This document discusses medical considerations and preparations for transporting trauma patients via airflight. It covers securing the airway, treating breathing issues like pneumothorax, controlling bleeding and maintaining adequate circulation, immobilizing injuries, managing risks from changes in altitude pressure, and providing care for specific conditions like burns, brain injuries, and abdominal issues. Preflight planning is emphasized to stabilize patients and prevent complications during transport.

1. Medical Transport in Trauma
Ekkit Surakarn,M.D
General Surgery
Aviation Medicine
Emergency Department

2. Stabilized patient – Fit to fly
 A - Airway secured
 B - Breathing with O2 +/- support
Pneumothorax drained
 C - Bleeding controlled, Shock treated
 D - Deformity immobilized
 E - Coverage

3. Flight factor
 Change in altitude
 Vibration
 Motion
 Limited resource
 Limited space
BE PREPARED.

4. Flight factor
Change in altitude
 Lower oxygen = Hypoxia
 Gas expansion
 Pneumothorax
 Lung cyst / bleb
 Bowel gas
 Middle ear
 Diving / Decompression sickness

5. Flight factor
 Vibration & Motion
 Team : Vertigo, Motion sickness
 Patient : Pain / Injury
 Equipment : Displaced / Damage
 Limited resource
 Oxygen / Drugs
 Equipment
 Space

6. Teamwork Flight Doctor
Payor or Specialist
Airline
Staff
Flight
Nurse
Patient
and Family

7. Equipment

8. What are possible injury ???

9. Burn – Burn – Burn

10. Monitor and Observation

11. Airway Injury
Risk Prevention
Noise - Unable to check breath sound
ET Tube malposition , Pneumothorax
 Secure airway
Straps + Tape + Marking
 Confirm ET Tube Position
End Tidal CO2 Monitoring
 Pulse Oximeter

12. End tidal CO2

14. Airway Injury
Risk Prevention
Movement and Vibration
 Close observation
 Secure airway
 Recheck – After each movement
 End Tidal CO2 Monitoring
 Pulse Oximeter

15. Cricothyroidotomy

16. C spine immobilization ?

17. C-Spine and ET Tube Fixation

18. Breathing - Chest Injury
 Air Leak – Tension Pneumothorax
 Bleeding – Massive Hemothorax
 Deformity
Flail Chest / Open Chest Wound
 Lung Contusion – ARDS / Pneumonia
 Pain – Limited breathing and Cough

19. Pneumothorax

20. Pneumothorax
Needle thoracostomy
 TENSION to SIMPLE
 Large bore needle
 2nd intercostal space
Midclavicular line
 One-way valve
Under water tube

21. Needle + One-way Valve + Container

22. Breathing - Chest Injury
Preflight Plan - Risk Prevention
 Drainage
 Any pneumothorax … Before
 Monitoring
 Chest symptoms
 Chest movement
 V/S
 SpO2

23. ICD

24. Breathing - Chest Injury
Chest Pain
Limited chest movement
 Breathing – Inadequate >>> Atelectasis
 Cough – Ineffective >>> Secretion
Preflight Plan - Adequate pain control
 Epidural block
 Analgesic

25. One-way valve

26. Breathing - Chest Injury
Hemothorax
Bleeding in pleural cavity
 Chest wall / Lung
 Great vessels / Heart
Preflight Plan – Stable with Patent ICD
 Blood < 100 ml/hr
 IVF / Blood products

27. Breathing - Chest Injury
Chest Surgery
CVT, ICD, Thoracentesis
Preflight Plan
 Fly with ICD - Safe
 Fly without ICD
 No residual air leak – CXR ???
 Low risk of leak in flight : 1-2 Week
 Prepare for E-Decompression

28. Bilateral Pneumothoraces

29. Bilateral Pneumothoraces

30. Hemopneumothorax

31. Bilateral Pneumothoraces

32. Respirator circuit

33. O2 – Ventilator - Suction

34. O2 needed, How much?

35. C - Circulation

36. Circulation
Preflight Plan - Blood
 Secure hemostasis … Before flight
 Bleeding control
 Coag. – FFP/ Cryo / Novo 7
 Keep Hb > 7 – 8.5 gm%
In trauma > 10 gm%
 Occult ongoing blood loss
 Cardio / Respiratory Reserve

