Table Of ContentAeromedical Evacuation
Springer
New York
Berlin
Heidelberg
Hong Kong
London
Milan
Paris
Tokyo
William W. Hurd, MD, MS, FACOG
Nicholas J.Thompson Professor and Chair,Department of Obstetrics and Gynecology,
Wright State University School of Medicine,Dayton,Ohio;Col,USAFR,MC,FS,
Commander,445th Aeromedical Staging Squadron,Wright-Patterson AFB,Dayton,Ohio
John G. Jernigan, MD
Brig Gen,USAF,CFS (ret),Formerly Commander,Human Systems Center,Brooks AFB,
San Antonio,Texas
Editors
Aeromedical Evacuation
Management of Acute and
Stabilized Patients
Foreword by Paul K. Carlton,Jr.,MD
Lt Gen,USAF,MC,CFS
USAF Surgeon General
With 122 Illustrations
1 3
William W.Hurd,MD,MS John G.Jernigan,MD
Nicholas J.Thompson Professor and Chair Brig Gen,USAF,CFS (ret)
Department of Obstetrics and Gynecology Formerly Commander
Wright State University School of Medicine Human Systems Center
Dayton,OH,USA Brooks AFB
Col,USAFR,MC,FS San Antonio,TX,USA
Commander
445th Aeromedical Staging Squadron
Wright-Patterson AFB
Dayton,OH,USA
Cover illustration:Litter bearers carry a patient up the ramp of a C-9 Nightingale
medical transport aircraft.(US Air Force photo by Staff Sgt.Gary R.Coppage).
(Figure 7.4 in text)
Library of Congress Cataloging-in-Publication Data
Aeromedical evacuation :management of acute and stabilized patients / [edited by]
William W.Hurd,John G.Jernigan.
p.;cm
Includes bibliographical references and index.
ISBN 0-387-98604-9 (h/c :alk.paper)
1. Airplane ambulances. 2. Emergency medical services. I. Hurd,William W.
II. Jernigan,John J.
[DNLM: 1. Air Ambulances. 2. Emergency Medical Services. 3. Rescue
Work.WX 215 A252 2002]
RA996.5 .A325 2002
616.02¢5—dc21
2002021045
ISBN 0-387-98604-9 Printed on acid-free paper.
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Foreword
As Surgeon General of the United States Air Force,it is a real plea-
sure to write this foreword for the first modern textbook describing
the medical aspects of aeromedical evacuation (AE). This textbook
would not only have proven invaluable to me and my colleagues as
we served our nation in Europe and Southeast Asia during the 1980s
and early 1990s, but today it will provide an absolutely invaluable
resource for all medics in the Department of Defense.I would like to
say a special thanks to Bill Hurd, whose idea it was to publish this
textbook and whose persistence was crucial to making it a reality.
As described in chapter 2,AE has always been a vital link in the
chain of medical care provided for all our soldiers, sailors, Marines,
and airmen. Without AE, neither I nor any of my fellow Surgeons
General could guarantee proper “full-spectrum”medical care to our
military men and women around the globe. This is our collective
responsibility, regardless of where in the world disease or injury
occurs.Because of the huge distances involved in moving many of our
patients, AE has always been a challenge, but never more so than
today.
Beginning with Operation Just Cause in Panama (1989),it became
apparent that our troops would, at times, suffer injury in a location
where only minimal stabilizing medical care is available. In such
situations, AE is absolutely critical to assure we can quickly move
patients to state-of-the-art trauma centers,even though such centers
are hundreds or thousands of miles away. During Operation Desert
Shield/Desert Storm (1990 to 1991),the amount of sealift required to
move “mobile hospitals,”together with the time required to set them
up,mandated that the medical services of all military branches find a
new way to deliver medical care to combat troops.
My predecessors and I,together with the Surgeons General of the
Army and Navy, worked throughout the 1990s to streamline our
medical forces.The end result is a truly light,lean,mobile,and capable
array of medical forces that can arrive quickly on-scene for medical
support of virtually any deployment anywhere in the world.However,
such forces are equipped only for stabilization-type procedures and
are far less capable than the old fixed facilities we had deployed in
Europe during the Cold War.We simply must have the capability to
v
vi Foreword
move our casualties out of the theater of operations as quickly as pos-
sible,and AE is the key to making that happen.In fact,today we can
aeromedically evacuate patients who are stabilized but not stable—
providing critical care in the air—greatly enhancing the speed and
capability of our AE service.
Currently, the only people with more than a mere casual under-
standing of the issues involved in moving patients are those USAF
Reserve and Air National Guard forces (mostly nurses and adminis-
trators) assigned to AE units,together with a handful of active-duty
personnel who have served in one or two AE-related assignments
during their careers.This textbook is rich with invaluable information
that captures that experience and supplements Air Force guidelines
and publications on AE.
This textbook will also prove a valuable resource to civilian
physicians as they make decisions regarding the medical factors they
must consider as they move their patients back to or around the
United States.As the world’s economy has become more integrated,
American companies are stationing ever more Americans in foreign
countries where medical care is often far substandard to expectations.
The result is an increasing number of civilian patients who also need
AE back to the United States.Further,even within the United States,
subspeciality centers such as pediatric cardiothoracic surgery and
burn centers often require the movement of patients over thousands
of miles.
