Table 1 Sample SOP “Infection prevention measures for HEMS missions during the COVID-19 pandemic”

CDR

• Maintain a distance of at least two meters from the patient. If this is possible, wearing PPE is not mandatory. This applies to the site where the HEMS crew is operating, as well as during the flight.

• Join the medical crew in the emergency department or intensive care unit only in exceptional cases. If so, wear the same personal protective equipment as the medical crew.

MCM/HCM

• Wear examination gloves, a filtering facepiece class 2 mask (FFP2/3), and goggles for eye protection on every mission. Carry a bottle of hand disinfectant with you.

• If possible, maintain a distance of > 2 m from the patient during initial contact and while checking for COVID-19 risk factors

• Put a surgical mask over the patient’s mouth and nose or (depending on the clinical condition) a tight-fitting non-rebreather oxygen mask with adequate oxygen flow and a surgical mask over the exhalation valves.

• Avoid aerosol-generating procedures such as non-invasive ventilation (NIV), high-flow oxygen therapy, tracheal suction, or nebulization of medications.

• When planning for aerosol-generating procedures (mechanical ventilation, airway management, oral suction, cardiopulmonary resuscitation, etc.), put on a protective gown (if time permits)

• Ventilator handover (e.g., emergency unit to Rega):

- Avoid unnecessary respirator circuit disconnections

- Set FiO₂ to 1.0

- Check sedation/analgesia and relaxation (consider bolus administration if necessary)

- Prepare a generic self inflating bag with flexible tube extension and airway filter, plus reservoir bag including attached oxygen supply

- Switch the Rega ventilator device to standby mode

- Switch off the ventilator device of the emergency unit

- Clamp the tube between the patient and the filter

- Connect Rega ventilation tubes with airway filter

- Unclamp the tube

- Switch on the Rega ventilator system

- Verify correct positioning of the tube by using the CO2 curve on the Rega monitor and comparing ventilation settings, in particular the ventilation pressure (avoid auscultation unless absolutely necessary)