The document provides guidelines for the aeromedical evacuation of a patient with 30% partial thickness burns, airway injury, hypotension, and possible smoke inhalation poisoning. The patient was initially stabilized on the ground with oxygen, IV fluids, wound cleaning, and analgesia. Safety checks were conducted before air transport, including securing equipment and monitoring lines. Potential complications during flight like hypothermia, anxiety, and hypovolemia were addressed. Continuous communication between all teams was essential to coordinate a successful transfer to the receiving hospital's emergency department.

1. Aeromedical Evacuation
The burn patient
Final: 12.09.2021

2. Framework
• Clinical problem.
• Management on ground and air.
• En-route complications and management.
• Flowchart.
• Talking points(notes)

3. The clinical problems
• 30% TBSA partial thickness burn.
• Signs of airway injury with oxygen saturation at 88%.
• Hypotension and tachycardia.
• Anxiety and Pain.
• Possible CO, Cyanide poisoning and methemoglobinemia.
The management:
• Remove victim from heat source and bring to the site clinic.
• Start NRB mask oxygen at 12 l/m, if saturation not above 94%, or signs of
inhalation injury, consider intubation.
• Raise leg side by 10 degrees, insert two large iv lines and start Ringer
Lactate as per Parkland formula.

4. The management continued.
• Remove clothing.
• Cool burn areas with towels soaked with cold water within 30
minutes of event time. Clean wounds and apply antibiotics and dry
sheet.
• Consider lorazepam for anxiety and delirium, and narcotic painkillers.
• Cover with blankets and aluminium blanket to prevent hypothermia.
• Insert urinary catheter, to monitor output.
• Insert nasogastric tube to prevent paralytic ileus.
• Do a arterial blood gas analysis.

5. The management continued
• Maintain high index of suspicion of poisoning if there is deterioration
in neurologic and cardiovascular functions.
• Consider normobaric 100% oxygen therapy.
• Consider hydroxocobalamin for cyanide poisoning.
• Consider carrying additional supplies of hydroxocobalamin, sodium
thiosulphate, methylene blue, and traditional antidote kits.

6. Safety considerations
Flight paramedic and nurse checklist before take-off:
• Safe approach to aircraft
• Safe loading and unloading
• Recheck ETT placement and secure it. Cuff inflated using NS.
• Oxygen supply tested for functionality and accessibility.
• Reassess ventilator parameters; Pressure mode cycle preferred.
• Monitors anchored and accessible.
• IV and arterial lines patent and accessible.
• IV bags secured and infusion rates checked.

7. Continued…
• Suction readily available.
• Receiving facility has been notified and has received all pertinent
information.
• Arrangements for ground transport confirmed.
• Give go ahead to flight crew. Maintain communication with receiving
facility

8. Fixed Wing AE; Safety considerations
• Follow pilot and flight crew instructions.
• Never approach the aircraft while the engine is running.
• Patient must be restrained before boarding and remain so during the
flight.
• Medical personnel must remain buckled to seat and inform pilot the
need to move for administering care.
• Be familiar with communication equipment and refrain from use
during taxi, ascent, descent, landing.
• Stow and secure all equipment.

9. Complications and management during AE.
• Hypothermia
Any patient with more than 25% TBSA is prone to hypothermia. The flight crew
should be requested to control ambient temperature. The patient should be
covered with a clean sheet and a wool blanket. Additionally an aluminium rescue
blanket should be used.
• Anxiety and delirium.
All burn patients with signs of anxiety and delirium should be given lorazepam.
Other anxiolytics can also considered.
• Pain
Frequent assessment and use of iv narcotics may be required.
• Hypovolemia
Hemodynamic profile and urinary output should be continuously monitored and
flow rate of iv fluids adjusted. A IABP line placed before flight, can be of help.

10. En-route management continued…
• Maintain high index of suspicion for any poisoning effect still
persisting.
• Any ECG changes, unexplained deterioration in neurologic and
cardiovascular status, ischaemic chest pain, should alert the medic to
use specific antidotes, preferably in combination, based on suspicion
alone.
• A repeat ABG compared to baseline readings pre-flight can be of help.
• Other minor problems can be otic barotrauma, emesis, etc.

11. Continued…
A repeat secondary survey to identify any bleeding due to previous
escharotomy may be needed. This is best managed by oversewing the
bleeding vessels using absorbable suture.
• Difficulty in monitoring due to ambient noise.
End tidal capnography, pulse oximeter, and CVP line should be
monitored at frequent intervals. Consider plethysmography, hand held
spirometer.

12. Communications and co-ordination plan
Site medic(SM) informs field office(FO) and logistics coordinator(LC) of
need for patient transport. Assigns flight medic(FM) and flight
nurse(FN) for transfer.
LC
• completes call sheet with patient information, location and
destination.
• Confirms bed availability at receiving facility. Activates ground
ambulance to airport. Contacts FN with initial information.
• Contacts DIA to activate air ambulance. Discusses special
requirements like altitude restriction, etc

13. Continued…
• Completes electronic flight booking
• Assist FM and FN for preparation and departure.
FM and FN
• Receive call sheet and complete patient assessment at site clinic.
• Receive complete patient information from site medic.
• Completes electronic booking at tertiary centre website.
• Check for patient preparation for transport
• Receive go ahead from LC

14. Continued…
Al Khor Airport Aeromedical Evacuation office
• Retrieves patient information on booking database.
• Reviews urgency rating and activates flight plan and aircraft.
• Confirms with LC regarding ability to complete transfer to DIA and
time of departure.
• Arranges for required flight crew.
• Contacts DIA to activate ground ambulance.

15. Continued…
At site clinic:
FM and FN
Advice HMC emergency department of patient status and tentative
ETA.
At Al khor airport:
Flight crew:
Advice FM, FN, and HMC ED of ETA.

16. Continued…
After arrival at emergency department of HMC
FM and FN
• Completes handover of patient to the doctor in charge.
• Completes transfer documentation.
• Enters details in electronic database.
• Informs LC regarding successful transfer and requests for return
arrangement.

17. References
• Branson, R. D., & Rodriquez, D. (2020). Monitoring During Transport. Respiratory Care, 65(6), 882–893.
https://doi.org/10.4187/respcare.07796
• Emergent Management of Thermal Burns: Practice Essentials, Prehospital Treatment, Initial Emergency
Department Treatment. (2021). https://emedicine.medscape.com/article/769193-overview
• Initial Evaluation and Management of the Burn Patient: Overview, Initial Evaluation and Resuscitation, Evaluation
of the Burn Wound. (2021). https://emedicine.medscape.com/article/435402-overview#a2
• Smoke Inhalation Injury Treatment & Management: Approach Considerations, Prehospital Care, Emergency
Department Care. (n.d.). Retrieved 17 September 2021, from https://emedicine.medscape.com/article/771194-
treatment
• https://nasemso.org/wp-content/uploads/National-Model-EMS-Clinical-Guidelines-2017-PDF-Version-2.2.pdf
• https://wellingtonicu.com/Data/Flight/2017%20Flight%20course%20manual.pdf