Aeromedical Evacuation

Aeromedical Evacuation Management of Acute and Stabilized Patients William W Hurd William Beninati Editors Second Edition 123 Aeromedical Evacuation William W Hurd • William Beninati Editors Aeromedical Evacuation Management of Acute and Stabilized Patients Second Edition Editors William W Hurd, MD, MPH, FACOG, FACS Col, USAF, MC, SFS (ret.) Chief Medical Officer American Society for Reproductive Medicine Professor Emeritus Department of Obstetrics and Gynecology Duke University Medical Center Durham, NC USA William Beninati, MD, FCCM Col, USAF, MC, CFS (ret.) Senior Medical Director lntermountain Life Flight and Virtual Hospital University of Utah School of Medicine Salt Lake City, UT USA Clinical Associate Professor (Affiliated) Stanford University School of Medicine Stanford, CA USA ISBN 978-3-030-15902-3 ISBN 978-3-030-15903-0 https://doi.org/10.1007/978-3-030-15903-0 (eBook) © Springer Nature Switzerland AG 2019 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword Killed in action (KIA), died of wounds (DOW), and case fatality (CF) rates among US service members are at their lowest points in the history of warfare Directly attributable to this striking rise in survivability are numerous factors, which include highly effective body armor, widespread use of Tactical Combat Casualty Care at the point of injury (POI), rapid casualty evacuation/ tactical critical care evacuation from POI to higher levels of medical care, forward resuscitative surgery, a standardized trauma network that is integrated across all theaters of operation, and aeromedical evacuation (AE) bolstered by Critical Care Air Transport Teams (CCATT) Clearly, all of the aforementioned capabilities have saved thousands of lives and mitigated incalculable suffering The en route care system (a series of clinical and mobility processes bridged by a command and control system, along with a network of organizations composed of highly trained, multidisciplinary personnel; machines, technology, and information systems) has been the keystone for the dramatic reduction in the footprint of medical personnel and infrastructure within the theater of operations As a result, logistics support is freed up for other purposes while further advancing the quality of care for our injured and/or ailing service members Moreover, whether supporting combat or humanitarian/disaster relief operations, the en route care system represents a national capability essential to the security of the United States Undoubtedly, America’s national security is based on the appropriate application of the instruments of national power (diplomacy, information, military, and economic) However, without the patriotic, courageous, dedicated, and self-sacrificing men and women serving in our nation’s armed forces, the instruments of national power would be fatally weakened It is, therefore, critical for America’s political and military leaders to heed the advice of Major (Dr.) Jonathan Letterman, Medical Director, Army of the Potomac, whose innovations still form the backbone of the US military’s standardized battlefield trauma system, as well as its en route care casualty evacuation system: “It is the interest of the Government, aside from all the motives of humanity, to bestow the greatest possible care upon its wounded and sick, and to use every means to preserve the health of those who are well, since the greater the labor given to the preservation of health, the greater will be the number for duty, and the more attention bestowed upon the sick and wounded, the more speedily will they perform the duties for which they were employed.” In other words, regardless of the cost, it is incumbent upon the US Government to provide all the resources required to optimize care for its v Foreword vi armed service members, and it is incumbent upon the leadership of the Military Health System to ensure all military medical personnel are resourced, trained, experienced, and always ready to deliver increasingly sophisticated healthcare This must encompass the total spectrum of care required to support the nation’s defenders of freedom, whether it be at home garrison, the battlefield, and all points in-between It is to this end this essential textbook lies Its contents have been updated by a distinguished panel of experts in disciplines who collectively and synergistically compose the US military’s unrivaled en route care system Bart O. Iddins, MD, DVM, SM Maj Gen, USAF, MC, CFS (ret.) Medical Director, Oak Ridge National Laboratory Oak Ridge, TN, USA Preface Aeromedical evacuation (AE), the long-distance air transportation of patients, has advanced dramatically since the first edition of this book was published almost two decades ago At that time, forward-deployed medical units have become lighter and more rapidly deployable, and thus have little patientholding capacity This evolution has made AE an essential element of contingency medical care throughout the world The reach of AE is global, and it spans contingencies from humanitarian operations and disaster relief to support for combat operations and the response to terrorism The second edition of this book is an update that summarizes much of what has been learned about important issues that should be considered in planning and executing long-distance AE We asked our expert authors to concentrate on two primary objectives as they rewrote their chapters The first objective is to describe the problems and limitations of medical care in-flight Ground-based medical teams manage patients before AE and determine the timing of when to request AE.  Their clinical and operational decisions can have a major impact on how their patients will tolerate the stresses and limitations of the AE environment The goal is to increase non-flying clinicians’ appreciation of the medical flight environment so that they can better select and prepare their patients for AE The second objective is to examine the unique challenges that AE presents for patients with specific medical conditions This applies to both elective and urgent AE.  It is especially important for urgent AE, since recently stabilized patients have less physiologic reserve, and are often more sensitive to the stresses of flight To minimize patient risks during flight, we have asked experts in their fields to provide criteria that patients with specific conditions should fulfill prior to AE. These experts have also outlined patient preparation and equipment required for safe air transportation and management of the most likely complications that can occur during flight Years of AE experience transporting stabilized patients who are critically ill or injured has greatly improved our understanding of the stresses of flight and the risks to specific patients during long-distance AE. We hope that the vii Preface viii updated information in this edition will help guide medical planners and serve as a useful reference for the military and civilian clinicians who prepare patients for AE, and especially the medical flight crews who take care of them in the air William W. Hurd, MD, MPH, FACOG, FACS Col, USAF, MC, SFS (ret.) Durham, NC, USA William Beninati, MD, FCCM Col, USAF, MC, CFS (ret.) Salt Lake City, UT, USA Disclaimer The views expressed herein are those of the authors and not