Briefly discuss the problems specific to aeromedical transport of a critically ill patient.
• Transport by any means involves risk to staff and patients
• Need to be familiar with the use of the transport vehicle’s O2, suction, communications,and other equipment systems.
• Reduction in partial pressure of oxygen with altitude, critically ill patients who are already dependent on high FiO2 may be further compromised.
• Expansion of trapped gases – pneumothoraces, intracranial air from injuries
• Expansion of air containing equipment – ET tube, Sengstaken tube. ET cuff pressures will need to be adjusted
• IABP difficult to transport
• Risk of hypothermia
• As water partial pressure falls, risk of dehydration through resp losses and passive humidification important
• Auscultation is difficult.
• The ventilated patient is placed in the Trendelenburg and the reverse Trendelenburg positions during take off and landing respectively. This can impact on perfusion and oxygenation.
• Potential for pacemaker malfunction due to avionic interference.
• Staff doing air transport should refrain from compressed gas diving for at least 24 hrs prior to transfer.
• Physical problems: cold, noise, lighting, access to patient, motion sickness, acceleration injuries (eg head to front of plane to avoid increased ICP on takeoff)
This answer would benefit from a systematic approach:
Limitations of the aircraft
Dangers of altitude: changes in the behaviour of gases
Dangers of altitude: changes in fluid behaviour
Dangers of aircraft operation
Parsons, Chris J., and Walter P. Bobechko. "Aeromedical transport: its hidden problems." Canadian Medical Association Journal 126.3 (1982): 237.
CICM "Minimum Standards for Transport of Critically Ill Patients" (IC-10, 2010)