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ONE WHO IN THE BEST CLINICAL JUDGMENT OF THE RESPONSIBLE
PHYSICIAN, CAN WITHSTAND A BED-TO -BED EVACUATION OF UP TO TWENTY
FOUR HOURS DURATION WITH A HIGH PROBABILITY OF NOT INCURRING
COMPLICATIONS REQUIRING INVASIVE TREATMENT OR INTERVENTION  BEYOND
THE SCOPE OF GENERAL NURSING CARE DURING EVACUATION IN ADDITION, SPECIAL CONSIDERATION MUST BE TAKEN TO PROTECT THE PATIENT FROM PHYSIOLOGICAL STRESSES ENCOUNTERED AT ALTITUDE.  THESE INCLUDE DECREASED PARTIAL   PRESSURE OF OXYGEN,   BAROMETRIC PRESSURE 
CHANGES, THERMAL STRESSES, LOW HUMIDITY (2-10%), VIBRATION, G
 FORCES, NOISE AND FATIGUE.  AN  ASSESSMENT OF MORBIDITY/STABILITY 
RISK OF STAYING AT THE PRESENT LOCATION VERSUS THE
MORBIDITY/MORTALITY RESULTING FROM SUBJECTING THE PATIENT TO AN 
 ARDUOUS, CLINICALLY RISKY AND PROLONGED TRIP.  MUST BE CAREFULLY
CONSIDERED.  PRACTITIONERS SHOULD REFER TO THE 1988 NATO WAR 
SURGERY HANDBOOK AND AFP 164-4/TB MED 289/NAVMED P5115 OR 
COMDTINST M6320.20  19 SEP 86 FOR ADDITIONAL INFORMATION ON CARE OF PATIENTS.  FURTHER QUESTIONS OR PROBLEMS SHOULD BE COORDINATED
 WITH FLIGHT SURGEONS IN THE AOR THROUGH THE MASF AND/OR AECC.  A 
BRIEF SYNOPSIS OF PREPARING PATIENTS FOR AEROMEDICAL EVACUATIONS



PAGE    6  RHCUAAA8998  UNCLAS
FOLLOWS.
  B.    AIRWAY MANAGEMENT:    IAW DEPMEDS GUIDELINES, ENDOTHRACHEAL
TUBES WILL BE USED IF THE CASUALTY REQUIRES ASSISTED VENTILATION
FOR RELATIVELY BRIEF PERIODS OF UP TO SEVEN DAYS.  BALLOON CUFFS 
SHOULD FILLED WITH NORMAL SALINE INSTEAD OF  AIR SINCE GAS
 EXPANSION AT ALTITUDE MAY CAUSE TRACHEAL DAMAGE.  ET TUBES, TRACHEOSTOMY OR CRICOTHYROIDOTOMIES SHOULD BE SPECIALLY SECURED FOR TRANSPORT.  NON-VENTILATOR DEPENDENT PATIENTS SHOULD HAVE A "T"-TUBE ATTACHED TO THE ET OR TRACHEOTOMY TUBE DURING EVACUATION   
TO  ENABLE DELIVERY OF HUMIDIFIED AIR AND REDUCE THE LIKELIHOOD OF TENACIOUS MUCOUS PLUGGING.
  C.    TRACHEOTOMY:     IDEALLY TRACHEOTOMY TUBES SHOULD BE CHANGED
PRIOR TO FLIGHT TO THOSE THAT HAVE INNER CLEANING CANNULAS.  
TRACHEOSTOMY STOMAS SHOULD HAVE LARGE, ACCESSIBLE SUTURES ON EACH 
SIDE OF THE TRACHEAL INCISION TO FACILITATE REPLACEMENT IN CASE 
OF DISPLACEMENT.   AEROMEDICAL EVACUATION INFLIGHT KITS WILL 
CONTAIN ONE NUMBER EIGHT TRACHEOSTORMY TUBE FOR EMERGENCY 
REPLACEMENT.
  D.    VENTILATORS:    VENTILATOR DEPENDENT PATIENTS WILL BE ACCOMPANIED BY A MEDICAL ATTENDANT OR RESPIRATORY THERAPIST FROM
BT
#8998

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