Aeromedical Transport of the Critically Ill

OVERVIEW

  • risk to staff and patient
  • taking patient into an uncontrolled, hostile environment
  • risks of transport has to be weighted up against the benefit offered by facility
  • limited space and personnel
  • risk with mechanics (helicopter blades, airplane rotors)

ISSUES

General

  • must be familiar with: equipment, vehicles, oxygen supply, suction, communication
  • gas law: expansion of air filled spaces with altitude
  • gas law: decreased partial pressure of O2 with altitude
  • some equipment difficult to transport: ECMO, IABP
  • electromagnetic interference between avionics and monitoring (defibrillation, pacemaker malfunction).
  • noise: unable to auscultate

Airway

  • secure endotracheal tube
  • measure and monitor cuff pressure (will expand with altitude)
  • difficult to perform advanced airway procedures in flight -> decision to intubate should be made on the ground.

Breathing

  • decrease in the partial pressure of O2 with altitude (patients on high FiO2 may be compromised)
  • expansion of trapped gas (pneumothorax) -> ICD
  • decompression sickness
  • finite high concentration of oxygen supply

Circulation

  • worsening of air embolism
  • limb swelling beneath plaster
  • take off and landing: haemodynamic instability (long take off and roll out)
  • bleeding or body fluid (burns) must be kept to a minimum otherwise damage to mechanics and electrics may mean craft out of action.

Disability

  • motion sickness (patients and staff).
  • expansion of intracranial air and middle ear.
  • patients can become agitated/anxious.

Exposure

  • risk of hypothermia
  • decompression sickness
  • risk of rapid depressurization
  • decrease partial pressure of water: risk of dehydration through respiratory losses (passive humidification important)
  • ambient noise: auscultation difficult, communication difficult
  • limited space, lighting and facilities for intervention
  • turbulence, vibration
  • danger from loose, mobile equipment

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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