Aeromedical Evacuation (MEDEVAC)*
Definition
Aeromedical evacuation (MEDEVAC) is one available transportation option when the medical needs of a
patient exceed the resources available in the local medical department or when
medical needs can be better met at another military treatment facility (MTF) .
The needs of the patient must be balanced against the operational needs of the
ship or unit. There are a number of factors that should be taken into account
when considering air evacuation.
Do the benefits of air transport outweigh the
risks to the patient and the aircrew?
-
Available Services - Air evacuation should be considered only if local resources are not
sufficient to meet the patient's needs, and the receiving facility can better
meet those needs.
-
Contraindications - There should be no medical or "aviation" contraindications to air transport.
-
Transport Safety - An unstable patient should never be transferred.
Does the referral
MTF accept the patient?
-
Once the benefits and
risks are considered, the need for air evacuation is determined, and the
medevac aircraft is available, the transferring MTF must ensure a physician at
the referral MTF will accept the patient. However, such notification and
acceptance may sometimes be impossible due to operational or military security
reasons.
Who should go?
Optimally, air medical transport personnel
should consist of a dedicated, specially trained team, expertly capable of
taking care of the patient’s medical needs, while also paying attention to
special aviation environmental concerns that may affect the patient directly or
indirectly. When taking these latter factors into consideration, air evacuation
may not be practical or possible. Personnel considerations are included in the
following list:
-
The size and
configuration of the medevac aircraft platform
-
No specific aeromedical
training is required, but some training is encouraged for medical
professionals attending medevacs.
-
Ideally, the medical
attendants should be familiar with the patient, care requirements during the
transport, and the transport environment. However, in the case of small
vessels with no medical officers (e.g. Cruiser, Destroyer, and Frigate), a
trained attendant will accompany the patient.
-
Two medical attendants
should accompany the patient (e.g., inflight medical technician and flight
surgeon).
-
If the medical condition
warrants, medical professionals with the ability to provide advanced airway
management including basic and advanced cardiac life support (ACLS) should be
in attendance.
-
If a nonphysician is the
attendant, means to communicate with a physician concerning changes in the
patient's status should be available. If such communication is not technically
possible, a registered nurse or advanced emergency medicine technician (EMT)
should be in attendance with preauthorized standing orders to perform advanced
cardiac life support (ACLS) measures if they become necessary.
-
Provision of the medical
attendants is the responsibility of the transferring MTF. The transferring MTF
is responsible for the patient until arrival at the referral MTF when the
"accepting physician" assumes the care.
-
Patients transported on
a cardiac monitor require a physician or specially trained nurse as the
attendant.
-
Patients on a ventilator
require a physician that is familiar with the equipment. Optimally a
respiratory therapist should also be in attendance.
-
One non-medical
attendant may accompany a patient if deemed necessary by the referring MTF.
What supporting resources do you need?
-
Medical providers to
coordinate the transfer with the available medical personnel (medical
specialists and with physicians trained in aviation medicine, such as flight
surgeons).
-
Medical equipment and
monitors, medications, communication resources, and oxygen.
-
Aviation assets. Prepare
patient appropriately, depending on what aircraft platform or platforms are
available for transport, and which one is optimal, given the patient’s
condition. (consult with a flight surgeon, SAR corpsman or the flight crew).
What specific
steps need to be taken to complete a successful aeromedical evacuation once
the need is determined and resources are available?
The checklist should include:
-
Notify the chain of
command. Although the medical
officer has direct access to the commanding officer, don’t forget to notify
the executive officer at the same time. Also talk with the operations officer
and the airboss. This will make transport logistics an easier process.
-
Contact the referral MTF
medical specialist and brief them on the case.
-
Obtain an "accepting
physician" at the referral MTF and document this in the medical record.
-
Initiate air evacuation
message traffic (as applicable).
-
Complete the medical
record in detail.
-
Copy all pertinent
information and collate into a transfer package (e.g., labs, x-rays, pertinent
medical record, narrative summary, etc.).
-
Complete all
transferring MTF forms as directed by transferring command.
-
Complete consult form:
Referral for Civilian Medical Care DD 2161 and/or SF 513, if applicable.
-
Contact the duty flight
surgeon or medical officer in charge of medevacs.
-
Have the officer of the
day contact the duty search and rescue (SAR) corpsman to assist in
coordination of the transfer, if applicable.
-
The flight surgeon
should determine type of attendants needed (anesthetist, obstetrician, EMT,
etc.).
-
Assure coordination for
the receiving facilities ambulance. If the patient cannot be flown directly to
the hospital, an ambulance transport must be prearranged to transfer the
patient upon arrival.
-
Discuss plans and obtain
consent from family members (civilians) as applicable.
-
Contact the Fleet
Liaison Services Office when necessary (foreign military, U.S. military
shipboard or detached personnel, embassy personnel and their dependents,
etc.).
-
Assemble all necessary
information and medical equipment.
-
Prepare the patient
appropriately for transportation in the designated aircraft platform.
What are some specific medical equipment considerations? Assume the
worst case scenario.
-
Cardiac monitor
-
Oxygen (portable
cylinder, masks, tubing, etc.) Ensure an adequate supply of full portable
oxygen cylinders is available.
-
Pulse oximeter and C02
monitor if available
-
Suction device, electric
and manual
-
Airway kit
(laryngoscope, endotracheal tube, bag-valve mask, etc.)
-
Medications: ACLS drugs
and/or those specific to each case.
What patient
information should be included in the transfer package?
-
Brief history and
physical exam (H&P to include time, mechanism, severity, allergies, past
medical history, type of work.)
-
Brief narrative summary,
current medications, and last meal
-
Labs, medical records,
x-rays, and other supporting data
-
Transfer summary flow
sheet: record all fluids and medications given.
Summary
Communication is the key! Follow the
checklist above for a smooth and efficient transfer. Overall, ensure each
patient is stable and rule out any contraindications before transport. See the
summary algorithm on the next page.
Suggested web sites for further aviation
related information:
http://www.aerospacemed.org
http://www.nomi.navy.mil
http://bumed.med.navy.mil/med23/default.htm
Original Submission by: LT W.P. Baugh,
MC, USN, Flight Surgeon. Revised by CAPT Charles O. Barker, MC, USN, Bureau of
Medicine and Surgery MED-23,Washington, D.C.(1999).
*From General Medical Officer (GMO) Manual:
Administrative Section, Department of the Navy, Bureau of Medicine and Surgery,
as found in Operational Medicine 2001,
Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of
Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington,
D.C., 20372-5300
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