necessarily reflect the official policies or positions of any agency of the US Government, including the US Air Force, the US Army, the US Navy, the Department of Defense, the Department of Veterans Affairs, and the Federal Aviation Administration ix Contents Part I The Need Introduction William W Hurd and William Beninati Aeromedical Evacuation: A Historical Perspective Kathleen M Flarity, Tamara A Averett-Brauer, and Jennifer J Hatzfeld Military Casualty Evacuation: MEDEVAC 21 Cord W Cunningham, Donald E Keen, Steven G Schauer, Chetan U Kharod, and Robert A De Lorenzo Civilian Air Medical Transport 41 William Beninati, J D Polk, and William F Fallon Jr Part II The Means Aircraft Considerations for Aeromedical Evacuation 61 John G Jernigan Preparation for Long-Distance Aeromedical Evacuation 77 Warren C Dorlac, Phillip E Mason, and Gina R Dorlac Aeromedical Patient Staging 93 Lisa Diane DeDecker and William W Hurd Military Aeromedical Evacuation Nursing 107 Elizabeth Bridges and Melissa A Buzbee-Stiles Critical Care Air Transport: Patient Flight Physiology and Organizational Considerations 127 William Beninati and Thomas E Grissom Part III The Patients 10 Aeromedical Evacuation of Patients with Abdominal, Genitourinary, and Soft Tissue Injuries 147 Christopher J Pickard-Gabriel, Raymond Fang, and Jeremy W Cannon xi 23 Aeromedical Evacuation of Psychiatric Casualties 401 References Ritchie EC.  Aeromedical evacuation of psychiatric casualties In: Hurd WW, Jernigan JG, editors Aeromedical evacuation New  York, NY: Springer; 2003 Peterson AL, McCarthy KR, Busheme DJ, Campise RL, Baker MT.  The aeromedical evacuation In: Ritchie EC, Bradley JC, Grammer GG, Forsten RD, Cozza SJ, Benedek DM, Schneider BJ, editors Combat and operational mental health San Antonio, TX: The Borden Institute; 2011 p. 191–207 Armed Forces Health Surveillance Center Medical evacuations from Operation Iraqi Freedom/ Operation New Dawn, active and reserve components, U.S.  Armed Forces, 2003–2011 MSMR 2012;19(2):18–21 Armed Forces Health Surveillance Center Medical evacuations from Afghanistan during Operation Enduring Freedom, active and reserve components, U.S. Armed Forces, October 2001 to 31 December 2012 MSMR 2013;20(6):2–8 Williams VF, Stahlman S.  Oh GT.  Medical evacuations, active and reserve components, U.S.  Armed Forces, 2013-2015 MSMR 2017 Feb;24(2):15–21 Lezama NG, Riddles LM, Pollan WA, Profenna LC. Disaster aeromedical evacuation Mil Med 2011 Oct;176(10):1128–32 National Research Council, Division of Behavioral and Social Sciences and Education; Board on Behavioral, Cognitive, and Sensory Sciences, Committee on the Youth Population and Military Recruitment: Physical, Medical, and Mental Health Standards In: Sackett PR, Mavor AS, editors Assessing fitness for military enlistment: physical, medical, and mental health standards Washington, DC: The National Academies Press; 2006 Bollinger MJ, Schmidt S, Pugh JA, Parsons HM, Copeland LA, Pugh MJ.  Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan Popul Health Metrics 2015;13:8 American Psychiatric Association Diagnostic and statistical manual of mental disorders 5th ed Arlington, VA: The American Psychiatric Association; 2013 10 Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations Behav Sci 2017;7(1):7 11 Hoge CW, Toboni HE, Messer SC, Bell N, Amoroso P, Orman DT.  The occupational burden of mental disorders in the U.S military: psychiatric hospitalizations, involuntary separations, and disability Am J Psychiatry 2005;162(3):585–91 12 Peterson AL, Baker MT, McCarthy KR.  Combat stress casualties in Iraq Part 2: Psychiatric screening prior to aeromedical evacuation Perspect Psychiatr Care 2008;44(3):159–68 13 Cohen SP, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels SA.  Diagnoses and factors associated with medical evacuation and return to duty for service 14 15 16 17 18 19 20 21 22 23 24 25 26 members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study Lancet 2010;375(9711):301–9 Rundell JR.  Demographics of and diagnoses in Operation Enduring Freedom and Operation Iraqi Freedom personnel who were psychiatrically evacuated from the theater of operations Gen Hosp Psychiatry 2006;28(4):352–6 Goodman GP, DeZee KJ, Burks R, Waterman BR, Belmont PJ.  Epidemiology of psychiatric disorders sustained by a US Army brigade combat team during the Iraq War Gen Hosp Psychiatry 2011;33(1):51–7 Hauret KG, Taylor BJ, Clemmons NS, Block SR, Jones BH.  Frequency and causes of nonbattle injuries air evacuated from operations Iraqi freedom and enduring freedom, US Army, 2001–2006 Am J Prev Med 2010;38(1):S94–107 Jones N, Fear NT, Wessely S, Thandi G, Greenberg N.  Forward psychiatry–early intervention for mental health problems among UK armed forces in Afghanistan Eur Psychiatry 2017;39:66–72 Stetz MC, McDonald JJ, Lukey BJ, Gifford RK. Psychiatric diagnoses as a cause of medical evacuation Aviat Space Environ Med 2005;76(7):C15–20 Turner MA, Kiernan MD, McKechanie AG, Finch PJ, McManus FB, Neal LA.  Acute military psychiatric casualties from the war in Iraq Br J Psychiatry 2005;186(6):476–9 Schmitz KJ, Schmied EA, Galarneau MR, Edwards NK.  Psychiatric diagnoses and treatment of US military personnel while deployed to Iraq Mil Med 2012;177(4):380–9 Peterson AL, Baker MT, McCarthy KR.  Combat stress casualties in Iraq Part 1: behavioral health consultation at an expeditionary medical group Perspect Psychiatr Care 2008s;44(3):146–58 Wilmoth MC, Linton A, Gromadzki R, Larson MJ, Williams TV, Woodson J. Factors associated with psychiatric evacuation among service members deployed to Operation Enduring Freedom and Operation Iraqi Freedom, January 2004 to September 2010 Mil Med 2015;180(1):53–60 US Department of the Air Force En route care and aeromedical evacuation medical operations Air Force Instruction 48-307, Vol 2017 http://static.e-publishing.af.mil/production/1/af_sg/publication/afi48307v1/afi48-307v1.pdf Accessed 31 Oct 2018 Department of the Air Force Aeromedical evacuation patient considerations and standards of care Washington, DC: US Government Printing Office; 1997 AFI 41–307 Department of Defense Requirements of mental health evaluations of members of the armed forces Washington, DC: US Government Printing Office; 1997 Directive 6490.1 Department of Defense Requirements of mental health evaluations of members of the armed forces Washington, DC: US Government Printing Office; 1997 Instruction 6490.4 Index A Abdominal compartment syndrome, 279 Abdominal injuries intestinal/gastric injuries abdomen with temporary closure, 149 elective AE, 150, 151 hemodynamic instability, 148 hemodynamic stability, 148 minimal conditions, urgent AE, 149 nasogastric/orogastric tube, 149 solid organ injuries blood product resuscitation requirements, 153 damage control resuscitation, 155 elective AE, 155 hemodynamical stable vs unstable, 151 liver/pancreas, 152, 153 nonoperative management, 153 postoperative leakage, 153 post-splenectomy, 153 splenic injuries, 151, 152 tubes, lines/drains management, 161, 162 Abdominal pain, 354, 361 Abdomino-pelvic organs AE considerations, 149 elective AE, 151 Abnormal uterine bleeding, 358 aeromedical evacuation implications, 358 differential diagnosis, 358 endometrial biopsy, 358 in-flight complications, 359 preparations for aeromedical