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Care in the air: Teams deliver patient care in challenging environments

U.S. Air Force Capt. Arik Carlson, 10th Expeditionary Aeromedical Evacuation flight critical care air transport team (CCATT) nurse, explains the role of CCATT to Partnership Flight Symposium participants at Ramstein Air Base, Germany, Jan. 17, 2018. The CCATT’s mission is to operate an intensive care unit in an aircraft during flight. (U.S. Air Force photo by Tech. Sgt. Rachelle Coleman)

U.S. Air Force Capt. Arik Carlson, 10th Expeditionary Aeromedical Evacuation flight critical care air transport team (CCATT) nurse, explains the role of CCATT to Partnership Flight Symposium participants at Ramstein Air Base, Germany, Jan. 17, 2018. The CCATT’s mission is to operate an intensive care unit in an aircraft during flight. (U.S. Air Force photo by Tech. Sgt. Rachelle Coleman)

FALLS CHURCH, Va. -- The back of an aircraft is a challenging place to deliver medical care. For Air Force medical crews, treating patients in the air is just part of the job.

Crews transporting seriously ill or injured patients, called critical care air transport teams, are uniquely qualified and prepared for the challenges flight places on patients. While critical care in the air is different from the traditional hospital setting, CCATS deliver en route care that is just as effective.

“It’s dark in the back of a cargo plane during flight,” said Lt. Col. (Dr.) Daniel Cox, medical director for the Air Force Medical Service En Route Medical Care Division. “It’s noisy, there’s significant vibration, and the temperature can change quickly. Oxygen concentrations and pressure in the air change when you change altitude. That all affects the patient.”

CCATTs account for these environmental factors when monitoring the severity of a patient’s conditions. Often, a minor issue on the ground can quickly become a life-threatening event in the air.

“For example, a patient who has a small amount of air in his chest that causes a collapsed lung is usually not much of a problem in a hospital setting,” said Cox. “But because air expands as you rise in altitude, this can quickly become life-threatening during AE.”

The environment at altitude also affects how medics treat certain health issues. Some medications require different dosages, and some conditions need different treatments during air transport.

“Treating pain on the ground, when patients are usually stationary on a bed, is much simpler than in the air,” said Cox. “On an aircraft, vibration and temperature extremes can increase the dosage required for the patient. Patients may even need more IV fluids because there is lower humidity in the air at altitude.”

There are times where the team’s efforts to control the impact of flight can only go so far and they have to make life-saving decisions with the aircrew.

“Some intensive care patients require a cabin altitude restriction be placed within the aircraft to keep a patient stable in flight,” said Lt. Col. (Dr.) Marie McIntee, Chief of Physical Standards and Development for the Air Force Medical Service. “In those cases, the aircraft may have to adjust its flight plan and fly at a lower altitude.”

Assessing a patient’s medical status becomes more challenging during flight, requiring different assessment methods and tools.

“Medics have to find ways to assess the patient in this environment where you have limitations not encountered on the ground,” said Cox. “If I have an intensive care patient on a ventilator and her oxygen level drops, I can’t assess the patient the way I would in the hospital. I can’t listen to their lungs because the aircraft is too loud, and I am working with a different kind of ventilator. I have to work around the limitations and rely on what is available on the aircraft.”

Constant training and pre-mission planning are critical for CCATTs to maintain mission readiness and to deliver care under difficult and limiting circumstances.

“I give a lot of credit to these teams and what they do,” said McIntee. “It is already a high stress situation when treating a critical patient in a hospital room that is well lit. To be able to deliver that same care in the air is just incredible.”