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In Flight Patient Care
Considerations for:
Burns
Neurological
Spinal Cord
Objective
• Apply knowledge of flight physiology and
aviation environmental stressors in the
planning and delivery of pre-flight and inflight care of patients with cardiopulmonary,
gastrointestinal, genitourinary, neurological,
ophthalmologic, otorhinolaryngologic,
orthopedic, and burn injuries and conditions
General Considerations
• Preflight
Mode of transport
Patient Assessment
Supplies
Equipment
General Considerations
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IV flow rates without pump
O2 conversion table – sea level equivalent
Securing patient and equipment
Securing self
Reliance on low tech physical assessment
Hearing protection for patient and ERC
personnel
Burn Injuries
• Preflight Assessment
%TBSA burned, location and source
Status of airway and patency
Vascular access
Fluid requirements
Patency of foley, NG
Vital signs, POX, urine output
Burn Injuries
• Preflight Assessment
Pain medication, sedation
Peripheral pulses
Present wound management
Associated injuries and need for altitude
restriction (CXR)
Secure vascular access, ET tube with
sutures
Burn Injuries
• Preflight Assessment
Assess Hct and transfuse if < 30% prior to
flight
If MD orders topical cream, apply evenly
1/16 to 1/8 inch thick and cover with
absorbent dressing and Kling
Burn Injuries
• Stresses of flight
All stresses of flight will affect the burn
victim
Thermal
Decreased partial pressure of oxygen
Decreased barometric pressure
Decreased humidity
Burn Injuries
• In-flight considerations
Monitor mental status
Administer warmed, humidified oxygen –
exception for face, head, neck burns
Elevate head
Continue with fluid resuscitation- second 24
hours add colloids – 200ml salt poor
albumin/800ml LR at 0.5ml/kg/%TBSA
Burn Injuries
• In-flight considerations
Second 24 hours addition of dextrose to
meet metabolic demands – D51/4 NS
Maintain urine output >50ml/hr(75-100ml
for electrical) monitor for myoglobinuria
NG to gravity or suction -monitor
Hourly evaluation of all peripheral pulses
Burn Injuries
• In-flight considerations
Protect from convection heat losses – shield
from drafts and airflow
Maintain core body temperature 99-100
Dressings should be occlusive, NEVER
change en route
Medicate frequently – use small doses
Morphine 2-4 mg IVP. Avoid Demerol
Neurological Injuries
• Preflight Assessment
Diagnosis, treatment
Airway, Mechanical ventilation settings
LOC, GCS
Pupil assessment
Vital signs
Motor, sensory evaluation
Neurological Injuries
• Preflight Assessment
Diagnosis, treatment
Airway, Mechanical ventilation settings
LOC, GCS
Pupil assessment
Vital signs
Motor, sensory eval
Neurological Injuries
• Preflight Assessment
 Seizure activity, medications
IVF, NG, Foley and patency
Neurological Injuries
• Stresses of flight
Decreased partial pressure of oxygen
Barometric Pressure Changes
Decreased Humidity
G-Forces
Neurological Injuries
• In-flight considerations
Field-level altitude restriction for all
penetrating, PBI induced head injuries
Maintain POX>/=95%, tight ETCO2
control between 25-27(pCO2 30-32)
Administer paralytics, sedation as needed
Avoid succinylcholine use for RSI – IIP
Neurological Injuries
• In-flight Considerations
 IVF in absence of causes of hypovolemia at 80ml
NS/hr – maintain MAP 65-70
 Closely monitor GCS, pupils –for deterioration in
GCS or pupil changes evidencing IIP administer
20% Mannitol 1-1.5 g/kg bolus
 Maintain normothermic – protect from thermal
changes
Neurological Injuries
• In-flight Considerations
Elevate head
NG/OG to gravity/suction
Monitor for seizure activity – administer
Dilantin prophylaxis, Valium for seizures
Hypertension – administer Metoprolol
Hearing protection, eye protection
ACCELERATION/DECELERATION
FORCES
POSITIONING THE LITTER PATIENT
DURING TAKE-OFF/ LANDING
Spinal Cord Injuries
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Preflight Assessment
Diagnosis and treatment
Level of function
Airway secured, mech ventilation settings
Vital signs, POX,
Foley, NG
Medications
Spinal Cord Injuries
• Preflight Assessment
IVF and rate
Spinal cord immobilization – goal to
preserve current level of function. Avoid
logrolling patient
Spring loaded traction
Spinal Cord Injuries
• Stresses of flight
ALL!
Spinal Cord Injuries
• In-flight Consideration
Maintain spinal immobilization
Maintain POX 95% or >, EtCO2 30-40
unless concomitant head injury then 25-27
Altitude restriction if associated head injury
IVF 80ml/hr NS
Monitor vital signs – Neosynephrine for
neurogenic shock? Dopamine?
Spinal Cord Injuries
• In-flight Consideration
Maintain Methylprednisolone drip if in
progress
Protect from hypothermia
Protect from G forces-loss of vasomotor
tone in spinal shock
ACCELERATION/DECELERATION
FORCES
POSITIONING THE LITTER PATIENT
DURING TAKE-OFF/ LANDING
Questions????