Air Force to study in-flight care

Data compiled on 160K patients evacuated over a 13-year period.

The Air Force is compiling a database of 160,000 patients flown on aeromedical evacuation missions to research the best ways to handle medical problems patients encounter in flight, a researcher says.

The registry would cover mostly wounded and injured military service members who flew on Air Force evacuation flights between 2001 and 2014 and mark the first time research focused this extensively on non-critical care patients, officials said.

“There’s going to be all kinds of questions that can be asked because what we’ll be able to do is look at what kind of treatment different people with different injuries had” and determine if health care practices should change, said Col. Susan Dukes, En Route Care Research Division Chief at the U.S. Air Force School of Aerospace Medicine at Wright-Patterson.

“We haven’t had a system in place to really capture that information, so it’s been very difficult to go back and look at patients as to what kinds of interventions they had right before the flight, in flight (and) right after flight,” she said.

Assembling the data is “a huge endeavor,” she said.

The database could help determine what actions to take with patients and when, how large a medical crew should be on board in wartime scenarios, and what equipment may be needed en route to hospitals, researchers say.

The new-found knowledge of patient trends will tie into a database Army researchers in Texas will assemble to track patients transported in helicopters, and with a Department of Defense trauma registry, Dukes said.

The registry follows a $2.5 million Air Force-funded University of Maryland School of Medicine study between 2011 to 2014 that raised questions of how soon patients who suffer traumatic brain injuries should be flown on an aeromedical evacuation flight and the effect of low pressure and pure oxygen on brain injuries. Researchers experimented with rats to determine initial findings published in the Journal of Neurotrauma.

The study suggested air evacuations within hours or days of a TBI patient’s injury may pose a “significant added risk, potentially causing more damage” to brain injuries, according to the university.

Researchers found “low air pressure worsened long-term cognitive function and increased chronic brain inflammation and brain tissue loss,” the university reported. Giving patients pure oxygen worsened TBI-related health concerns, the study found.

“I think one of the main takeaway points … is too little oxygen can be bad, but too much oxygen (also) can be bad,” Dukes said. “It’s very important to assess the patients individually and provide that optimal amount of oxygen.”

Questions of when the best time to fly a patient with a TBI injury linger, researchers indicated.

“There’s a lot of work being done related to that question of when is the best time to fly a patient,” Dukes said. “In a wartime environment or scenario, there might not be a choice. Sometimes you need to fly that patient when the plane is available.”

Dukes said a follow-on study is in the works.

Among more than 80 ongoing studies, the School of Aerospace Medicine is investigating the effects of hypoxia, or a lack of oxygen at high altitude, on crew and patients; the impact of barometric pressure on equipment; and the amount of vibration a patient is exposed to in the air.

“If you can imagine having a broken leg and being in that constant vibration, you’re pretty much in pain the whole way,” said Col. Annette Gablehouse, leader of the school’s International and Expeditionary Education and Training Department.

Battling crew fatigue and finding ways to improve communication between patients and crew members on noisy cargo planes were key areas under study, researchers said.

“You can get distracted very easily,” Gablehouse said. “You can’t hear. It’s dark. …. This is another huge problem.”

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