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Aeromedical evacuation

Peter L Jernigan, Matthew C Wallace, Christine S Novak, Travis W Gerlach, Dennis J Hanseman, Timothy A Pritts, Bradley R Davis
BACKGROUND: Critical Care Air Transport Teams (CCATTs) are integral to the U.S. Air Force aeromedical evacuation paradigm. The current study was conducted to evaluate predictors of nontechnical skills (NOTECHS) in CCATT trainees. METHODS: Sixteen CCATTs were studied over a 6-month period. Team members completed a biographical survey and teams were videotaped during a simulated CCATT mission. Teams and individuals were assigned a "red flag score" using a validated assessment tool for NOTECHS...
October 2016: Military Medicine
Thomas Blakeman, Dario Rodriquez, James Woods, Daniel Cox, Joel Elterman, Richard Branson
BACKGROUND: Successful mechanical ventilation requires that the airway be controlled by an endotracheal tube (ETT) with an inflatable cuff to seal the airway. Aeromedical evacuation represents a unique challenge in which to manage ETT cuffs. We evaluated three methods of automatic ETT cuff pressure adjustment during changes in altitude in an altitude chamber. METHODS: Size 7.5 and 8.0 mm ETTs that are currently included in the Critical Care Air Transport Team allowance standard were used for the evaluation...
November 2016: Journal of Trauma and Acute Care Surgery
S A G Roberts, E Toman, A Belli, M J Midwinter
OBJECT: In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. METHODS: The UK military Joint Theatre Trauma Registry (JTTR) was searched for all UK survivors in Afghanistan and Iraq between 2004 and 2014 requiring craniectomy and cranioplasty resulting from trauma...
October 2016: British Journal of Neurosurgery
James A Watts, Frank D Russo, Todd C Villines, Samuel O Jones, Gilberto Patino, Javed M Nasir, Robert E Eckart, Kevin E Steel
During Operation Enduring Freedom, the US military began deploying a dedicated theater cardiology consultant to Afghanistan in an effort to increase rates of return to duty in service members with cardiovascular complaints. This study was designed to categorize these complaints and determine the effect on both aeromedical evacuation and return to duty rates during a 2.5 year observation period. A total of 1,495 service members were evaluated, with 43% presenting due to chest pain followed by arrhythmias/palpitations (24...
April 2016: U.S. Army Medical Department Journal
Femke Streijger, Jae H T Lee, Neda Manouchehri, Angela D Melnyk, Jason Chak, Seth Tigchelaar, Kitty So, Elena B Okon, Shudong Jiang, Rachel Kinsler, Khalid Barazanji, Peter Alec Cripton, Brian K Kwon
In the military environment, injured soldiers undergoing medical evacuation via helicopter or mine resistant ambush protected vehicle (MRAP) are subjected to vibration and shock inherent to the transport vehicle. We conducted the present study to assess the consequences of such vibration on the acutely injured spinal cord. We used a porcine model of spinal cord injury (SCI). After a T10 contusion-compression injury, animals were subjected to i) no vibration (n=7-8), ii) whole body vibration at frequencies and amplitudes simulating helicopter transport (n=8), or iii) whole body vibration simulating ground transportation in an MRAP ambulance (n=7)...
May 23, 2016: Journal of Neurotrauma
William P Butler, Lawrence W Steinkraus, Esther E Burlingame, Brittany L Fouts, Jennifer L Serres
INTRODUCTION: Military aeromedical evacuation, especially that associated with the present Middle East conflict, is seeing increasing research. This ecological study initiates research into the validating flight surgeon by looking at cabin altitude restriction (CAR), arguably the validating flight surgeon's prescription with the highest patient-mission impact, and its association with postflight complications. METHODS: CAR rates from January 2006 through February 2008 were determined from the U...
April 2016: Aerospace Medicine and Human Performance
Anke H Scultetus, Ashraful Haque, Steve J Chun, Brittany Hazzard, Richard T Mahon, Martin J Harssema, Charles R Auker, Paula Moon-Massat, Debra L Malone, Richard M McCarron
BACKGROUND: There is inadequate information on the physiologic effects of aeromedical evacuation on wounded war fighters with traumatic brain injury (TBI). At altitudes of 8,000 ft, the inspired oxygen is lower than standard sea level values. In troops experiencing TBI, this reduced oxygen may worsen or cause secondary brain injury. We tested the hypothesis that the effects of prolonged aeromedical evacuation on critical neurophysiologic parameters (i.e., brain oxygenation [PbtO2]) of swine with a fluid percussion injury/TBI would be detrimental compared with ground (normobaric) transport...