evacuation, 358 treatment, 358 Abruptio placenta, 344 Acidemia, 286 Acute chest syndrome, 377 Acute coronary syndrome (ACS), military nursing, AE, 121 Acute epiglottitis, 372 Acute glaucoma, 227 Acute kidney injury, 314 Acute respiratory distress syndrome (ARDS), 266, 292, 304, 309 Acute respiratory failure, 308, 309 Acute respiratory obstruction, 372 © Springer Nature Switzerland AG 2019 W W Hurd, W Beninati (eds.), Aeromedical Evacuation, https://doi.org/10.1007/978-3-030-15903-0 Acute stress disorder (ASD), 394 Advanced body armor, 148 Advanced cardiac life support (ACLS), 22 Advanced trauma life support (ATLS) guidelines, 378 AE, see Aeromedical evacuation (AE) Aerial port of embarkation (APOE), 96 Aeromedical biological containment system (ABCS), 326, 327 Aeromedical crew configurations, 52 advanced training and expertise, 48 composition of, 47 members, 108 nurse-only crews, 48 nurse-paramedic crews, 48 on-board physician, 48 physician-nurse crews, 47, 48 tertiary-care facility, 47 Aeromedical evacuation (AE) definition of, 302 history, 17, 18 before World War I, between World War I, 6, Korean War, 9, 10 Operation Iraqi Freedom/Enduring Freedom, 14, 15 postwar period and new service, Pre-Vietnam War, 10 TCCET, 17 USTRANSCOM, 16 Vietnam War, 10–12 World War I era, 5, World War II, 7–9 Worldwide Aeromedical Evacuation Network, 12–14 Aeromedical patient staging administrative processing, 93 AE mission launch, 103, 104 AE mission recovery, 104, 105 contingency staging facilities, 94, 95, 103 personnel positioning, 104, 105 disaster staging facility, 96 equipments, 102, 103 fixed staging facilities, 94 government identification, patients, 101 403 404 Aeromedical patient staging (cont.) medical/nonmedical attendants, 102 medical records, 102 mobile staging facility, 95 patient preparation, 101 crutches and canes, 102 valuables, 102 patient’s baggage, 99 patient-staging facility, 93, 94 personnel and duties, 96 anti-hijacking precautions, 98, 99 facility security, 99 flight surgeon, 97, 98 food allergies, 98 hand-carried baggage, 100 logistical support services, 101 medical equipment, 96 MTF administrators, 96, 97 nursing services personnel, 98 nutrition services, 98 patient discomfort, 100 patient hydration, 98 patient regulation, 97 patient-staging command and control, 97 pharmacy personnel, 98 staging mission, 97 transportation, 100, 101 pre- and post-flight medical care, 93 ten-bed patient-staging facility, 95, 96 transportation, 101 Turkish contingency staging facility personnel members, 104 types, 93, 100, 102 Aerotitis media, 376 Air ambulance systems, 42, 44 Airborne infection, 319 Aircraft cabin altitude restriction, 224 Aircraft cabins air, ecology of, 318 Aircraft considerations, AE characteristics, 62 equipment, 74 logistic considerations, 61 aircraft availability, 63 airfield serving patients, 62 distance, patient transport, 62, 63 en route stops, 63 number and complexity of patients, 62 and patient-related factors, 61 runway environment, landing/takeoff, 63 patient-related, 61, 62, 64 cabin area, 65 cabin pressure, 63, 64 electrical aeromedical evacuation equipment, 64 lighting levels, 66 loading litters capacity, 65 noise level during flight, 65, 66 partial pressure of oxygen, 64, 65 pressurization, 63, 64 temperature control, 65 Index Aircraft transport isolator (ATI), 320 Aircrew chemical, biological, radiological and nuclear (CBRN) defense system, 329 Aircrew eye/respiratory protection (AERP) system, 328, 329 Aircrew Training Manual for H-60 utility helicopters, 22 Air distribution systems and airflow, 318, 319 Air embolism, 258 Airline cabin airflow, 319 Airline Deregulation Act (ADA), 42 Air National Guard Critical Care Air Transport Team (CCATT), 143 Airsickness, 313 Air splints, 169 Air transportable isolator (ATI), 325, 326 Airway control, 205 Airway management after maxillofacial trauma lung auscultation, 206 needle cricothyroidotomy, 206 needle cricothyrotomy, 206 orotracheal vs nasotracheal intubation, 205, 206 surgical cricothyrotomy, 206, 207 Airway pressure release ventilation (APRV), 284 Alcoholism, 314, 315 Alcohol withdrawal syndrome, 314 Alternobaric vertigo, 201 Alveolar oxygen (PaO2), 291 American Association for the Surgery of Trauma Splenic Injury Grading Scale, 152 Amitriptyline (Elavil), 397, 398 Anastomosis dehiscence, 260 Anemia, 312, 313, 315 Ankle-brachial index (ABI), 240 Anovulatory bleeding, 358 Anti-hijacking procedures, 98, 99 Anti-seizure medications, 374 ARDS, see Acute respiratory distress syndrome (ARDS) Argyle shunts, 241 Army multi-purpose vehicle (AMPV) ambulance variant, 35 Arterial oxygen saturation, 310 Arterial pressure index (API), 240 Aspirin, 346 Assist/control ventilation, 295 Association of Air Medical Services (AAMS), 42 Asthma acute, treatment of, 371 death rate, 371 implications for aeromedical evacuation, 371 Aviation medicine, 41 Aviation otitis, 376 B Bacterial infection, 384 Barodontalgia, 203 Barotrauma, 262 Basilar skull fractures, 177 Benzodiazapenes, 280, 285 Benztropine (Cogentin), 397, 398 Index Bilateral frontal lobe-delayed traumatic intracerebral hemorrhage, 179 Biologic and chemical casualties, 315, 316 Bipolar mood disorders, 398 Bivalved cast, 169 BK 117 helicopter, 45 Bladder injuries, 155–157 Blunt aortic trauma, 261, 262 Blunt genital trauma, 356 Blunt ocular trauma, 229 hyphema, 230 posterior vitreoretinal segment hemorrhage, 230 Bowel anastomosis, 150 Bowel injuries, 148 Boyle’s law, 128 Brain contusions, 179 cognitive and motor disability, 179 white matter injury, 179 Breast engorgement, 354, 355 Bupropion (Wellbutrin), 397, 398 Burn and inhalational injuries, 204 Burn casualties aeromedical evacuation timing for, 284 burn care systems Army Burn Center, 268 definition, 268 epidemiology, 266, 267 members, 266 prehospital care and transfer, 268 stabilized patient, 268 burn flight team program, 266 burn team equipment requirements, 285 CCATT, 266 chemical burn injury (see Chemical burn injury) common in-flight problems, 285 agitation, 285 hypotension, 285, 286 dermal burns (see Dermal burns) electrical burns, 273 aeromedical evacuation considerations for, 275 high-voltage injury, 274 myoglobinuria, 274 resuscitation, 274 escharotomy, 281 aeromedical evacuation considerations, 282 procedure, 281, 282 final preflight evaluation, 285 infection prophylaxis, 282, 283 mafenide acetate, 283 silver-nylon stretch wrap burn dressings, 283 silver sulfadiazine, 283 topical antimicrobial agents, 282 inhalation burns (see Inhalation burns) pain management, 280 benzodiazapenes, 280 propofol infusion syndrome, 280, 281 preflight treatment and stabilization, fluid resuscitation, 275, 276, 278–280 ventilation considerations, 283, 284 405 C C-21A Learjet, 72, 73 C-9A Nightingale, 73 Carbamazepine, 397 Carboxyhemoglobin, 271 Cardiac trauma, 260, 261 Cardiogenic shock, 312 Cardiopulmonary resuscitation (CPR), 298 Cardiothoracic injuries AE considerations for fluid management, 253 pain control, 253 respiratory hygiene, 253 thromboembolic prophylaxis, 253 air embolism, 258 blunt aortic trauma, 261, 262 cardiac trauma, 260, 261 chest tube, 250 aeromedical evacuation implications, 252 early complications, 251 hemothorax, 250 late complications, 251 local anesthesia, 250 Critical Care Air Transport Team, 250 diaphragmatic rupture, 262, 263 esophageal