Selection of Patients for Air travel

FLTLT Dave Dunn, Royal Australian Air Force

• Characteristics of aircraft• Discuss the classification & types of

Aero Medical Evacuation (AME)• Define patient classification• Discuss the advantages/disadvantages

of AME

Objectives

Aero Medical Evacuation (AME) definition:

The movement of patients to and between medical treatment facilities using air transportation

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Aircraft characteristics

Rotary or Fixed Wing

Pressurised or Non-Pressurised

Rotary wingSeats Litter

Nuri 12 4IROQUOIS UH-IH 7 6/2BLACKHAWK 10 6/2SEAKING 21 9CHINOOK -CH47 32 24MRH 90 12 6

Fixed wing

Seats Litter

CARIBOU 31 20C130 H 92 74C17 130 9Lear jet 4 1

Military casualty priority system

PRIORITY ONE• Immediate threat to life. Rapid

evacuation, urgent resuscitation and/or surgery are required (within 1 hr) penetrating ocular, severe head inj, airway probs, MI, open chest,

PRIORITY TWO

• Casualties whose life or limb is in serious jeopardy. Early surgery or resuscitation is required. Some delay acceptable.(within 2-6 hrs) visceral injuries, open #, limb threatened- <cap refill

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PRIORITY THREE

• Neither life or limb in jeopardy. Rx is required, evacuation should be as soon as possible(up to 24hr) pneumonia, closed #

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Opportunity AME

• AME using service transport aircraft where tasking is not specific for the AME – thumb lift

Types of AME

Special AME

• The aircraft is specifically tasked for that AME – no other cargo - a civilian Lear jet, air ambulance, SAR chopper

Types of AME

Scheduled AME

• Where the demand for AME is such that a regular service is required e.g. weekly AME flights from Timor / Butterworth / Vietnam to Australia. Iraq, Afghanistan

Types of AME

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• Quick• Efficient on manpower• Improve morale• Reduces morbidity and mortality• Increases choice of medical facility• Less need to relocate medical facilities

Advantages of AME

• Competing need for aircraft• Possible curfew on hours of operation• Route restrictions (foreign air space)• Expensive• Air superiority – got to have it• Ground defence (Surface to Air Missils)• Weather

Disadvantages of AME Fixed wing aircraft advantages

• Fly higher, faster and farther • Shorter en route time and more on board

facilities• Able to provide more comprehensive in-

flight medical care• Can transport more casualties• More comfortable and stable flight for

casualty and attendants – sea level pressure capability

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Rotary Wing Advantages

• Tactical, can be used well forward• Can retrieve casualties from most areas• Quicker turn - around time • Quicker on and off loading of casualties• Can fly at low levels• No landing strip required

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Class 1 Psychiatric

Class 2 Litter

Class 3 Sitting

Class 4 Passenger

Military AME patient classification

CLASS 1A Severely disturbed psychiatric patients, require restraint, sedation, constant supervision

CLASS 1B No restraint, may react badly to flight, restraint available

CLASS 1C Co-operative psychiatricpatients, no litter required

Class 1 Psych CLASS 2A Unable to assist themselvesunder any circumstances e.g.unconscious / intubated patient

CLASS 2B Able to assist themselves inemergency to egress aircrafte.g. fractured ankle

CLASS 2C Patients whose medicalcondition would benefit fromcarriage on a litter e.g. backpain

Class 2 Litter

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Class 3A May need assistance inan emergency e.g.Handicapped / child

Class 3B May need assistance ormedication during flighte.g. Diabetic, Asthmatic

Class 3 Sitting

Class 4 = Passenger

Physically able to travel unattended e.g. going to specialist appointment, accompanying casualty

• Patients in infectious stages of serious disease

• Patients whose condition is so poor - unlikely to survive flight

• Pregnant persons beyond 34 weeks• Patients involved in diving operations in last

48 hours or suffering from decompression sickness - can with sea level cabin

Patients not normally AME’d

• Characteristics of aircraft• Discuss the classification & types of

AME• Define patient classification• Discuss the advantages/disadvantages

of AME

ObjectivesQuestions?