Cooperation of health and defence departments in the transport of critically ill patients with COVID-19

Over 3 600 patients with COVID-19 disease, 637 of whom were critical, were transferred to individual hospitals in Slovakia in six months. This was a difficult logistical operation coordinated by OSPN. It has been developed as a joint project of Ministries of Health and Defence in response to the increase in hospitalizations in October 2020 and the acute need for redistribution, in particular, of critical patients connected to artificial pulmonary ventilation, to make maximum use of reprofiled ventilated beds throughout the country.The Ministry of Health of the Slovak Republic, in cooperation with the Operational Centre for the Rescue of the Slovak Republic and the Office of the Chief Physician of the Slovak Republic, established 6 November 2020 in pilot operations Surgery centre for transport of critically ill patients with COVID-19. The center is located in the premises of OS ZZS SR and works in it soldiers, trained NATO, operators of emergency line 155 and employees of the Ministry of Health. In the first weeks the operation was secured during working days, later it was extended to continuous operation, 24 hours a day 7 days a week.

The centre was set up at a time when the Regional Emergency Service Operations Centres throughout Slovakia experienced enormous pressure in the number of incoming calls to the emergency call 155, coordinated the ZZS crews and their route to hospitals from the ground and worked on 140% of the normal load; said in this regard Director of the Operational Centre of ZZS SR Michal Weinciller. He added that this national coordinator accepts hospital requirements which, despite reprofiling ventilated beds, have filled their critical capacity and redistributes critical patients to other hospitals that are capable of receiving the patient. The transfer of patients is subsequently carried out by the crews of emergency medical services ambulances. At the beginning of its activities, the Centre ensured in particular transfers of patients from the most affected region in Nitra and the surrounding area. Following the deterioration of the epidemic situation in all regions of Slovakia, requests for transfers increased by hundreds of percent. At the time of the peak pandemic, it was necessary to contact an average of 15 to 30 hospitals to find a single ventilated area until the patient found a free bed. In case of failure to find a bed in nearby hospitals, patients were often transported even across Slovakia, added M. Weinciller. I am pleased that I have started the project of the Operations Centre to support the transport of critically ill patients with COVID-19 disease on the one hand and ended on the other. This idea arose during a visit by colleagues from the Ministry of Health at the Central Military Hospital in Ružomberok, where I worked as director at that time. Soon I contacted General Roman Jantoš and then the idea turned into reality. I would also like to thank everyone involved very much from this place. This cooperation is also an example that we are still one team in saving health and human lives. Thank you to everyone on behalf of our patients, stated Minister of Health Vladimír Lengvarský.In the period from 1 October 2020 to 31 March 2021, a total of 637 patients were transferred between hospitals in Slovakia for artificial lung ventilation. These transports by rescue crews lasted 2478 hours in total. The so-called "bridges of assistance" were created between Slovak hospitals, when 15% of patients on lung ventilation were imaginaryly constantly moving

moved to freshly released bed capacity. The officers of the Armed Forces of the Slovak Republic made a total of 8613 calls to individual health institutions to secure these transfers. He gave sincere thanks to all health care professionals and other staff who helped patients, and Minister for Defence of SR Jaroslav Come on.. I also want to point out the amazing work of women and men in uniform, not only of health professionals, but also of non-health professionals and standard armed forces. Even these days we allocate about 1 500 soldiers a day to support Slovakia in the fight against COVID-19, a large part of which is available to the Ministry of Health, he said. He also stressed that the pandemic as well as successful cooperation with the health sector showed what an essential element the Armed Forces of the Slovak Republic are in the domestic crisis management of the country. This is the excellent and functional synergy of the two departments, which has led to the saving of many lives, Minister J. Nade picked up.

He also drew attention to the fact that by the end of March, 87 768 man-days had been involved in the task of professional soldiers in a pandemic. In addition, the Central Military Hospital SNP-FN Ružomberok, which has invested more than 7 million euros in the development of the defence department last year, is heavily involved in the fight with Covid-19. It became really one of the bearable so-called red hospitals and belonged to the tip of our country, while patients evaluated the standard of its services as the best in Slovakia, and the head of the department of defense said. We have proven that we can help in other than standard military matters and I believe that even though none of us wants the situation to be repeated, the department of defence and armed forces will always be there for the citizens of Slovakia, Closed Minister J. Come on.. In addition to the transfers of patients to artificial pulmonary ventilation, the Regional Health Service Operations Centres and the Critical Transport Operations Centre were coordinated with a further 2,982 transports of patients with COVID-19, mainly with oxygen support, in particular to release capacities in critical regions. At the end of February, Germany and Poland offered us ventilated intensive beds. The resort, together with the Ministry of Health of the Slovak Republic, coordinated transfers of ventilated patients to these countries. The operation took place at a time when approximately 25 ventilation beds were available in Slovakia, which was critical capacity. The Slovak Republic has made use of the Early Warning and Response System of the European Union (EWRS), a tool for monitoring threats to public health in the Community. With this mechanism, a total of 9 patients were transferred to Germany and Poland for artificial lung ventilation by aircraft, helicopters and emergency medical field ambulances, with the cooperation of international coordinators, consulates and Member States' security forces. This was the first operation of this kind in Slovakia using the EWRS. To date, all 9 Slovak citizens have been repatriated to Slovakia, six in a significantly improved state and three citizens have been so seriously ill that they have unfortunately died. Patient transports were fully funded again by the European Emergency Support Instrument (ESI).