Aeromedical evacuation in Israel--a study of 884 cases.

We analyzed 884 moderately severe and severe casualties evacuated by the aeromedical evacuation unit of the Israel Air Force. Of these, 452 were evacuated during the "Yom Kippur" War in 1973, and 432 during 1974-76. The aeromedical teams performed 24 rescusitations and 13 emergency operations, and provided primary medical care for 37 cases; 95% of the casualties reached the next stage of evacuation without deterioration in their medical condition. These data support our concept that the participation of a flight surgeon in aeromedical evacuation is highly valuable. The advantages of small helicopters for aeromedical evacuation purposes are outlined. The suitability of the aeromedical evacuation system in Israel for wartime as well as for peacetime is pointed out.     

The role of the flight surgeon in Greece

From 1915 [corrected], the first time a flight surgeon participated in an aeromedical evacuation, to the present, the role has become more fundamental by working in wars and operations, experiencing search and rescue aeromedical evacuations from mass accidents or motor accidents, treating seriously ill individuals, and caring for wounded victims of attacks either at the scene or at the hospital. The improvements in cognitive and technological standards of medical science and in the education available have contributed in upgrading the role of flight surgeons; however, their presence in flight is considered essential in 20-60% of aeromedical evacuations, with the remainder of the flights being covered by paramedical personnel. In the Greek territory, the development of Air Force medicine began with the U.S. education of Panagiotis Korombilis, founder of the Center for Flight Crew Health Examination in 1936. In 1976, the Air Force Medical Center was established in the General Air Force Hospital while the educational and medical work of Air Force physicians led to the development of Air Force Medicine and supported Olympic Airways and Military Air Force development, which provides aircraft and personnel for patient aeromedical evacuations. An organized aeromedical evacuation system based on the National Health System, however, began operating in 1982 and was upgraded in 1994. Currently, the flight surgeon's work remains important in supporting the Military Air Force by offering regular examinations at the Air Force Medical Center for all personnel flying on civil and military aircrafts, and by educating all the Greek territory and Cypriot Air Force surgeons (of the National Emergency Assistance Center and the Military Services) at the Air Force Medical Center. Their presence at Air Force bases is important, as is their support of the overall well-being of flight personnel, their assistance in upholding the territory's future by improving aircraft and equipment and by purchasing search-rescue aeromedical evacuation helicopters and hospital aeromedical transportation aircraft capable of transporting seriously ill patients, their promotion of collaboration with other countries in educating Air Force surgeons, and in support of valuable human life according to the Hippocratic Oath.     

美国空军的医疗保障体系

借鉴与学习美国空军医疗保障体系与先进理念,以及稳定航空军医队伍的有效手段.主要引用美国空军两个网络资料,文献4篇,军标1个.这些资料表明,美国空军高层已形成共识——良好的医疗服务是飞行安全与战斗力的重要保障.因此,每年预算庞大的经费,以维持75个医疗中心、医院、诊所或医疗站的专一而高效地运转.而军事人员通用医疗保险制度(TRICARE)使三军人员就近就诊,大幅节省费用.全球搜救、空运医疗服务系统和分级健康维护与治疗,构成完备的医疗保障体系.航空军医则是保障空军全体官兵健康的重要前哨,通过分级培训与较高待遇,使航空军医在专业与生活水平两方面均能不断提升,有效地稳定了这支队伍.美国TRICARE制度可以借鉴,稳定航空军医队伍的手段值得学习.     

Aeromedical evacuation: remembering the past, bridging to the future

Operations Desert Shield/Desert Storm saw the largest mobilization of aeromedical evacuation (AE) assets since the Vietnam War. Ultimately, more than 1,950 AE personnel were deployed to support the medical airlift of personnel. With aircrews based at 17 locations in the region, at its peak the system could move up to 3,600 intratheater and 2,500 intertheater casualties per day. Fortunately, the demand for AE fell far short of predictions. During the period from August 12, 1990, to March 31, 1991, more than 12,500 patients were successfully airlifted using converted cargo aircraft, a concept originally validated in World War II. The authors describe the Operations Desert Shield/Desert Storm AE system and identify the efforts underway to construct a new aeromedical evacuation system capable of meeting the needs of the battlefield of the 21st century.     

