Transcript Aviation medicine aspects of Aero medical Evacuation

Aviation medicine aspects of
Aero Medical Evacuation
Dr. A. Khamaki
Flight Surgeon
The first
Aero Medical Evacuation
During the siege of Paris in 1870 a total of
160 patients were removed by means of
an observational balloon
HISTORY
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The history of aero medical transportation is almost as
long as the history of powered flight itself.
The earliest recorded evacuation of wounded casualties
by aircraft took place during the first world war (1915)
when 12 Serbian patients were carried in French aircraft.
The second world war heralded rapid advancement and
created military casualty evacuation organizations .In the
later years of conflict more tan 90% of allied casualties
were evacuated by air from all theatres.
The potential value of Helicopters in reducing the
mortality rates of battlefield casualties demonstrated in
Korean and Vietnam conflict.
Aero medical transport is a rapidly
developing health care concept
which can decrease disability and
save lives
Golden time
The time saving factor of Aero
medical transport is often the
crucial element in a patient's
progress and recovery.
Aero Medical Evacuation
(AME)
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Many studies have shown that the main cause of
preventable death prior to the hospitalization
was loss of air way.
AME can assist in early resuscitation by:
Rapidly getting the patient to medical help
Rapidly getting good care to patient
Trained personnel should be transported to the
patient, then the patient can be stabilized and
transported back to the hospital.
Specific considerations
There are some specific aspects of
transferring patients by air due to the
effects of altitude and physical
characteristics and limitation of the aircraft
environment as well as psychological
effects of flight.
Problems of altitude
A decrease in air density
 A fall in air pressure
 Low temperature
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Flight stressors
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Hypoxia
Hyperventilation
Barotraumas
Low temperature
Low humidity
G-forces
Vibration
Noise
Fatigue
Motion sickness
Jet lag
D.V.T
Hypoxic hypoxia
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Hypoxic hypoxia occurs when there is a
lack of available oxygen in the atmosphere
The most lethal factor of all physiological
causes of accidents is Hypoxic hypoxia.
Cabin mild hypoxia
Although mild hypoxia, experienced in a
modern airliner is not noticed by the
healthy passengers, the sudden exposure
to mild hypoxia may be the final step over
the threshold into the significant tissue
hypoxia.
Conditions susceptible to
Hypoxia
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Cardiovascular disease
Respiratory disease
Blood disorders
Neurological disorders
Cardiovascular disease
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Congestive heart failure
Recent myocardial infarction
Unstable angina
Significant cardiac arrhythmia
Respiratory disease
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Chronic bronchitis
Emphysema
Bronchioectasis
Blood disorders
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Severe anemia
Hemoglobinopathies
Neurological disorders
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CVA
Arteriosclerosis
Epilepsy
Cerebral tumors
Head injuries
Oxygen therapy
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The problems of hypoxia may be largely
overcome by the use of supplementary
oxygen in flight.
Passengers’ own oxygen cylinders are
generally unacceptable as they may not
comply with safety regulations.
Barotraumas
Pressure changes in gas containing cavities
Body gas-filled cavities
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Semi closed cavities:
Lungs
Middle ear
Para nasal sinuses
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Closed cavities:
Gastro-intestinal tract
Teeth
Conditions susceptible to
Barotraumas
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Otic & sinus barotraumas
Gastro-intestinal disorders
Recent GI surgery
Recent intestinal hemorrhage
Recent laparoscopy
Colostomies
Paralytic ileuses/bowel obstruction
Pneumothorax
Head injuries
Skull fractures
Closed gun-shot wounds
craniotomy
Penetrating eye injuries
Plaster of Paris
Vibration
Vibration can cause a deterioration in the
condition of patients with head or spinal
injuries. Fractures may be more painful
due to movement.
Motion sickness
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Motion sickness is a physiological response to
discordant sensory information.
It is characterized primarily by nausea, vomiting,
pallor and cold sweating.
Preventive procedures:
Prophylactic anti emetics
Placing the patient over the centre of gravity of aircraft
Using nasogastric tube
DVT
(Orthostasis)
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Prolonged immobilization predispose the
patient to deep vein thrombosis.
Prophylaxis with calf movement, TED
stockings or subcutaneous heparin should
be instituted.
Low humidity
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Many aircraft cabins have very low
humidity (often less than 15% relative
humidity).
Care must be taken for:
Eye and mouth
Hydration
Heat conservation
Noise
Although there is no good evidence that
noise directly compromises any patient’s
condition, but hearing protection is
necessary.
Spinal injuries
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Fixed traction
The Soehngen vacuum mattress
A full length sheepskin
Core body temperature monitoring
6-12 L of oxygen by nasal tongs
Betamethasone 4mg. 6hourly
Head injuries
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Ventilator settings before transport
Intubations of the patient
Passing a nasogastric tube
Determining presence of air in the head
Monitoring of BP and PR
A good IV line
A urinary catheter
Monitoring of core body temperature
Orthopedic injuries
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Blood loss »» »» IV fluid administration
Fractures »» »» Immobilization with splints or
vacuum mattress
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Pain »» »»
Administration of small doses of
intravenous narcotics
Serious burns
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Protection of the air way and ventilation
Assessment of the degree of thermal damage
Appropriate intravenous fluid administration
Pain relief by suitable intravenous infusion
Care of the burnt area
Eye injuries
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The eye is sensitive to hypoxia
An eye with a perforating injury is at risk
of extruding the contents if there is a drop
in pressure
Precaution procedures for transport
of
Psychiatric patient
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Well restrained before flight
Trained medical escort
Sedation
Prevention of barotraumas, DVT & nerve palsy.
Contraindications to
air travel
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Infectious disease
Late pregnancy
The moribund
Offensive conditions
General principles of
AME
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Stabilize before take-off
Don’t be rushed by any one
Anticipate and prevent:
Complications
Movement induced changes
Position changes
‫التماس دعا‬