Critical Care Air Transport: Patient Flight Physiology and Organizational Considerations

Beninati, William; Grissom, Thomas E.

doi:10.1007/978-3-030-15903-0_9

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…In addition, it must be taken into account that the AE flights were flown as carefully as possible depending on the mission scenario and the condition of the patients (e.g., adjustment of the cruising altitude to increase cabin pressure, avoiding unnecessary sudden flight maneuvers). However, this approach leads to higher fuel consumption decreases their range, and increases the probability of turbulence, which over all may result in stopovers with increase overall travel time (27). It is therefore always necessary to consider whether a possible improvement of the patients' condition through a possibly more careful transport is advantageous given the longer transport time.…”

Section: Discussionmentioning

confidence: 99%

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Changes in vital signs, ventilation mode, and catecholamine use during intensive care aeromedical evacuation flights

Post¹,

Maeckelburg²,

Jagel³

et al. 2023

Front. Public Health

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IntroductionEspecially after (natural) disasters, local health systems are also destroyed or their ability to work is massively restricted. The transport of injured patients is therefore often necessary for further care. Numerous nations keep fixed-wing aircraft with intensive-care capabilities available for secondary transport, but little data on the transport is available to date.MethodsAn analysis of all flights with the German Air Force's intensive care fixed-wing-aircraft carried out in the context of humanitarian aid missions since 2002 with a focus on intubated patients was done.ResultsA total of 38 patients were transported. Two patients had to be intubated on or during transport. There were significant changes in the necessary positive end-expiratory pressure (PEEP) and the fraction of inspired oxygen. Circulatory parameters did not change.DiscussionOverall, there are no clinically relevant deteriorations due to secondary transport with corresponding air transfers. Due to the hypobaric hypoxic conditions on board of all aircrafts, intubation in clinically borderline patients should be performed electively on the ground before flight.

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Section: Discussionmentioning

confidence: 99%

“…It is therefore always necessary to consider whether a possible improvement of the patients' condition through a possibly more careful transport is advantageous given the longer transport time. Furthermore, the resulting (additional) burden on medical and flight personnel must be taken into account (27).…”

Section: Discussionmentioning

confidence: 99%

Changes in vital signs, ventilation mode, and catecholamine use during intensive care aeromedical evacuation flights

Post¹,

Maeckelburg²,

Jagel³

et al. 2023

Front. Public Health

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Pathophysiology of Flight

Ramin¹

2023

In-Flight Medical Emergencies

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Descriptive Analysis of Intratheater Critical Care Air Transport Team Patient Movements During Troop Drawdown: Afghanistan (2017–2019)

Zingg

Elterman²,

Proctor

et al. 2022

Military Medicine

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Background The majority of critical care air transport (CCAT) flights are regulated, meaning that a theater-validating flight surgeon has confirmed that the patient is medically cleared for flight and that evacuation is appropriate. If the conditions on the ground do not allow for this process, the flight is unregulated. Published data are limited regarding CCAT unregulated missions to include the period of troop drawdown at the end of the Afghanistan conflict. The objective of our study was to characterize the unregulated missions within Afghanistan during troop drawdown and compare them to regulated missions during the same timeframe. Study Design We performed a retrospective review of all CCAT medical records of patients transported via CCAT within Afghanistan between January 2017 and December 2019. We abstracted data from the records, including mission characteristics, patient demographics, injury descriptors, preflight military treatment facility procedures, CCAT procedures, in-flight CCAT treatments, in-flight events, and equipment issues. Following descriptive and comparative analysis, a Cochran–Armitage test was performed to evaluate the statistical significance of the trend in categorical data over time. Multivariable regression was used to assess the association between vasopressors and preflight massive transfusions, preflight surgical procedures, injury patterns, and age. Results We reviewed 147 records of patients transported via CCAT: 68 patients were transported in a regulated fashion and 79 on an unregulated flight. The number of patients evacuated increased year-over-year (n = 22 in 2017, n = 57 in 2018, and n = 68 in 2019, P < .001), and the percentage of missions that were unregulated grew geometrically (14%, n = 3 in 2017; 37%, n = 21 in 2018; and 81%, n = 55 in 2019, P < .001). During the time studied, CCAT teams were being used more to decompress forward surgical teams (FST) and, therefore, they were transporting patients just hours following initial damage control surgery in an unregulated fashion. In 2 instances, CCAT decompressed an FST following a mass casualty, during which aeromedical evacuation (AE) crews assisted with patient care. For the regulated missions, the treatments that were statistically more common were intravenous fluids, propofol, norepinephrine, any vasopressors, and bicarbonate. During unregulated missions, the statistically more common treatments were ketamine, fentanyl, and 3% saline. Additional analysis of the mechanically ventilated patient subgroup revealed that vasopressors were used twice as often on regulated (38%) vs. unregulated (13%) flights. Multivariable regression analysis demonstrated that traumatic brain injury (TBI) was the only significant predictor of in-flight vasopressor use (odds ratio = 3.53, confidence interval [1.22, 10.22], P = .02). Conclusion During the troop drawdown in Afghanistan, the number of unregulated missions increased geometrically because the medical footprint was decreasing. During unregulated missions, CCAT providers used ketamine more frequently, consistent with Tactical Combat Casualty Care guidelines. In addition, TBI was the only predictor of vasopressor use and may reflect an attempt to adhere to unmonitored TBI clinical guidelines. Interoperability between CCAT and AE teams is critical to meet mass casualty needs in unregulated mission environments and highlights a need for joint training. It remains imperative to evaluate changes in mission requirements to inform en route combat casualty care training.

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Critical Care Air Transport: Patient Flight Physiology and Organizational Considerations

Cited by 4 publications

References 25 publications

Changes in vital signs, ventilation mode, and catecholamine use during intensive care aeromedical evacuation flights

Changes in vital signs, ventilation mode, and catecholamine use during intensive care aeromedical evacuation flights

Pathophysiology of Flight

Descriptive Analysis of Intratheater Critical Care Air Transport Team Patient Movements During Troop Drawdown: Afghanistan (2017–2019)

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