Bosnia and Kosovo: aeromedical evacuation in the initial stages of deployment

METHOD: A comparative analysis of aeromedical evacuation (AE) from operations in Bosnia-Herzegovina and Kosovo during the first months of deployment was performed in order to determine how medical assets were utilized and to explore the potential for multi-national cooperation. METHODS: Retrospective analysis of casualties evacuated and aircraft utilization during the first 4 mo of both operations and the first year of deployment to Operation Joint Endeavor (Bosnia-Herzegovina) was performed. RESULTS: Categories of casualties evacuated (in accordance with international ICD codes) were compiled, and most frequent diagnoses of patients evacuated, average patient load, and frequency of critical care team transport were determined. CONCLUSIONS: To increase cooperation among multi-national forces deployed to the same operation, a database can be established with numbers and diagnoses of casualties evacuated. Trended data can then be used to tailor AE forces to meet both medical needs and multi-national operation requirements.     

Air ambulance regulations: a model

Prior attempts at establishing minimal federal air ambulance regulations and standards have been unsuccessful. However, reports of poor patient medical care during transport by some air ambulance services is now forcing many states to initiate air ambulance regulations. In 1984, the State of Utah Emergency Medical Services convened a special subcommittee to develop aeromedical regulations for the State of Utah. Using a three-level approach based upon the patient's requirements for basic, advanced, or specialized medical care and the urgency of transport, the subcommittee was able to derive medical categories necessary for the selection and utilization of air ambulance services. Minimum air ambulance regulations were then established for aircraft configuration, flight crew requirements, minimal equipment and medications, and the responsibilities of the medical director or designee for each of the three levels of medical care. We conclude that the application of a levels approach based upon the patient's medical requirements may be useful in assisting other states attempting to establish flexible but specific regulations directed at the safe transport of patients by aeromedical evacuation.     

Chemical hazards in aeromedical aircraft

Several potentially hazardous chemicals are required to make modern military aircraft fly. With each airevac mission, the possibility exists for structural failure of a fluid system, resulting in contamination to flight/medical crews, patients, and passengers. Aeromedical Evacuation Crewmembers (AECMs) need to be aware of the hazardous chemicals used in aircraft and areas where there is an increased risk to those in and around the aircraft. This study identified potential areas for chemical leakage, such as refuel receptacles, hydraulic reservoirs, hydraulic motors, doors, ramps, engines, and more. Further, it identified the basic first aid procedures to perform on people contaminated with jet fuel, hydraulic fluid, engine oil, fire extinguisher agents, LOX and other fluids. First aid procedures are basic and can be performed with supplies and equipment on a routine aeromedical evacuation mission, AECMs trained in a basic awareness of hazardous aircraft chemicals will result in crews better prepared to cope with the unique risks of transporting patients in a complicated military aircraft.     

Strategic aeromedical evacuation: the inaugural flight

Strategic aeromedical evacuation, a vital subsystem of the overall aeromedical airlift system, had its beginning in a confidential, poorly planned, poorly coordinated Air Transport Command flight from Karachi, Pakistan (then part of India) to Washington, DC, in January 1943. That the flight was successfully completed was due in large measure to the untiring efforts of the nurse, Second Lieutenant Elsie S. Ott, aboard the flight. Lessons learned in the form of recommendations made by Lt. Ott were implemented to improve succeeding strategic aeromedical evacuation missions. Largely through Lt. Ott's efforts, long range aeromedical evacuation was demonstrated to be a practicable method of transportation for seriously ill and wounded patients. A new dimension had been added to the overall aeromedical airlift mission.     