perforation, 262 flail chest, 258 hemothorax definition, 255 implications for AE, 255, 256 in-flight complications, 256 in-flight emergencies, 260 patient’s condition, factors influencing, 249 pleural effusion, 256 pneumomediastinum, 256, 257 pneumothorax, 253, 254 pulmonary contusion, 259 respiratory insufficiency, 259 sequelae of massive fluid resuscitation, 249 tension pneumothorax needle thoracostomy, 255 symptoms of, 255 tracheobronchial bleeding, 257–260 Casualty evacuation (CASEVAC), 236 description, 24 Casualty management system, 138 C-141B Starlifter, 73 CCATT, see Critical Care Air Transport Team (CCATT) Central diabetes insipidus (DI), 86 Central (trans-tentorial) herniation, 181 Cerebellar pontine angle surgery, 211 Cerebral edema, 375 Cerebral perfusion pressure (CPP), 185, 379 Cervical collar, 190 Cervical loop electrosurgical excision procedure (LEEP), 359 Cervical spine injuries, 87 C-17 Globemaster, 69, 70 Challenger 601-3R, 74–76 Charles’ law, 128 406 Chemical burn injury acid burns, 272 aeromedical evacuation considerations, 273 alkali burns, 272 hydrofluoric acid, 272 initial treatment, 273 sulfur mustard, 273 white phosphorus, 272 Chemical eye injuries, irrigation technique, 225, 226 C-130 Hercules, 66–69 Chest tube, 250, 256 aeromedical evacuation implications, 252 early complications, 251 late complications, 251 local anesthesia, 250 Chlorpromazine (Thorazine), 398 Chronic obstructive pulmonary disease (COPD), 295, 309, 310 Circumferential casts, 169 Civilian AE missions, 74 Challenger 601-3R, 74–76 commercial airline seats, 76 Learjet 35 and 36, 74 Civilian aeromedical crew members, 51 Civilian air medical helicopters, 49 Civilian air medical transport aircraft, and control systems, 41 airway management, 49 applications disaster evacuation, 55 helicopters comparison, 45 wilderness search and rescue, 55, 56 cardiac patients cardiogenic shock, 50 flight echocardiography, 50 MI, 50 post-cardiac arrest, 51 ST-elevation MIs, 50 symptomatic aortic aneurysm, 50 clinical care, 42 convalescent category, trauma, 50 crew training, 41 development of, 41, 42 ground traffic conditions, 43 hemopneumothorax, 52 hemorrhage control, 49 higher level of care, 42 history, 41 indications, 48 of infants and children neonatal transport, 53, 54 pediatric airway, 54, 55 pediatric trauma, 54 premature delivery, 53 sepsis, 54 intracranial hemorrhage, 51, 52 ischemic stroke, 51, 52 lung-protective strategy, 52 medical care, 41 capability, 43 Index military air medical transport, 41 military clinical capabilities, 41 military operations, 41 obstetric transport, 52, 53 patient preparation, 44 pneumothorax, 52 receiving facility, 43 scene stabilization, 49 transport distance, 43 transport equipment, 41 trauma patients, 48–50 weather conditions, 43 Civil Reserve Air Fleet (CRAF), 74 Clonazepam (Klonopin), 397, 398 Clostridial myonecrosis, 173 CMF injuries, 205 Colonic injuries, 149 Colorectal injuries, 160 Combat Application Tourniquet (CAT) Generation 7, 238 Combat deployments, 392 Combat eye injuries, 215 medical care, 216 Combat eye protection and eye injuries, medical care, 216 Combat-related extremity vascular injuries, 242 Combat-related wounds, 169 Combitube, 206 Combitube blind insertion airway device, 206 Commercial airline service, 76 Communicable diseases, 317, 324 Compartment syndrome, 172, 244, 245 prevention, 82 Complete abortion, 340 Compound skull fractures, 176 Compressed skull fractures, 176 Congestive heart failure, 312 Contact lens-associated ulcers, 232 Contagious infections, patients, 317 aircrew chemical/biological protective systems, AERP system, 328, 329 airframe as microbial environment aircraft cabins air, ecology of, 318 air distribution systems and airflow, 318, 319 HEPA filtration, 319 disinfection of aircraft, 321 in-flight preventive measures, 324 ABCS, 326, 327 airflow compartmentalization, 325 air transportable isolator, 325, 326 C-130, 324 CBCS, 327 HEPA filtration, 325 high-containment isolation systems, 325 transportation isolation system, 328 microbial aerosols in aircraft, 320–321 transmitting infections in aircraft, survey of influenza, 322 measles, 322, 323 SARS, 324 smallpox, 323 407 Index tuberculosis, 321, 322 viral hemorrhagic fevers, 323, 324 US Military Policies and biologic warfare casualties history, 329, 330 international legal and regulatory aspects, 331, 332 regulations, 332 USAF Surgeon General, 330 Containerized Biocontainment System (CBCS), 327 Contingency AE, 180 Contingency aeromedical staging facility (CASF), 24 Contingency ASFs (CASFs), 14 Continuous negative-pressure vacuum-assisted therapy, 243 Continuous positive airway pressure (CPAP) modes, 283, 298 Continuous renal replacement therapies (CRRT), 265, 314 Contrecoup injury, 179 Copilot, 45 Corneal abrasions, 231, 232 Corneal ulcers, 231, 232 Coup injury, 179 Cranio-cervical traction, 191, 192 Critical care air transport CCATT (see Critical Care Air Transport Team (CCATT)) survival and recovery, 127 Critical Care Air Transport Team (CCATT) program, 3, 13, 14, 127, 147, 250, 256, 260, 261, 265, 266, 283, 291, 304, 364 airworthiness testing, 140 arterial blood oxygen saturation monitoring, 141 bedside blood testing, 142 biomedical equipment, 140 blood pressure monitoring, 140 ECG monitoring, 141 end-tidal carbon dioxide in exhaled air monitoring, 141 goals of, 139 history, 138 hospital-based practice, 140 infusion therapy, 141 mechanical ventilation, 141 and medical personnel, 175 operational experience, 142, 143 patient monitoring, 140 patient movement items, 139 physiological monitoring, 140 team members, 88, 139, 285 temperature monitoring, 141 transport infusion device, 142 Critical Care Flight Paramedic Training Support Package, 22 Critical coarctation of aorta, 388 Crush syndrome, 173 Crystalloids, 269, 379 Cushing’s triad, 181 Cyanotic congenital heart disease (CHD), 387, 388 D Dalton’s law of partial pressures, 114, 128 Damage control ophthalmology, 220 Decompression sickness (DCS), 202 Decompressive craniectomy, 179, 181 Decubitus ulcer prevention, 194 Deep vein thrombosis (DVT), 173, 353, 360 Deep venous thrombosis prophylaxis, 284 Delayed otic barotrauma, 201 Delayed spinal cord ischemia, 261 Delayed traumatic intracerebral hemorrhage, 179 Delivery of placenta, 347, 349 Delta-P method, 244 Department of Defense Form 1380 (DD1380) Combat Casualty Care Card, 32 Department of Health and Human Services (DHHS), 96 Department of Homeland Security (DHS), 96 Depression, 398 Dermal burns classification, 269, 270 pathophysiology, 268, 269 Diabetes mellitus diabetic ketoacidosis, 374–376 hypoglycemia, 374 Diabetic ketoacidosis (DKA), 374–376 Diaphragmatic hernia, 385 diagnosis, 386 implications for AE, 386 Diaphragmatic rupture, 262, 263 Diazepam (Valium), 397, 398 Diphenhydramine (Benadryl), 377, 397, 398 Disaster evacuation, Civilian air medical transport, 55 Disaster staging facilities, 94, 96 Disinfection of aircraft, 321 Dismounted complex blast injury, 159, 160 antibiotic coverage, 161 bleeding, 161 early sepsis, 161 elective AE, 161 massive transfusion protocol, 161 polytrauma injury complex, 159 traumatic amputations, 160 urgent AE, 161 Disseminated intravascular coagulation (DIC), 384 Dopamine, 315 Doxepin (Sinequan), 397, 398 Duotron transport ventilator, 284 DVT, see Deep vein thrombosis (DVT) Dysrhythmias, 312 E Ear block, 119, 200, 376 nasal balloon inflation device, 200 prevention, 200 treatment, 200, 201 tympanic membrane perforation, 201 Ebola virus disease, 323, 326, 327, 331 Echelons, 236 Eclampsia, 344, 346 408 ECMO, see Extracorporeal membrane oxygenation (ECMO) Ectopic pregnancy, 342 implications for aeromedical evacuation, 342 in-flight emergencies, 342, 343 preparations for aeromedical evacuation, 342 threatened spontaneous abortion, 342 Elective aeromedical evacuation, 260, 263, 302, 303 Electrical burns, 273 aeromedical evacuation considerations for, 275 high-voltage injury, 274 myoglobinuria, 274 resuscitation, 274 Electrolyte management, 84 Embolectomy catheter (Fogerty), 241 Emergency Medical Services (EMS) direction, 23 Emergency Medical Technician-Basic (EMT-Basic), 22 Emergency ocular injury care, 219, 220 Emergency vaginal delivery, 346, 348, 350 Endoscopic sinus surgery, 209, 210 Endotracheal intubation, 257, 259 Endotracheal tubes (ETTs), 297, 306, 380 End-tidal CO2, 380 Enroute Critical Care Nurse (ECCN) program, 23 Environmental stressors, 305 Epidural hematomas computed tomography scanning, 177 mortality, 178 size and mass effect, 178 surgery, 178 Epistaxis, 203, 204 Eschar, 270 Escharotomy, 270, 281, 282 aeromedical evacuation considerations, 282 procedure, 281, 282 Esophageal perforation, 262 Esophageal tracheal double-lumen airway, 206 Eustachian tube dysfunction, 200 Expansile surgical gas, 228 Expeditionary Combat Medic (ECM) program, 23 External ventricular drain (EVD), 380 Extracorporeal cardiopulmonary resuscitation (ECPR), 368 Extracorporeal life support, 368 Extracorporeal membrane oxygenation (ECMO), 299, 301, 309, 312, 368, 369 Extrapyramidal symptoms (EPS), 398 Extremely low birthweight (ELBW) infant, 384 Exudative effusions, 256 Eye shields, 220 F Fasciotomy, 282 Fat embolism syndrome, 166, 172, 173 Federal Aviation Administration (FAA), 56 Federal Emergency Management Agency (FEMA), 96 Fetal demise, 343 Fever, 346 Index Fixed-wing medical transport, 44 Fixed-wing turboprop/jet aircraft, 43, 44, 46, 47 Flail chest, 258 Flight-associated otorhinolaryngology alternobaric vertigo, 201 barodontalgia, 203 DCS, 202 delayed otic barotrauma, 201 ear block, 200, 201 epistaxis, 203, 204 inner ear barotrauma, 201, 202 sinus barotrauma, 202, 203 Flight edema, 166 Flight stresses, 114 Flight surgeons, 97, 98 Flight worthiness testing, 79 Fluid resuscitation, 280 burn size, 275 capillary integrity, 279 early albumin, 279 heart rate and urine output, 275 Joint Theater Trauma System resuscitation guidelines, 279 Joint Trauma System flow sheet, 275, 278 modified Brooke formula, 275–276 over- and under-resuscitation, 279 Parkland formulas, 275 total body surface area, 275–277 urine output, 279 Fluoxetine, 397 Foam-filled cuffs, 208 Foley catheter, 306 Free/pedicled flap, 212 Frontal epidural hematoma, 178 Functional residual lung capacity (FRC), 309 G Gas gangrene, 173 Gastrointestinal (GI) disease, 313 Gastroschisis, 386, 387 Genital trauma, 355, 356 blunt genital trauma, 356 implications for aeromedical evacuation, 356 lacerations, 356 penetrating peritoneal injuries, 356 Genitourinary injuries, 160 bladder, urethral and testicular injuries, 155–157 renal injuries, 155 transport checklist, 157 tubes, lines/drains management, 161, 162 Glasgow Coma scale (GCS) score, 186, 187 Glaucoma, acute, 227 Global Patient Movement Requirements Center (GPMRC), 100 Gravitational force (g-force) effects of, 339 in military aircraft, 116 Gynecological patients abnormal uterine bleeding, 358, 359 409 Index chronic gynecological conditions, implications for AE, 355 contraindications, 340 emergency equipment, 338 genital trauma (see Genital trauma) pelvic infections, 356–358 postoperative, 359 abdominal pain, 361 dehiscence, 361, 362 implications for aeromedical evacuation, 359 incisional bleeding, 361 infection, 361 intra-abdominal hemorrhage, 360 preparations for aeromedical evacuation, 360 pulmonary embolism, 360, 361 H Haloperidol, 397 Head/spine injuries brain contusions, 179 complications pneumocephalus, 179, 180 post-traumatic seizures, 180 epidural hematoma, 177, 178 intracranial space-occupying mass lesions, 177 management and stabilization, 175 seizure prophylaxis with phenytoin/levetiracetam, 180 skull fractures, 176, 177 subarachnoid hemorrhage, 179 subdural hematoma, 178, 179 Helicopter ambulances, 44–46 budgetary restraints, 46 UH/HH-60 Black Hawk helicopter, 37, 38 UH-72 Lakota, 38 Helicopters invention, 22 transport, 43 Hemoglobinuria, 274 Hemorrhage, 345–347, 353, 354 Hemorrhage control hemostatic adjuncts, 239 IED, 237 tourniquets, 238 Hemostasis, 239 Hemothorax, 83, 84, 251, 259 definition, 255 implications for AE, 255, 256 in-flight complications, 256 Henry’s law, 128 High-containment isolation systems, 325 High-efficiency particulate air (HEPA) filtration, 319, 324, 325 High-frequency jet ventilation (HFJV), 298 High-frequency oscillation (HFO), 298 High-frequency percussive ventilation (HFPV), 265, 271, 284, 298 High-frequency ventilation (HFV), 298 High-mobility multipurpose wheeled vehicle (HMMWV), 35 High-voltage injury, 274 Histotoxic hypoxia, 130 Hospital-based helicopter air medical services, 45 Human factors/systems engineering analysis, pain management, 118 Hydrofluoric acid, 272 Hypemic hypoxia, 129 Hyperemesis of pregnancy, 343 Hyperemia, 269 Hyperglycemia, 84, 374 Hyperkalemia, 274, 275, 375 Hyperketonemia, 374 Hypernatremia, 384 Hyperosmotic therapy, 376 Hyperoxia, 294 Hyperphosphatemia, 272 Hyperthermia, 380, 382 Hyphema, 230 Hypoalbuminemia, 384 Hypo- and hyperthermia, prevention, 82 Hypobaric hypoxia, 114, 115 Hypocalcemia, 272, 273 Hypoglycemia, 84, 373, 374, 384, 385 Hyponatremia, 380 Hypoplastic left heart syndrome (HLHS), 388, 389 Hypotension, 285, 286, 373, 378, 379 Hypothermia, 380 Hypovolemia, 286 Hypovolemic shock, 269 Hypoxemia, 305, 373, 378 Hypoxia, 128, 269, 312, 315, 377 types, 128–130 Hypoxic hypoxia, 128, 129 I IHR, see International Health Regulations (IHR) Impact Uni-Vent Eagle Model 731 Positive Pressure Ventilator, 368 Improvised explosive devices (IEDs), 237 Incompetent cervix, 343 Incomplete abortion, 340 Inevitable spontaneous abortion, 340 Infection control, 317, 323–325, 330 Influenza, 322 In-Garrison/fixed staging facility, 94 Inhalation burns AE considerations for, 271, 272 carbon monoxide, 271 diagnosis, 271 smoke inhalation injury, 270 Initial fluid therapy, 375 Injured limb elevation, 167 Inner ear barotrauma, 201, 202 Inspired oxygen partial pressure (PIO2), 305 Insulin therapy, 375 Integral aircraft oxygen systems, 292 Intermittent hemodialysis (IHD), 314 410 Intermountain Life Flight helicopter, 56 International Health Regulations (IHR), 332 Intestinal obstruction, 386 Intimal flaps, 236 Intra-abdominal hemorrhage, 360 Intra-abdominal injury, 378 transport checklist, 154 Intracranial hypertension, 379 Intracranial space-occupying mass lesions, 177 Intraocular gas, 228, 229 Intrathoracic tracheobronchial injuries, 259 Intrauterine fetal demise, 343 Intravenous fluid management, 384 Intraventricular hemorrhage, 384 Isobaric-differential aircraft pressurization, 135 Isolated/combined musculoskeletal trauma, 165 Isolated gastric injuries, 148 iStat® arterial blood gas analyzer, 286 J Javid shunts, 241 Joint Trauma System, 