July 2016: Journal of Trauma and Acute Care Surgery
Marco Lucertini, Alberto Autore, Jacopo Covioli, Roberto Biselli, Raffaele D'Amelio
INTRODUCTION: Aeromedical evacuation of patients affected by severe infectious diseases inside an aircraft transit isolator (ATI) system is at potential risk of motion sickness (MS). A test flight was then conducted to quantify this risk during the transfer of an Ebola patient from West Africa to Italy. CASE REPORT: A mannequin was inserted inside an ATI and instrumented to provide acceleration parameters throughout the test flight. The analysis of the data predicted a MS incidence of about 2% for a 6-h flight, so the decision to use anti-MS drugs only in selected cases was taken (i...
January 2016: Aerospace Medicine and Human Performance
David Gaskin, Nicholas A Kroll, Alyson A Ochs, Martin A Schreiber, Prakash K Pandalai
Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, the US military has treated more than 51,000 casualties and sustained more than 6,600 deaths. The past decade of conflict has solidified major advances in the use of blood component therapy and the liberal use of fresh whole blood during damage control resuscitation. This resuscitation strategy, combined with far forward damage control surgery, rapid aeromedical evacuation, and major improvements in critical care air transportation and personal protective equipment has led to a 90% to 92% survival rate in US casualties...
October 2015: AANA Journal
Brittany L Fouts, Jennifer L Serres, Susan F Dukes, Genny M Maupin, Molly E Wade, Daniel M Pohlman
Musculoskeletal injuries (MSIs) are a concern for the military community because of medical expenses, possible disability, and separation from the military. This study investigated the prevalence of MSIs in deployed aeromedical evacuation (AE) populations reported on Post-Deployment Health Assessment (PDHA) forms. A secondary aim was to examine the relationship between the occurrence of self-reported MSIs on PDHAs and a subsequent medical diagnosis. Flight nurses (Air Force Specialty Code [AFSC] 46F) and AE technicians (AETs) (AFSC 4N0 with a flight duty badge) who completed a PDHA during 2008-2010 were investigated...
December 2015: Military Medicine
Jacob W Skovira, Shruti V Kabadi, Junfang Wu, Zaorui Zhao, Joseph DuBose, Robert Rosenthal, Gary Fiskum, Alan I Faden
Aeromedical evacuation, an important component in the care of many patients with traumatic brain injury (TBI), particularly in war zones, exposes them to prolonged periods of hypobaria. The effects of such exposure on pathophysiological changes and outcome after TBI are largely unexplored. The objective of this study was to investigate whether prolonged hypobaria in rats subjected to TBI alters behavioral and histological outcomes. Adult male Sprague-Dawley rats underwent fluid percussion induced injury at 1...
July 15, 2016: Journal of Neurotrauma
Tim Michiel Oosterveer, T Kue Young
BACKGROUND: Despite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC) system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population. OBJECTIVE: The objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT) from the perspectives of users and providers of PHC services...
2015: International Journal of Circumpolar Health
J Bordes, D Loheas, A Benois
INTRODUCTION: The pratice of intensive care in Africa is marked by a wide variety of health care delivery. Only a few centers offer specialized intensive care units, as cardiac or neurological units. That may explain the need for aeromedical evacuations for patients whose condition exceeds local capacity. Our objective was to assess whether the proportion of patients admitted to intensive care and evacuated had increased between 1997 and 2013 in a developing country, Djibouti. MATERIALS AND METHODS: We examined the activity register of Bouffard Hospital intensive care unit in Djibouti to determine the number and characteristics of patients evacuated by air ambulance during a 16 years period...
