collective Critical Care Ambulance: an innovative transportation of critical care patients by bus in COVID-19 pandemic response
Background
During the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route.
Methods
The expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency.
With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances.
Results
Four COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred.
Conclusions
It was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.
Journal Article
La Légende de Desaix
Les mémoires des acteurs de l’épisode napoléonien (comme ceux de Rapp et Savary), et les écrits de Sainte-Hélène (Las Cases, Antommarchi, Gourgaud, O’Meara, Bertrand) ont contribué à rendre populaire le portrait d’un Desaix intelligent, magnanime, un des meilleurs généraux de la Révolution. Ce portrait est rehaussé par les sentiments d’amitié et d’admiration que Desaix aurait nourris à l’égard de son chef Bonaparte. Réciproquement, Napoléon a contribué à grandir la mémoire de celui qui sacrifia sa vie pour le sauver à Marengo. La légende de Desaix, général à l’antique, créée dès le Consulat, se fonde, entre autres facteurs, sur ce type de récits. The Legend of Desaix in the Memoirs of Two of his Aides-de-camp and in the writings of Saint Helena.The memoirs of those who took part in the Napoleonic saga (such as Rapp and Savary) and the writings of Saint-Helena (Las Cases, Antommarchi, Gourgaud, O’Meara, Bertrand) have contributed to the popular image of Desaix as intelligent, magnanimous and one of the best generals of the Revolution. This image is strengthened by the feelings of friendship and admiration Desaix is said to have nurtured towards his chief Bonaparte. Reciprocally, Napoleon helped magnify the memory of the man who sacrificed his life to save him at Marengo. The legend of Desaix, a general in the antique mould, created under the Consulate, is based in large part on this type of narrative.
Journal Article
La Légende de Desaix
Les mémoires des acteurs de l’épisode napoléonien (comme ceux de Rapp et Savary), et les écrits de Sainte-Hélène (Las Cases, Antommarchi, Gourgaud, O’Meara, Bertrand) ont contribué à rendre populaire le portrait d’un Desaix intelligent, magnanime, un des meilleurs généraux de la Révolution. Ce portrait est rehaussé par les sentiments d’amitié et d’admiration que Desaix aurait nourris à l’égard de son chef Bonaparte. Réciproquement, Napoléon a contribué à grandir la mémoire de celui qui sacrifia sa vie pour le sauver à Marengo. La légende de Desaix, général à l’antique, créée dès le Consulat, se fonde, entre autres facteurs, sur ce type de récits.
Journal Article
La légende de Desaix
Les mémoires des acteurs de l'épisode napoléonien ( comme ceux de Rapp et Savary ), et les écrits de Sainte-Hélène ( Las Cases, Antommarchi, Gourgaud, O'Meara, Bertrand ) ont contribué à rendre populaire le portrait d'un Desaix intelligent, magnanime, un des meilleurs généraux de la Révolution. Ce portrait est rehaussé par les sentiments d'amitié et d'admiration que Desaix aurait nourris à l'égard de son chef Bonaparte. Réciproquement, Napoléon a contribué à grandir la mémoire de celui qui sacrifia sa vie pour le sauver à Marengo. La légende de Desaix, général à l'antique, créée dès le Consulat, se fonde, entre autres facteurs, sur ce type de récits.
Thierry Lentz, The Legend of Desaix in the Memoirs of Two of his Aides-de-camp and in the writings of Saint Helena.
The memoirs of those who took part in the Napoleonic saga (such as Rapp and Savary) and the writings of Saint-Helena (Las Cases, Antommarchi, Gourgaud, O'Meara, Bertrand) have contributed to the popular image of Desaix as intelligent, magnanimous and one of the best generals of the Revolution. This image is strengthened by the feelings of friendship and admiration Desaix is said to have nurtured towards his chief Bonaparte. Reciprocally, Napoleon helped magnify the memory of the man who sacrificed his life to save him at Marengo. The legend of Desaix, a general in the antique mould, created under the Consulate, is based in large part on this type of narrative.
Lentz Thierry. La légende de Desaix. In: Annales historiques de la Révolution française, n°324, 2001. pp. 151-159.
Journal Article