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the patient movement should be coordinated by a team leader, similar to the coordinated effort required to move a patient with a potential cervical spine injury Precautions, such as planned, temporary disconnection of the ventilator from the endotracheal tube, may need to be considered during these moves Finally, the patient must be carefully reassessed immediately after each movement The team must be assured that the airway is stable, immobilization is secure (if appropriate), and potentially lifesaving tubes, lines, and medications have not become dislodged or disrupted Monitoring is imperative during the transport process Observation and palpation may be hindered by patient position relative to the provider within the vehicle This may be especially evident in a transport helicopter Auscultation may also be impaired in a noisy transport environment The air transport environment may be 50% louder than a comparable ground transport Therefore, more reliance is placed on sophisticated monitoring tools, including cardiorespiratory parameters, pulse oximetry, capnography, gas delivery monitors with audible and visual alarms, ultrasound, and point-of-care laboratory testing ALTITUDE PHYSIOLOGY AND THE AIR MEDICAL ENVIRONMENT When pediatric patients are transported by helicopter or FW aircraft, one must be cognizant of issues regarding altitude physiology An increase in altitude brings with it a decrease in ambient oxygen as well as the potential for an increase in the size of air spaces For most patients, however, these are not major issues For patients with severe hypoxia at sea level, diving injuries, or large, enclosed pockets of air, air transport can be dangerous Two gas laws are important in the transport process Boyle Law states that with a constant temperature, the volume of a gas varies inversely with the pressure (P1 V1 = P2 V2 ) ( Fig 11.10 ) As altitude increases, barometric pressure decreases; therefore, the volume of the gas increases Dalton Law (the law of partial pressure) says that the partial pressure of a gas mixture is the sum of all the partial pressures of the gas within the mixture (PT = P1 + P2 + P3 …) ( Fig 11.11 ) For example, the total pressure of air is The partial pressure of nitrogen is 0.78, oxygen is 0.21, and other gases is 0.01 The partial pressure of oxygen will always be 21% At higher altitudes, air becomes less dense and the partial pressure of oxygen, while still 21%, offers diminished oxygen availability