23 K KC-135 Stratotankera, 71, 72 Ketafol, 281 Kidney injuries, 155 L Labor, 346 signs of, 346, 347 stages of, 347 Lacerations, 356 Laryngectomy, 211 Lassa fever, 323, 331 Lateral thoracostomy, 250 Learjet 35, 74 Learjet 36, 74 Life-threatening injuries, 215 Linear skull fractures, 176 Lithium, 397 Liver injuries, 152 Liver laceration, 153 Long-distance AE preparation administrative considerations AE crew, 88 aircraft selection, 88, 89 contingency plans, 89 documentation and imaging, 89 facility selection, 89 in-flight care and outcome, 88 medical transport team approach, 88 patient transportation to and from airfield, 89 and preventive treatment compartment syndrome, 82 gas filled devices, 81 hypo- and hyperthermia, 82 negative pressure wound therapy, 83 Index neuromuscular blockade, 82 non-vented gas, 81 nutrition, 82 pain and discomfort, 81 peripheral pain catheters/nerve blocks, 82 temperature control, 82 tubes, lines and drains, 81 VTE prophylaxis, 81 wound care, 83 automatic non-invasive blood pressure cuffs, 84 bacterial infections, 85 Contingency Aeromedical Staging Facility, 79 critical care patient transport, 77 cross-contamination, 85 extra precautions, 85 gastrointestinal considerations, 84 hemodynamic considerations, 84 hypovolemic casualties, 84 ICP treatment algorithm, 87 infectious disease considerations, 85 in-flight point of care testing, 84 long-range aeromedical transport checklist, 80–81 medical equipment, 79 metabolic considerations electrolyte levels, 84 glycemic control, 84 hyperglycemia and hypoglycemia, 84 neurologic injuries cerebral perfusion pressure, 86 intracranial pressuring monitoring, 86, 87 spinal injuries, 87 traumatic brain injury, 86 physiologic stressors acceleration and deceleration forces, 78 cabin temperature, 78 hypobaric environment at altitude, 78 hypoxia, 78 life-threatening concerns, 79 logistical factors, 78 noise and vibration, 78 oxygenation and ventilation, 79 physiologic stressors, 77 preflight assessment and stabilization, 78, 79 pre-transport checklists, 79 respiratory considerations, 83 pneumothorax and hemothorax, 83, 84 ventilator-dependent patients, 83 secondary infection, 85 therapeutic oxygen, 83 ventilators, 79 Lorazepam (Ativan), 397, 398 Low-dose heparin therapy, 339 Lower extremity injuries, 241 Lung injury, 258 M M113A2/A3 Armored Ambulance, 35, 36 M2A0 Armored Medical Evacuation Vehicle (AMEV), 35, 37 M997 wheeled “Humvee” ambulance, 36 Index Mafenide acetate, 283 Mandible fractures, 211, 212 Mangled Extremity Severity Score (MESS), 243 Massive muscle injury, 274 Mastoidectomy, 210, 211 Maxillofacial trauma, 204 Maxillomandibular fixation, 211, 212 McRobert’s maneuver, 349 Mean arterial pressures (MAPs), 285, 379 Measles, 322, 323 Mechanical stressors, 304 Mechanical ventilation, 304, 305 adjuncts to cabin altitude restriction, 297 extracorporeal membrane oxygen, 299 high-frequency ventilation, 298 inhaled pulmonary vasodilators, 298 noninvasive ventilation, 298 prone positioning, 298 recruitment maneuver, 297 air transportation acute respiratory distress syndrome (ARDS), 292 adverse events, 291 altitude physiology, 289–291 ancillary devices endotracheal tube, 297 humidifiers, 297 vs manual ventilation, 297 gas laws, 290 oxygen delivery system concentrators, 293 cylinders, 293 integral aircraft oxygen systems, 292 portable therapeutic liquid oxygen system, 292, 293 partial pressure and effective oxygen with altitude, 291 transport ventilators, 295 device characteristics, 295, 296 PEEP, 293, 294 pressure- vs volume-controlled ventilation, 294 rate considerations, 295 tidal volume, 293 ventilation mode, 294, 295 ventilator performance, 296 ventilator failure, 296 MEDEVAC, see Medical evacuation (MEDEVAC) Medical capabilities during AE, 175 Medical care, 25 nomenclature, 148 and transportation processes, military and civilian scenarios, 176 Medical care and transportation processes, military and civilian scenarios, 176 Medical care of ocular casualties, 215 Medical casualties acute kidney injury, 314 airsickness, 313 alcoholism, 314, 315 alcohol withdrawal syndrome, 314 anemia, 312, 313 411 barometric pressure, 306 biologic and chemical casualties, 315, 316 cardiovascular conditions cardiogenic shock, 312 congestive heart failure, 312 dysrhythmias, 312 myocardial infarction, 310, 311 pacemakers, 312 unstable angina, 310, 311 decreased pressure, 305 ECMO, indications for, 309 elective aeromedical evacuation, 302, 303 equipment, effects of, 306 gastrointestinal disease, 313 low humidity, 307 MEDEVAC, 302 medical conditions, 303 medical equipment, 308 neurological disorders, 313, 314 oxygen therapy, 305, 306 patients’ conditions, 304 pulmonary conditions acute respiratory failure, 308, 309 chronic obstructive pulmonary disease, 309–310 pneumothorax, 308 renal failure, 314 sepsis, 315 stabilized patients, 304 stressors of flight, 304, 305 temperature changes, 307 transportation, technology required for, 301 medical equipment, 307 monitoring devices, 307 unstable patients, 304 urgent aeromedical evacuation, 303, 304 Medical evacuation (MEDEVAC), 3, 14, 236, 237, 302, 341, 344, 345 ABCDE algorithm, 28 advanced patient monitors, 30 air ambulances, 22 airway and breathing, 29 airway management, 28 analgesia, 30, 31 battlefield and tactical movement of casualties, 21 casualty care, 21 chemical/biologic attacks, 31 circulation, 28 clinical practice guideline adherence, 23 condition decompensation en route, 21 of critically wounded combat casualties, 23 damage control resuscitation, 30 description, 24 drug therapy, 30 en route care, 21, 23–25, 39 ground vehicles and rotary wing aircraft, 36 helicopter ambulances, 37–39 history of, 22 hypothermia and head injury, 28 intravenous fluid resuscitation, 30 limitations, 39, 40 massive hemorrhage, 27 412 Medical evacuation (MEDEVAC) (cont.) medical regulating, 31, 32 military medical providers, 21 military roles of care system assessment and care, 27 MARCH algorithm, 27, 28 precedence, 26 PAWS (Pain medication, Antibiotics, Wound care and Splinting), 28 prehospital care, 21, 29 principles, 24–26 prophylactic antibiotics, 31 pulse and blood pressure, 29 respirations, 28 SMEED (Special Medical Emergency Evacuation Device), 28 Speed and effectiveness of transport, 24 standard US Army precedence categories, 27 tactical evacuation, 21, 27 TCCC training, 27 transportations modes ground vehicles, 35, 37 litter transportation, 35 manual carries, 35 US Army “nine-line” Medical Evacuation Request Form, 27 US Military Roles of Medical Care, 25 Medical regulation, 31, 32 Medical transport modes, comparison, 43 Medical treatment facility (MTF), 215 Meperidine, 377 Metabolic acidosis, 384 Microbial aerosols in aircraft, 320–321 Middle ear barotrauma, 200 Midface trauma, 204 Mild alcohol withdrawal symptoms, 314 Mild anemia, 313 Mild-to-moderate hypoglycemia, 374 Military Airlift Command (MAC) AE system, 12 Military anti-ballistic eye protection, 216 Military anti-shock trousers (MAST), 169 Military medical care, roles, 26 Military nursing, AE AE regulation, 108 ambient aircraft noise, 115 barometric pressure changes, 113, 114 cardiac arrest, 121 crew fatigue, 113 crew safety, 113 diagnostic categories, 108 education and training, 107, 108 environmental awareness, 121 ground-based simulators, 107 ground training, 107 handoffs, 