transporting
severely paralysed patients BY
JAMES MACRAE,
Ham Green
M.D.
Hospital,
Bristol
The transport of patients suffering from diseases wg, ?r both, is a problem which has become of great 1 p This is hecausemost of these patients suffer
the past decade, ^ t^e recently
.
established respiratory centres now provide a much the lives of many of these desperately ill patients. a carrying patient whose unassisted vital capacity
10 save
racing ambulance unnecessary drives which ended
^Tan During the years .947 ,954 ^ diedBridgwater of these, y this hospital with dead patient: ^^""Tyoung ^is
rama.
n
.
..
g
1
to
n
g
one
a
.
J
Weston-super-mare.
r
own
in
n
^
appeared to have died in the ambulance mile away , , h.0me six miles from Ham Green before the arrival of an ambular one pa at During these years only rom another transp of conditions under planned hospital of batteries aspirator driven a a
which was station-
transferred
r
s
to us
a
tank
g^e
Was
arrived in
.
^^XSvelled
in a by precarious system accompanied by eight men and two nurses; everything an vomit Z:ent ;nsPired that the patient inspired
furniture van.
After such a valiant effort it was a pity the move and died as a result within the day. u??g an ^n_ With the introduction of artificial positive pressure respira n:ratorv insufficirom P creasing experience of the management of cases suffering Thus in IQ55> ency a better and safer method of transport was obviously patients we thought it a duty of this hospital to provide a service designe sa into ely our respiratory unit. Initially the plan seemed to have three elements: r^^le FePorting ?f cases; lh\ v ) Sending assistance and equipment to the patient, the patient to Ham Green. \\7 Pnninmpnt readv We imagined that this hospital would provide doctors, nurses ll(.otonny, 1'go to the patient at short notice and we thought we m.ght ?ed t? do tracheoton UP lntravenous drips, give nasal-gastric tube feeds and possi Y Eauipment me or in ,, another hospital for a few days before transfer \\ as pos rp^e v e Y accordance with these ideas was assembled and proved to warded e 1 ec t P ovision of a but specially equipped ambulance was mooted on manual From the beginning, we decided to depend p al mechanica breathing and so have never attempted to carry ,
nece*sa^\ thes;
?
^ransP?rting
:u'\'eC"P
i
.
mrthods^
art!?^TCticable" emergency
cases.
-
O
of this new transport service was advertised to Medical doct. Health ava^ability by the Regional Hospital Board and it was specially requested that.the:
inithishosprts of the should get in direct personal touch with doctors ^charge enever the service would that considered It case
was
required.
we
was
nee
.uWic
o gi the needs of the case ant charge ^ whi am from team could apply in the until maintaining the patient 1 lVe> mos the p this telephone conversation has remained ^ ot the emergency service afternoon Our first call for assistance came from Exeter on an August Bank e ln ion ) bulbar of case po 0rmation received by telephone severe suggested a Exctermlesstha to dead alreadY- Hence, since our team could hardly get th to insert 0r four hours, it was suggested that a local anaesthetist be called
doctor
ar-C ?
m
in order
to assess
.
"Undoubtedly
^?^day
11 near!y
45
DR. JAMES MACRAE
46
endo-tracheal cuffed tube quickly and breathe the patient manually on the journey1 $ Ham Green. This was in fact done very successfully and the patient arrived in maint3 condition so and that we could safely perform tracheotomy markably good ventilation by a mechanical positive pressure machine. This first experience poifl1' to a fresh conception of the problem of transporting such patients: supervision $ management should be undertaken by a local anaesthetist. The hospital team is still in being; there are two doctors in this team without this has proved quite sufficient. We discovered that the amount of equipment can much reduced. What is required for these patients consists of: (a) Equipment for posture in an ambulance, so we carry a simple, inverted V frame for cases of simple swallowing defect; (b) Equipment for manual mask ventilation for cases of breathing insufficiency o1* (c) Equipment for passing a cuffed endotracheal tube and manual ventilation the after for combined swallowing and breathing deficiency. A limited assortment of drugs and instruments are carried, especially pentothal scoline with sterilized syringes. A sucker and oxygen cylinder completes the ment. In all, these materials weigh about fifty pounds and are easily carried by The sole purpose of the team is now confined to the reasonably quick movement; the patient to hospital, and the providing of adequate artificial respiration on the Some twenty-six patients have actually been transported into hospital since Nineteen have been cases of poliomyelitis; five were cases of infective one of acute ascending myelitis and one with myasthenia gravis. Apart from?, child with pneumonia we have not been sent any unsuitable cases. These patie
nurs^ ,
adjustab' ,
e^'j
polyneur'1'
E^er' IT0'eight SwTnd^r tV," / nil
nton,
*Y
severely paralysed patients BY
JAMES MACRAE,
Ham Green
M.D.