Containment aircraft transit isolator

The Containment Aircraft Transit Isolator is a self-contained unit capable of transporting a patient with a highly virulent disease and at the same time providing maximum microbiological security while full nursing care and treatment are carried out. The isolator was employed in a trans-Atlantic simulated aeromedical evacuation in a Canadian Forces Boeing 707. During the exercise, flight testing was undertaken and nursing care, treatment, and decontamination procedures were developed and evaluated. Flight medical personnel were trained in the use of the unit. It was concluded that flight-trained medical teams, well versed in general aviation medicine and with a detailed familiarity with the isolator, are necessary for safely transporting patients with exotic diseases.     

Aeromedical evacuation in the "Luftwaffe" from its origins until 1945

Prior to WWII, Germany had little experience in aeromedical evacuation (AE) of the sick and wounded. The need for a specialized AE organization was recognized, organized, and used extensively on all fronts during WWII. Nearly 2.5 million casualties were transported by regular troop carriers and 11 specialized AE Units, which concentrated on the intensive care air transport of the seriously wounded, especially those with injuries of the brain, eyes, or jaw, thoracic or abdominal wounds, or gun-shot fractures. The AE Units were commanded by medical officers, most of whom were pilot-physicians, who had command jurisdiction over flying and line personnel as well as medical service personnel. The AE Units were equipped with both Junkers Ju-52s, which could carry up to 12 litter patients plus 3 to 5 ambulatory patients each, and with Fieseler Fi -156s (STOL "Stork" for 1 or 2 litter patients), ambulances, as well as the personnel needed for operating and maintaining the vehicles and materiel. The AE Units of the Luftwaffe--the Sanitaetsflugbereitschaften--made an outstanding contribution to military medical care in achieving this significant number of casualties evacuated under the humanitarian symbol of the Red Cross.     

Management control of aeromedical evacuation systems

Aeromedical evacuation has been extensively used by military forces for evacuation of wartime casualties, but has also proven useful in civilian disaster response. In contrast to the broad coverage of the clinical aspects of the aeromedical evacuation, the operational and management control issues have rarely been addressed. The sophisticated battlefield of the 1980s has had an impact also in air evacuation, adding to the factors to be considered before launching an evacuation mission. The professional control of aeromedical evacuation is, therefore, crucial to the efficient and smooth operation of this high-cost resource. In an attempt to shed light on some of the operational perspectives of military air evacuation, the Israeli experience in the management control of such systems is discussed.     

Case from the aerospace medicine residents' teaching file. Case #35. Renal cell carcinoma in an aviator with a long history of renal lithiasis

This case study discusses the presentation, evaluation, and aeromedical disposition of an aviator with renal cell carcinoma, a disease seldom seen in the military flying population. It emphasizes the necessity of flight surgeon awareness of preventive medicine aspects of waivered medical disorders.     

Psoriatic arthritis in a military aviator

Psoriatic arthritis is a chronic spondyloarthropathy whose pathogenesis is unknown. We present a case of a naval flight officer who presented with chronic psoriatic arthritis, which ultimately became well controlled with etanercept treatment. The naval flight officer was granted military aeromedical waivers for psoriatic arthritis, cutaneous psoriasis, and chronic medication use. We also review the medical literature on psoriatic arthritis disease and etanercept and discuss their aeromedical implications in military aviation.     

西方国家军队空运医疗后送体系建设综述

目的 综述当前西方国家军队空运医疗后送体系建设的特点和发展趋势,指出构建完善的空运医疗后送体系所需的要素.资料来源与选择 国内外相关领域的学术专著、公开发表的学术论文和研究报告.资料引用 引用文献27篇.资料综合 近年来,空运医疗后送作为西方国家军队伤病员后送的首选方式,在组织指挥、保障力量、卫生装备、专业训练和法规制度建设方面更加完善,在平战时伤病员救治中发挥了重要作用.目前各国关注的重点是通过研发、改进卫生飞机及机载医疗设备,加强空运医疗人员训练来提高途中救治能力.同时,提供机上远程医疗服务已成为外军空运医疗后送体系建设的发展趋势.结论建立完善的组织指挥体系,加快研发专用卫生飞机,加强空运医疗后送人员训练将是我军空运医疗后送体系建设的重点.     

