Aeromedical Transport

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What is aeromedical transport?

Aeromedical transport was born out of the need to move wounded service members during World War I. Injured soldiers could be transported to more definitive care in a shorter time, increasing survivability. Throughout the 20th and 21st centuries, the US Military advanced the field of aeromedical transport and battlefield evacuation to include point of injury care with rotor-wing aircraft and transfer to major theater hospitals with fixed-wing aircraft. During the Vietnam war, helicopters were used extensively to pick up wounded soldiers and transport them back to high levels of care, which greatly improved their chances of survival. The idea of flight to rapidly move patients to specialty care was not a strictly American idea; programs were developed in places like Australia, Canada, and Germany. The United States opened its first civilian hospital-based helicopter program in 1972 at St. Anthony’s Hospital in Denver, CO; this program remains open to this day. Since that time, hundreds of rotor-wing patient transport programs have opened in the United States and abroad.

One should not forget that fixed-wing aircraft are also used to move patients. Although less likely to be used for point of injury transport, airplanes have a much longer range, can fly at higher altitudes, and can fly much faster than rotor-wing aircraft. The military model for patient transport illustrates this well when one compares the UH60 “Blackhawk” to the C-130 “Hercules.” The Blackhawk can only transport a handful of injured patients a short distance, but they can be picked up on the battlefield and brought to Combat Surgical Hospital for initial stabilization. Those patients can then be grouped with other injured patients and placed on a waiting Hercules aircraft that can hold 70+ patients depending on configuration and transport them several hours by air to more definitive medical care at a large theater hospital.

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Who should be considered for transport by air?

Air transport has some unique challenges that come with it. There are not a lot of hard exclusions for transport, but care should be taken in selecting the mode of transport. To start, it should be noted that violent and overtly aggressive or suicidal patients should not be transported by air without chemical or physical restraints. Also, patients who have been exposed to hazardous materials should not be flown without proper decontamination. Beyond these situations, most patients will qualify for transport by flight. The limiting factor for transport usually rests more with the crew abilities, weight and balance, and en-route weather. Ultimately, the clinician that is making the call for transport should weigh the risk and benefits of air versus ground transport. Time, distance, weather, patient condition, and possible complications should all be part of the equation when deciding on the transport method. For example, a patient who is involved in a high-speed motor vehicle collision on a highway and has a significant traumatic injury to the abdomen may only be 10 minutes from the nearest trauma center, but because of traffic caused by the accident, ground transport will take 45 minutes while air transport will only take 15 minutes. Transport by air, in this case, will save critical time as long as weather permits flight. Another example to consider is an American that gets ill or injured while in another country and needs to be transported back to the United States for more definitive care. Fixed-wing air transport is the most likely resource to transport this patient unless they are close to a US border in either Mexico or Canada.