37. Circulation
Preflight Plan - Volume
 Euvolemia
 Stable = Controlled hypotension is OK.
 No dehydration
 Urine output 0.5ml/kg/hr
 IVF – Crystalloid, Colloid, Blood
 Secure venous access
 2 good lines – Large / Patenty checked

38. Fit to fly ?
 Liver injury
 Hemopericardium
 Burn at chest wall
 Post cardiac arrest

39. Transfusion Rx

40. Preflight preparation

41. POCT
Point of Care Test
 Blood sugar
 PT & INR

42. PASG
Application
 Standby
 Before move
 Shock > Inflate

43. Urine output

44. Circulation
Preflight Plan - Perfusion
 Inotropes
types – Mixed component
 All
 Vasoconstriction – NO FLOW
 Keep warm
 IVF/Blood Products
 Blankets

45. Circulation
On board
 Check : venous access sites
 Monitor
 P, BP, SpO2
 Conscious
 Cap. Refill – Central / 2 sec
 Urine Output

46. Tubes and Lines

47. Deficit – Brain injury
Check list
 A-B-C
 Initial assessment – AVPU or GCS
 Localizing signs
 Associated injury – Face/Neck
 C-Spine protection
 T-L Spine protection
 Monitoring : BP and Neuro signs

48. Bleeding – Contusion - Swelling

49. Secondary Injury
CPP = MAP – ICP
Intracranial SOL / Swelling
 MAP is normal.
 ICP is high.
 CPP is LOW !!!
Systemic Perfusion – OK.
Brain – Shock ???

50. Save Body & Brain
A–B–C–D
 Airway Control
 Breathing & Oxygenation
 CPP : keep MAP
 Decrease demand
Fever – Fighting – Fit

51. Pneumocephalus – Tension ???

52. Pneumocephalus

53. Requirement : Brain injury
Medical staff - Competency in
 Neuro. assessment + Consultation
 Basic airway technique
 Definite airway procedure
 Ventilation support
 Monitoring
 Spine immobilization

54. Recheck
• Neck Pain
• Motor Power
• Sensory
• Pulse Rate
• Blood Pressure

55. Spinal protection

56. Immobilization

57. Fx : Femur – T Spine – C Spine

58. Deformity – Limb injury
 Immobilization
 Distal perfusion
 Compartment syndrome
 Cast
 Vascular injury
 Reperfusion injury
 DVT

59. Immobilization – Traction Splint

60. Non-constricted immobilizer

61. Compound fracture
Vascular injury and limb ischemia

62. Pelvic fracture with C-Clamp

63. Pelvic fracture with Binder

64. Burn

65. Burn Problems
A – Airway
 Swelling
 Difficult / Obstruction
B – Breathing
 Inhalation Injury & ARDS
 Increase Systemic Injury
 Carbon monoxide + Gaseous toxicity
 Body Eschar – Chest Movement

66. Burn Problems
C – Burn Shock
 20% BSA in Adult
 Less in Child/Elderly
 Systemic Response
 Leak
 Depressed Myocardial Fn.

67. Burn Problems
C – Distal Circulation
 Tissueswelling
 Circumferential Burn
 Compartment Syndrome
 Circum. Dressing

68. Burn or more ???
Associated Injury
 Burn and fall, car accident, ….
 Electrical Injury to …
Muscle, Heart, Neuro - Cord, Lens …..
 Bleeding
 Debridement
 Escharotomy
 Fasciotomy
 Myoglobinuria
 Heat loss – Cold IVF

69. Burn Care – On board
 Airway – Swelling
 ET Tube ? – Do it on the ground
 Breathing – Hypoxia
 Ventilator / O2 in flight
 Circulation
 V/S – Limb swelling : NIBP ?
 Urine output

70. Burn Care – On board
 Distal Limb – Swelling
 Circumferential Wound
 Circum. Dressing
Monitor
 Distal pulse/Cap. Refill – SpO2
 Sensory / Motor
 Bleeding

71. Abdominal Distension

72. Abdominal
Compartment
Syndrome

73. Rectal Tube

74. Decompression Tube