1. Introduction
Urosepsis is a systemic disease caused by the body’s response to infection, leading to severe sepsis. It is known as the combination of urinary tract infection and sepsis. Urosepsis can be split into complications related to obstructed urinary tract stones, and complicated urinary tract infections. Urosepsis is a condition which is being recognized increasingly by emergency care physicians as a severe systemic infection. Several authors have estimated the incidence of urosepsis in the general population to be 1-2%. Urosepsis and severe sepsis are often used interchangeably, however, the former is a subset of the latter and it is helpful to distinguish between them. Usually, urosepsis is due to acute uncomplicated urinary tract infection or obstruction and is an avoidable condition with significant morbidity and mortality.
1.1. Definition of Urosepsis
Urosepsis is defined as a serious and potentially life-threatening infection of the blood as a complication of a urinary tract infection. In the present era, this could be resulting from anything from simple urological procedures to renal stone disease and obstructing uropathy to the more common culprits of urinary tract infections and acute pyelonephritis. There is a small but significant portion of patients who develop severe sepsis and septicaemia, requiring intensive care admission and advanced organ support with mortality rates ranging from 20-50%. Although many of these patients would be classified as having severe sepsis or septic shock, urosepsis has its own separate entity in the medical community given its high morbidity and mortality rates and specific pathways and aetiologies. This will not be a consideration for aeromedical retrieval in patients with these subsequent complications, but one that would typically involve an urological inpatient requiring transfer for either an ESWL procedure in the case of renal stone disease, or complex clean intermittent self-catheterisation tutorial for a patient with spinal cord injury and neurogenic bladder. These patients could still potentially develop urosepsis and it is fair to say that in our collective experiences, there has often been underestimation and delay in the recognition of these patients developing a systemic infection and consequent septicaemia. This may often result in an emergency call for aeromedical retrieval for acute deterioration when the situation becomes more pressing with the need for various healthcare providers involved in a specific and often urgent patient transfer requiring expert urological management at a tertiary centre.
1.2. Importance of Aeromedical Retrieval
These methods of transport offer better access to tertiary care with minimal delay, especially for areas where the road network is poor. There is also a significant reduction in travel time to better-resourced hospitals, resulting in better outcomes for critically ill patients. This mode of transport is often the only means of retrieval for the remote geographic locations prevalent in Australia. With a land area of 7.7 million square kilometers and a sparse population, there are many areas where it may take hours to days to reach a suitable medical facility by vehicle. In these situations, aeromedical retrieval helps to level the playing field by bringing the advanced medical capabilities available in major urban centers to the patient, thus bridging the geographical disparity in access to healthcare.
Aeromedical retrieval is a specialized form of patient retrieval undertaken by personnel with advanced training in the aviation environment and the clinical management of the patient. Some missions involve repatriating patients who have become ill while traveling abroad. This type of transfer has several potential advantages over ground transfer, especially for critically ill patients, and it generally involves either fixed-wing aircraft or helicopters. Fixed-wing aircraft have a longer range and are more comfortable for patients and crew, especially for adverse weather conditions. Helicopters are ideal for shorter distances and where the site of the patient does not have an airstrip and are often the only means of retrieval for the remote geographic locations prevalent in Australia.
2. Pre-Flight Considerations
2.1. Patient Assessment
2.2. Stabilization of Vital Signs
2.3. Infection Control Measures
3. Evaluation of Urosepsis Patients
3.1. Diagnostic Procedures
3.2. Monitoring and Management of Septic Shock
3.3. Antibiotic Therapy
4. Special Considerations for Aeromedical Transfer
4.1. Selection of Appropriate Transport Mode
4.2. Equipment and Supplies
4.3. Staffing and Training Requirements
5. Communication and Coordination
5.1. Interdisciplinary Collaboration
5.2. Transfer Planning and Logistics
5.3. Handover and Continuity of Care
6. Risk Management and Safety
6.1. Risk Assessment and Mitigation
6.2. Safety Protocols and Procedures
6.3. Emergency Preparedness
7. Ethical and Legal Considerations
7.1. Informed Consent and Patient Autonomy
7.2. Confidentiality and Privacy
7.3. Legal Framework for Aeromedical Transfer
8. Conclusion