Hospital,
Bristol
The transport of patients suffering from diseases wg, ?r both, is a problem which has become of great 1 p This is hecausemost of these patients suffer
the past decade, ^ t^e recently
.
established respiratory centres now provide a much the lives of many of these desperately ill patients. a carrying patient whose unassisted vital capacity
10 save
racing ambulance unnecessary drives which ended
^Tan During the years .947 ,954 ^ diedBridgwater of these, y this hospital with dead patient: ^^""Tyoung ^is
rama.
n
.
..
g
1
to
n
g
one
a
.
J
Weston-super-mare.
r
own
in
n
^
appeared to have died in the ambulance mile away , , h.0me six miles from Ham Green before the arrival of an ambular one pa at During these years only rom another transp of conditions under planned hospital of batteries aspirator driven a a
which was station-
transferred
r
s
to us
a
tank
g^e
Was
arrived in
.
^^XSvelled
in a by precarious system accompanied by eight men and two nurses; everything an vomit Z:ent ;nsPired that the patient inspired
furniture van.
After such a valiant effort it was a pity the move and died as a result within the day. u??g an ^n_ With the introduction of artificial positive pressure respira n:ratorv insufficirom P creasing experience of the management of cases suffering Thus in IQ55> ency a better and safer method of transport was obviously patients we thought it a duty of this hospital to provide a service designe sa into ely our respiratory unit. Initially the plan seemed to have three elements: r^^le FePorting ?f cases; lh\ v ) Sending assistance and equipment to the patient, the patient to Ham Green. \\7 Pnninmpnt readv We imagined that this hospital would provide doctors, nurses ll(.otonny, 1'go to the patient at short notice and we thought we m.ght ?ed t? do tracheoton UP lntravenous drips, give nasal-gastric tube feeds and possi Y Eauipment me or in ,, another hospital for a few days before transfer \\ as pos rp^e v e Y accordance with these ideas was assembled and proved to warded e 1 ec t P ovision of a but specially equipped ambulance was mooted on manual From the beginning, we decided to depend p al mechanica breathing and so have never attempted to carry ,
nece*sa^\ thes;
?
^ransP?rting
:u'\'eC"P
i
.
mrthods^
art!?^TCticable" emergency
cases.
-
O
of this new transport service was advertised to Medical doct. Health ava^ability by the Regional Hospital Board and it was specially requested that.the:
inithishosprts of the should get in direct personal touch with doctors ^charge enever the service would that considered It case
was
required.
we
was
nee
.uWic
o gi the needs of the case ant charge ^ whi am from team could apply in the until maintaining the patient 1 lVe> mos the p this telephone conversation has remained ^ ot the emergency service afternoon Our first call for assistance came from Exeter on an August Bank e ln ion ) bulbar of case po 0rmation received by telephone severe suggested a Exctermlesstha to dead alreadY- Hence, since our team could hardly get th to insert 0r four hours, it was suggested that a local anaesthetist be called
doctor
ar-C ?
m
in order
to assess
.
"Undoubtedly
^?^day
11 near!y
45
DR. JAMES MACRAE
46
endo-tracheal cuffed tube quickly and breathe the patient manually on the journey1 $ Ham Green. This was in fact done very successfully and the patient arrived in maint3 condition so and that we could safely perform tracheotomy markably good ventilation by a mechanical positive pressure machine. This first experience poifl1' to a fresh conception of the problem of transporting such patients: supervision $ management should be undertaken by a local anaesthetist. The hospital team is still in being; there are two doctors in this team without this has proved quite sufficient. We discovered that the amount of equipment can much reduced. What is required for these patients consists of: (a) Equipment for posture in an ambulance, so we carry a simple, inverted V frame for cases of simple swallowing defect; (b) Equipment for manual mask ventilation for cases of breathing insufficiency o1* (c) Equipment for passing a cuffed endotracheal tube and manual ventilation the after for combined swallowing and breathing deficiency. A limited assortment of drugs and instruments are carried, especially pentothal scoline with sterilized syringes. A sucker and oxygen cylinder completes the ment. In all, these materials weigh about fifty pounds and are easily carried by The sole purpose of the team is now confined to the reasonably quick movement; the patient to hospital, and the providing of adequate artificial respiration on the Some twenty-six patients have actually been transported into hospital since Nineteen have been cases of poliomyelitis; five were cases of infective one of acute ascending myelitis and one with myasthenia gravis. Apart from?, child with pneumonia we have not been sent any unsuitable cases. These patie
nurs^ ,
adjustab' ,
e^'j
polyneur'1'
E^er' IT0'eight SwTnd^r tV," / nil
nton,
*Y