西方国家军队空运医疗后送体系建设综述

目的 综述当前西方国家军队空运医疗后送体系建设的特点和发展趋势,指出构建完善的空运医疗后送体系所需的要素.资料来源与选择 国内外相关领域的学术专著、公开发表的学术论文和研究报告.资料引用 引用文献27篇.资料综合 近年来,空运医疗后送作为西方国家军队伤病员后送的首选方式,在组织指挥、保障力量、卫生装备、专业训练和法规制度建设方面更加完善,在平战时伤病员救治中发挥了重要作用.目前各国关注的重点是通过研发、改进卫生飞机及机载医疗设备,加强空运医疗人员训练来提高途中救治能力.同时,提供机上远程医疗服务已成为外军空运医疗后送体系建设的发展趋势.结论建立完善的组织指挥体系,加快研发专用卫生飞机,加强空运医疗后送人员训练将是我军空运医疗后送体系建设的重点.     

Disaster aeromedical evacuation

Successful disaster aeromedical evacuation depends on applying the principles learned by moving patients since World War II, culminating in today's global patient movement system. This article describes the role of the Department of Defense patient movement system in providing defense support to civil authorities during the 2008 hurricane season and the international disaster response to the 2010 Haiti earthquake. Adapting and applying the principles of active partnerships, establishing patient movement requirements, patient preparation, and in-transit visibility have resulted in the successful aeromedical evacuation of over 1,600 patients since the federal response to Hurricane Katrina.     

Patient movement in the Pacific theater: changing the strategic focus from airplane to patient

The U.S. military health care system forms a vast network across thousands of miles to serve patients in the Pacific theater. The medical treatment facilities in the Pacific, however, act independently and do not effectively track patients in the air evacuation system. The patients and the tracking systems are so disconnected that patients' whereabouts are unknown to both the command structure and the medical treatment facilities as soon as the plane leaves the ground. Furthermore, the databases cannot analyze treatment trends, and the cost of transport--a major part of the cost of health care in the Pacific--is hidden inside the air evacuation system. To ensure that managed care works effectively in the Pacific, Tricare Pacific has created an Internet-based database that will support a new network of case managers and effectively track patients. The Lead Agency's analysis of aeromedical evacuation also concluded that the wartime method of routine patient transport is not efficient in peacetime and, in fact, delays treatment. The recommendations from this financial analysis will reduce patient delays, enhance access, and save millions of health care dollars.     

The roots of flight nursing: Lauretta M. Schimmoler and the Aerial Nurse Corps of America

In any history of flight nursing or aeromedical evacuation, one usually sees reference to Lauretta Schimmoler and the Aerial Nurse Corps of America. A pioneer aviatrix with the foresight to see that one day there would be a need for military evacuation of wounded troops by air, Schimmoler spent nearly 15 years developing a paramilitary nursing organization that proved that such a thing could be successfully accomplished. This paper will survey the career of this remarkable woman, examine the structure and function of her organization, and discuss why it never gained official recognition by the military or the Red Cross.     

Historic aeromedical perspective on left bundle branch block

Military aviators represent a very highly trained, expensive personnel resource. It is incumbent upon the military medical care systems to manage the health aspects of this resource as wisely as possible. This can best be accomplished through a combination of preventive medicine and health promotion oriented clinical care coupled with epidemiologically sound aeromedical standards which ensure that flying safety and mission completion will not be compromised. Epidemiologically sound aeromedical standards, in most cases, can be formulated only through responsible clinical aeromedical research and investigation which is performed within the population for which the aeromedical standards are intended.     

The principles of rendering surgical care in catastrophes

Organization of surgical service in disaster is based on the principles of military medicine, provided for conducting triage, evacuation measures and timely rendering all types of medical aid. In extreme situations during peacetime skilled surgical is provided in medical institutions, deploying with the help of medical teams arriving to the most proximal of disaster focus zones. It is important to follow the main aspects of military surgery with the strategy of surgical procedures, therapy of shock, combined and multiple trauma, prevention of wound infection.