I heartily congratulate the editors and chapter authors of Aeromed-
ical Evacuation: Management of Acute and Stabilized Patients. I am
confident it will become a much used resource by the thousands of
physicians,nurses,and technicians charged with the responsibility of
moving patients over long distances using aircraft.These individuals
include members of all branches of the military and the many civil-
ians involved in the commercial AE industry.For them,this book may
be,quite literally,a “lifesaver.”
Paul K.Carlton,Jr.,MD
Lt Gen,USAF,MC,CFS
USAF Surgeon General
Contents
Foreword,by Paul K.Carlton,Jr. . . . . . . . . . . . . . . . . . . . . . . v
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Part 1 The Need
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
William W.Hurd and John G.Jernigan
2 Aeromedical Evacuation:A Historical Perspective . . . . . 6
Kathleen Vanderburg
3 Indications and Considerations for Emergent
Evacuation of the Peacetime Casualty . . . . . . . . . . . . . . . 13
J.D.Polk and William F. Fallon,Jr.
4 Combat and Operational Casualties . . . . . . . . . . . . . . . . 27
Robert A.De Lorenzo
Part 2 The Means
5 Military Casualty Evacuation:MEDEVAC . . . . . . . . . . . 45
Robert A.De Lorenzo
6 Aeromedical Triage Support to Mass-Casualty Events . . 60
Frederick M.Burkle,Jr.,Richard Brennan,and
Victoria Garshnek
7 Patient Staging for Aeromedical Evacuation . . . . . . . . . . 75
William W.Hurd,Anthony M.Rizzo,Eunice K.Taylor,
and John M.McNamara
8 Aircraft Considerations for Aeromedical Evacuation . . . 88
John G.Jernigan
vii
viii Contents
9 Critical-Care Air Transport:Patient Flight Physiology
and Organizational Considerations . . . . . . . . . . . . . . . . . 111
Thomas E.Grissom
10 Nursing Care In-Flight . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Susan B.Connor
11 Aeromedical Evacuation of Patients with
Contagious Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Mark R.Withers,George W.Christopher,
Steven J.Hatfill,and Jose J.Gutierrez-Nunez
12 In-Flight Emergencies:Capabilities and Limitations . . . . 160
R.T.Ross and M.Gage Ochsner,Jr.
Part3 The Patients
13 General Surgical Casualties:Abdominal Wounds,
Urogenital Traumas,and Soft-Tissue Injuries . . . . . . . . . 173
J.D.Polk,Charles J.Yowler,and William F.Fallon,Jr.
14 Air Evacuation of the Neurosurgical Patient . . . . . . . . . . 184
Mick J.Perez-Cruet and Rose Leary
15 Otorhinolaryngology Head and Neck
Surgery Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
David G.Schall and John R. Bennett
16 Ophthalmic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Douglas Joseph Ivan
17 Peripheral Vascular Casualties . . . . . . . . . . . . . . . . . . . . . 225
David L.Dawson
18 Aeromedical Evacuation of Cardiothoracic Casualties . . 241
Kenton E.Stephens,Jr.
19 Patients Requiring Mechanical Ventilation . . . . . . . . . . . 256
Steven L.Chambers and Thomas G.Ferry
20 Orthopedic Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Steven L.Oreck
21 Burn Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
David J.Barillo and James E.Craigie
22 Aeromedical Evacuation of Obstetric and
Gynecological Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
William W.Hurd,Jeffrey M.Rothenberg,and
Robert E.Rogers
Contents ix
23 Medical Casualties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Thomas J.McLaughlin,J. Christopher Farmer,and
Robert A.Klocke
24 Pediatric Casualties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Robert J.Wells,Howard S.Heiman,and
William W.Hurd
25 Aeromedical Evacuation of Psychiatric Casualties . . . . . 350
Elspeth Cameron Ritchie
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Contributors
David J.Barillo,MD,FACS Frederick M.Burkle,Jr.,MD,MPH,FAAP,
Chief,Division of Plastic Surgery FACEP
Director,Adult Burn Center Senior Scholar,Scientist,and Visiting
Medical University of Professor
South Carolina The Center for International Emergency,
Charleston,SC,USA Disaster and Refugee Studies
LTC,MC,USAR Departments of International Health and
Formerly Chief,Clinical Emergency Medicine
Division Schools of Public Health and Medicine
US Army Burn Center The Johns Hopkins University Medical
U.S.Army Institute of Surgical Institutions
Research Baltimore,MD,USA
Fort Sam Houston,TX,USA Senior Medical and Public Health Advisor
Defense Threat Reduction Agency
Ft.Belvior,VA,USA
CAPT,MC,USNR
John R.Bennett,MD
Maj,USAF,MC Paul K.Carlton,Jr.,MD
Department of Otolaryngology-Head and Lt Gen,USAF,MC,CFS
Neck Surgery USAF Surgeon General
RAF Lakenheath Hospital Bolling AFB,MD,USA
Lakenheath,Suffolk,UK
Steven L.Chambers,MD
Col,USAF,MC
Chief,Department of Medicine
Richard Brennan,MBBS,MPH,
Director,Medical Intensive Care Unit
FACEM
Wright-Patterson USAF Medical Center
Director,Health Unit
Wright-Patterson AFB,Dayton,OH,USA
International Rescue Committee
New York,NY,USA
Assistant Clinical Professor,Division of George W.Christopher,MD
Emergency Medicine LtCol,USAF,MC
John A.Burns School of Medicine Chief,Infectious Diseases Service
University of Hawaii,Honolulu Landstuhl Regional Medical Center
Honolulu,HI,USA Landstuhl-Kirchberg,Germany
xi