111 humidity, 117 hypobaric hypoxia, 114, 115 launch crew, 110 mission planning, 109 mission preparation requirements, 109 Index pain management and safety, 118 patient movement requests, 107 patient safety, 111 patient transfer checklist, 111 patient transport epidural analgesia, 119 human factors/systems engineering analysis, 118 intravenous/oral analgesics, 119 pain management, 117 pain scores, 118 peripheral nerve block, 119 preflight assessment, 117 preflight preparation, 111 psychological sequelae, 113 SBAR Handoff tool, 112 stresses of flight, 113 thermal stress, 115–117 vibration, 117 Miscarriages, 340 complete abortion, 340 definition, 340 implications for aeromedical evacuation, 340, 341 incomplete abortion, 340 inevitable spontaneous abortion, 340 missed abortion, 340 potential in-flight emergencies, 341, 342 preparations for AE, 341 septic abortion, 340 threatened absortion, 340 Missed abortion, 340 Mobile aeromedical staging facility (MASF), 12 Modified Brooke formula, 275, 276 Motion sickness, 313 Multifocal hemorrhages, 179 Myocardial infarction (MI), 310, 311 Myoglobinuria, 274 N National Defense Authorization Act, 23 Natural disaster relief, 176 Neck dissection, 212 Needle cricothyroidotomy, 206 Needle cricothyrotomy, 206 Needle thoracostomy, 255 Negative-pressure wound dressing, 156 Negative-pressure wound therapy (NPWT), 169, 170 Neonatal Resuscitation Program (NRP), 364 Neonatal transport, 365 advantages of, 364 CHD, 387, 388 critical coarctation of aorta, 388 diaphragmatic hernia, 385 diagnosis, 386 implications for AE, 386 gastroschisis, 386, 387 HLHS, 388, 389 intestinal obstruction, 386 omphalocele, 386, 387 prematurity, 383 Index bacterial infection, 384 conditions and complications, 383, 384 disseminated intravascular coagulation, 384 DuoDERM, 383 hypoglycemia, 384, 385 implications for AE, 385 intravenous fluid management, 384 respiratory distress, 385 preparation for AE data collection, 381 final preparation, 383 psychosocial considerations, 383 respiratory management, 382, 383 thermal management, 382 vascular access, 381 risks aeromedical environment, 369 altitudes, effects of, 370 comprehensive medical care, isolation from, 370 psychological, 369 thermal stress, 369, 370 tertiary care, conditions requiring, 370 asthma, 371 seizure, 373, 374 upper airway obstruction, 372, 373 timing of AE, 381 transport team equipment, 365–367 extracorporeal membrane oxygenation, 368 incubator, 367 supplies, 365 ventilator, 367, 368 Neurological disorders, 313, 314 Neurologic injuries complications, 175 monitoring, 176 planning and preparation, 176 TBI (see Traumatic brain injury (TBI)) Neuromuscular blockade, 82, 280 Next Generation Portable Therapeutic Liquid Oxygen System (NPTLOX), 292 Noninvasive ventilation, 298 Nonsteroidal anti-inflammatory drugs (NSAIDs), 346 Normal blood pressure maintenance, 373 Normal glucose maintenance, 373, 374 Normovolemia, 253 Nortriptyline (Pamelor), 397, 398 Nutritional support for unconscious and semiconscious trauma patients, 82 O Obstetric patients contraindications, 340 emergency equipment, 338 first half of pregnancy, problems ectopic pregnancy, 342, 343 first-trimester bleeding, 340–342 hyperemesis of pregnancy, 343 postpartum patient 413 abdominal pain, 354 breast engorgement, 354, 355 hemorrhage, 353, 354 implications for aeromedical evacuation, 352, 353 infection, 354 postpartum seizure, 354 preparations for aeromedical evacuation, 353 prerequisites for aeromedical evacuation, 353 second half of pregnancy, problems breech presentation, 349 cord prolapse, 351 delivery of placenta, 347, 349 emergency vaginal delivery, 346 fetal demise, 343 fever, 346 hemorrhage, 345, 346 implications for aeromedical evacuation, 344, 345 incompetent cervix, 343 labor, 346 postpartum hemorrhage, 351, 352 pregnancy-induced hypertension, 344 premature labor, 343, 344 premature rupture of membranes, 344 preparations for aeromedical evacuation, 345 seizure, 346 shoulder dystocia, 349, 351 signs of labor, 346, 347 stages of labor, 347 third trimester uterine bleeding (see Third trimester uterine bleeding) uterine inversion, 352 vaginal delivery with vertex presentation, 347 uncomplicated pregnancy, 338, 339 altitude, effects of, 339 gravitational force (g-force),effects of, 339 immobilization, 339 onset of labor during flight, 339, 340 Ocular injuries acute glaucoma, 227 AE precedence, 222 AE regulators, 220, 221 head and neck teams, 221 Ophthalmology Subspecialists and Strategic Regulation, 221, 222 ambulatory ocular casualties, 223 analgesics, 219 antibiotics, 219 antiemetics, 219 army combat optotypes, 218 with bilateral vision impairment, 223 blunt trauma (see Blunt ocular trauma) chemical eye injuries, 225, 226 computerized tomography, 219 contact lens, 218 documentation, 217 evaluation and treatment, 219 eye examination, 216, 217 eye glasses, 218 eye motility, 217 eye shield, 219, 220 414 Ocular injuries (cont.) history, 216 in-flight care, 223 in-flight emergencies, 224 intraocular gas, 228, 229 intraocular pressure, 218 medications and monitoring, 223 open globe injuries, 224, 225 orbital compartment syndrome, 226, 227 outpatient and inpatient care, 223 patient care, 217 physical findings, 224 retinal tear/detachment, 227, 228 tetanus, 219 Ocular irrigation, 225 Ocular trauma, CATS mnemonic, 217, 219 Olanzapine, 397 Oliguria, 162 Omphalocele, 386, 387 Open globe injuries, 224, 225 Operation Enduring Freedom, 142 Operation Iraqi Freedom, 142 Orbital compartment syndrome, 226 AE implications, 226, 227 diagnosis, 226 treatment, 226 Orogastric (OG) tube, 383, 386 Orotracheal vs nasotracheal intubation, 205, 206 Orthopedic and soft tissue injuries, Military nursing, AE, 119 Orthopedic contraindications, elective aeromedical evacuation, 168 Orthopedic injuries administrative preflight checklist, 170 cast/traction devices, 170 clinical preflight checklist, 170 complications, 166, 167 implications, 167 in-flight care capillary perfusion pressure, 172 compartment syndrome, 172 concealed hemorrhage, 171 contraindications to elective aeromedical evacuation, 168 crush syndrome, 173 fat embolism syndrome, 172, 173 gas gangrene, 173 gravitational forces during take-off, 171 jugular venous distension, 173 limb neurovascular status, 171 neurovascular compromise, 171 nursing care, 171 patient monitoring, 171 pulmonary thromboembolism, 173 shock, 171 vascular and neurological complications, 171 vascular repair, 171 neurovascular compromise, 167 neurovascular status, limb, 168 NPWT, 169, 170 Index nursing and transport challenge, 167 pathophysiology fat embolism syndrome, 166 fluid shifts, 166 fracture hematoma, 166 injury-related edema, 166 limb movement, splintage, 166 long-bone manipulation, 166 massive bleeding, 166 movement techniques, 166 pain and deformity, 165 patient monitoring, 166 substantial tissue edema, 166 personal protective equipment, 165 preflight checklists, 170, 171 soft-tissue injuries, 119, 165 standard of care, 167 surgical care, 170 treatment, 167 urgent AE, 168 vital signs, 167 Otitis media, 376 Otorhinolaryngologic procedures, postoperative, 208 Otorhinolaryngologic trauma AE, contraindications, 209 epidemiology, 204 flight medicine and aeromedical evacuation, 199 flight-associated problems (see Flight-associated otorhinolaryngology) midface, 204 physiological