Physician roles in aeromedical evacuation: current practices in USAF operations

Physicians play an increasingly important role in the critical medical process of aeromedical evacuation (AE). Incomplete or inappropriate preparation for AE can result in increased patient discomfort, and in the worst cases, potentially serious or insurmountable in-flight medical problems. During military operations and in response to natural disasters, physicians are responsible for four processes necessary for a successful AE mission. These include: 1) AE screening, including determination of appropriate classification, precedence, and special medical requirements; 2) validation; 3) medical preparation; and 4) clearance. Physicians responsible for preparing patients for AE need to understand both the patient evacuation system and the unique medical aspects associated with AE. The U.S. military patient evacuation system is comprised of three principal transportation phases: casualty evacuation; inter-theater AE; and intra-theater AE. Important elements of the USAF AE system are patient movement requirements centers, the validating flight surgeon, aeromedical staging facilities, AE liaison teams, aeromedical crews, and critical care air transport (CCAT) teams. Important medical aspects unique to AE include the effects of flight physiology on medical conditions, oxygen limitations, and distinctive medication and supplies requirements.