October 2015: Médecine et Santé Tropicales
Jay Johannigman, Travis Gerlach, Daniel Cox, Jon Juhasz, Tyler Britton, Joel Elterman, Dario Rodriquez, Thomas Blakeman, Richard Branson
BACKGROUND: Hypobaric hypoxemia is a well-known risk of aeromedical evacuation (AE). Validating patients as safe to fly includes assessment of oxygenation status as well as oxygen-carrying capability (hemoglobin). The incidence and severity of hypoxemia during AE of noncritically injured casualties have not been studied. METHODS: Subjects deemed safe to fly by the validating flight surgeon were monitored with pulse oximetry from the flight line until arrival at definitive care...
October 2015: Journal of Trauma and Acute Care Surgery
Masato Homma
After the Great Hanshin-Awaji Earthquake in 1995, the Japanese national disaster medical system (NDMS) was developed. It mainly consists of four components, namely, a disaster base hospital, an emergency medical information system, a disaster medical assistance team (DMAT), and national aeromedical evacuation (AE). The NDMS was tested for the first time in a real disaster situation during the Great East Japan Earthquake in 2011. Two airports and one base were appointed as DMAT gathering places, and approximately 393 DMAT members divided into 78 teams were transported by Japan Air Self-Defense Force (JASDF) aircrafts to two AE staging bases the following day...
June 2015: Yonago Acta Medica
Andrew T Cox, J Lentaigne, S White, D S Burns, I Parsons, M O'Shea, M Stacey, S Sharma, D Wilson
BACKGROUND: Detailed knowledge of the likely volume and nature of the diseases presenting to deployed secondary care facilities aids operational planning. Now the British operation in Afghanistan has ended and a record of the experience is useful to preserve the lessons learned. METHODS: Over a 2-year period from April 2011, prospective demographic and clinical data were collected on consecutive general internal medicine admissions to the Role 3 Hospital in Camp Bastion, Afghanistan...
February 2016: Journal of the Royal Army Medical Corps
Thomas C Blakeman, Dario Rodriquez, Travis W Gerlach, Warren C Dorlac, Jay A Johannigman, Richard D Branson
BACKGROUND: Hypoxemia secondary to reduced barometric pressure is a complication of ascent to altitude. We designed a study to compare the reversal of hypobaric hypoxemia at 14,000 ft with continuous flow oxygen from a cylinder and pulsed dose oxygen from a portable concentrator. METHODS: There were 30 healthy volunteers who were randomized to one of three study groups, placed in an altitude chamber, and ascended to 14,000 ft. There were 10 subjects in each study group...
April 2015: Aerospace Medicine and Human Performance
George W Peck, Sandra M Helgeson, Eric D Powell, Amanda L Roth, Micah Flores, Benjamin C Kirkup
An investigation was conducted to test and certify medicinal maggots to facilitate rapid healing of traumatic and chronic wound infections in Wounded warriors being transported onboard military aircraft. Our specific aims included (1) to test the ability of medical grade larvae to withstand the rigors of U.S. Army aeromedical certification, including tolerance to change in pressure, temperature, and humidity inside ground-based chambers; (2) to evaluate the efficacy of the medical grade larvae during a high-vibration rotary-wing medical transport flight; and (3) to gain U...
May 2015: Military Medicine
Olivier Manen, Caroline Dussault, Fabien Sauvet, Stéphanie Montmerle-Borgdorff
BACKGROUND: Altitude and gravity changes during aeromedical evacuations induce exacerbated cardiovascular responses in unstable patients. Non-invasive cardiac output monitoring is difficult to perform in this environment with limited access to the patient. We evaluated the feasibility and accuracy of stroke volume estimation by finger photoplethysmography (SVp) in hypergravity. METHODS: Finger arterial blood pressure (ABP) waveforms were recorded continuously in ten healthy subjects before, during and after exposure to +Gz accelerations in a human centrifuge...
2015: PloS One
Christopher Taylor
An elderly female cruise ship passenger developed chest pain shortly after an emotionally charged incident involving shipboard authorities. The electrocardiogram and cardiac enzyme profile were indicative of myocardial infarction but the final diagnosis, established after aeromedical evacuation, was stress-related cardiomyopathy. This case is an example of a relatively unknown clinical entity that is easily mistaken for acute myocardial infarction and which may be disproportionately prevalent in the cruise ship passenger population...
2015: International Maritime Health
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