challenges, 199 skull base fracture, 205 temporal bone trauma, 205 Otosclerosis, 210 Oxygenation, 373 Oxygen therapy, 305, 306, 310 P Pacemakers, 312 Packed red blood cells (pRBCs), 245 Pancreatic injuries, 152, 153 Papaverine, 241 Parkland formula, 275 Paroxetine, 397 Partial pressure of oxygen in atmosphere (PiO2), 290 Patient flight physiology and stressors, 127 acceleration, 137 aircraft cabin temperature, 135, 136 altitude restriction, 135 barometric pressure on oxygen delivery and gas expansion, 128 cabin humidity, 137 cabin pressurization, 133, 135 duration of exposure, 127 environmental factors, 127 gas expansion, 130–132 hypoxia, 128–130 medical crew, 137 noise, 136 Index patient and AE crew member fatigue, 137 vibration, 136 Pediatric Advanced Life Support (PALS) algorithms, 364 Pediatric transportation otitis media and ear block, 376 pediatric trauma, 377–381 risks aeromedical environment, 369 altitudes, effects of, 370 comprehensive medical care, isolation, 370 psychological, 369 thermal stress, 369, 370 sickle cell disease (see Sickle cell disease) tertiary care, conditions asthma, 371 diabetes mellitus, 374–376 seizure, 373, 374 upper airway obstruction, 372, 373 transport team, 364 composition, 364, 365 ECMO, 368, 369 equipment, 365–367 supplies, 365 training, 365 Pediatric trauma, 377–381 hypotension, 378, 379 intra-abdominal injury, 378 pneumothorax, 378 pulmonary contusion, 378 TBI, 379–381 Pelvic inflammatory disease (PID) diagnosis of, 356 differential diagnosis, 356 implications for aeromedical evacuation, 357 potential in-flight complications, 357, 358 preparations for aeromedical evacuation, 357 symptoms, 356 Pelvic injuries, 159 Pelvic stabilization, 160 Penetrating ocular trauma, 224 Penetrating peritoneal injuries, 356 Peripherally inserted central catheter (PICC), 387 Peripheral vascular casualties advanced body armor, 235 care, role of, 236 injury intervention, point of, 236 level I trauma center, 237 level II/III civilian trauma center, 236, 237 compartment syndrome, 244, 245 diagnosis of angiography, 240 Doppler ultrasound, 240 hard signs, 239, 240 soft signs, 240 hemorrhage, 244 incidence of, 235 limb amputation, scoring systems predictive for, 243 management of, 236 hemorrhage control, 237–239 resuscitation, 239 415 monitoring, 245 resuscitation, 245 surgical treatment of limb salvage/revascularization/primary repair, 242 primary repair and bypass, 242 tissue coverage, 242, 243 vascular shunts (see Vascular shunts) Personal protective equipment (PPE), 327 Physical stressors, 304 Physiologic PEEP, 294 Placenta previa, 344, 345 Pleural effusion, 256 Pneumocephalus, 179, 180 AE implications, 180 in-flight treatment, 180 Pneumomediastinum, 256, 257 Pneumopericardium, 256 Pneumothorax, 52, 83, 84, 119, 250, 253, 254, 260, 306, 308, 310, 378 Portable therapeutic liquid oxygen system (PTLOXS), 65, 292, 293 Positional pressure injuries, 120 Positive end-expiratory pressure (PEEP), 293, 294, 309, 378 Postabdominal surgery, 119, 120 Posterior vitreoretinal segment hemorrhage, 230 Postoperative otorhinolaryngologic patients, 208 Postpartum seizure, 354 Post-traumatic hematomas, 177 Post-traumatic seizure, 381 Post-traumatic stress disorder (PTSD), 392, 394 Predictive Salvage Index (PSI), 243 Preeclampsia, 344, 346, 354 Pregnancy-induced hypertension, 344 Prehospital hypoxia, 86 Premature labor, 343, 344 Premature neonate aeromedical evacuation checklist, 382 Premature rupture of membranes, 344, 345 Pressure-controlled ventilation, 294 Pressure equalization (PE) tubes, 210 Pressure-regulated volume control (PRVC) ventilation, 294 Pressure- vs volume-controlled ventilation, 294 Prolonged Field Care (PFC), 23 Propofol, 286, 380 Propofol infusion syndrome, 189, 280, 281 Pruitt-Inahara shunt, 241 Psychiatric casualties agitation, 398 category 1A severe psychiatric inpatients, 396 category 1B intermediate psychiatric inpatients, 396–397 deployment psychiatry, 392, 394 indications for return to medical facility, 400 medical management of violent/agitated patient, 399 military members and dependents, procedures for, 399, 400 military populations, 392 patient classification codes, 393–394 preparation for AE, 400 416 Psychiatric casualties (cont.) psychiatric diagnoses, 394, 395 psychiatric medications, doses and side effects, 397 psychiatric patient classification for AE, 395 psychiatric patient medications for AE acute management of violent/agitated patients, 398, 399 agitation, 395, 398 bipolar mood disorders, 398 depression, 398 mania and psychosis, 398 restraints, 399 Psychiatric conditions, military nursing, 120 Psychiatric screening, 391 Pulmonary artery catheters, 253 Pulmonary contusion, 259, 378 Pulmonary embolism, 360, 361 Pulmonary hypoplasia, 386 Pulmonary thromboembolism, 173 Q Quaternary blast injuries, 204 R Regional conflicts, 176 Renal failure, 274, 314 Renal injuries, 155 Renal therapy dialysis, 156 Respiratory distress, 385 Respiratory insufficiency, 259 Retinal tear and detachment, 227, 228 Retired Aeromedical Evacuation Aircraft C-9A Nightingale, 73 C-141B Starlifter, 73 CRAF, 74 Retroperitoneal approach, 241 Retropharyngeal abscess (RPA), 372 RG33 Heavily Armored Ground Ambulance (HAGA), 37, 38 RG33L Mine Resistant Ambush Protected (MRAP) wheel vehicles, 37 Rhinoplasty, 209 Risperidone, 397 Rummel tourniquets, 242 S Saline-inflated endotracheal tube cuffs in a laryngeal model, 134 Seizure disorder, 314 Seizures, 346, 354 administer antiseizure medications, 374 etiologies, 373 normal blood pressure maintenance, 373 normal glucose maintenance, 373, 374 oxygenation, 373 treatment, 373 Selective serotonic reupdate inhibitors (SSRIs), 398 Sepsis, 315 Index Septic abortion, 340 Septoplasty, 209 Sequential compression devices (SCDs), 81 Sertraline, 397 Severe acute respiratory syndrome (SARS), 324 Severe hypoglycemia, 374 Shock, 171 Sickle cell disease implications for aeromedical evacuation, 377 sickle cell pain crises, 376, 377 treatment of, 377 Sickle cell pain crisis, 376, 377 Sikorsky S-76A helicopter, 46 Silvadene®, 283 Silverlon®, 273, 283 Silver sulfadiazine, 273, 283 Sinus barotrauma, 202, 203, 210 Sinus tachycardia, 274 Skeletal traction, 87 Skull base fracture, 176, 177, 205 Smallpox, 323 Smoke inhalation injury, 270 Soft tissue injuries AE considerations, 149 elective AE, 151 extremity dressings, 158 negative-pressure wound therapy devices, 158 timing, 158 negative-pressure wound dressing, 158 surgical evaluation, 158 transport checklist, 159 tubes, lines/drains management, 161, 162 urgent AE constriction, dressings, 158 indications, 158 negative-pressure wound dressings, 158 with/without associated amputation, 160 Spinal blood flow, 87 Spinal cord injuries, 190 AE considerations clinical guidelines, 193 cranio-cervical traction, 193 decubitus ulcers, 194 histamine H2 receptor blockers, 194 imaging reports, 192 nasogastric tube, 194 norepinephrine, 194 systolic blood pressure, 193 thoracolumbar-sacral orthosis braces, 193 complete/incomplete, 190 cranio-cervical traction, 192 Gardner-Wells skull tongs, 192, 193 medical therapy, 191 nontraumatic intracranial conditions, 194 prehospital patient movement, 190, 191 primary injury, 190 secondary spinal cord injury, 190 spinal surgery, 191 stroke, 194 blood pressure monitoring, 194 moderate blood pressure reduction, 194