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Aeromedical Evacuation Springer New York Berlin Heidelberg Hong Kong London Milan Paris Tokyo William W Aeromedical Evacuation Springer New York Berlin Heidelberg Hong Kong London Milan Paris Tokyo William W. Hurd, MD, MS, FACOG Nicholas J. Thompson Professor and Chair, Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio; Col, USAFR, MC, FS, Commander, 445th Aeromedical Staging Squadron, Wright-Patterson AFB, Dayton, Ohio John G. Jernigan, MD Brig Gen, USAF, CFS (ret), Formerly Commander, Human Systems Center, Brooks AFB, San Antonio, Texas Editors Aeromedical Evacuation Management of Acute and Stabilized Patients Foreword by Paul K. Carlton, Jr., MD Lt Gen, USAF, MC, CFS USAF Surgeon General With 122 Illustrations 1 3 William W. Hurd, MD, MS John G. Jernigan, MD Nicholas J. Thompson Professor and Chair Brig Gen, USAF, CFS (ret) Department of Obstetrics and Gynecology Formerly Commander Wright State University School of Medicine Human Systems Center Dayton, OH, USA Brooks AFB Col, USAFR, MC, FS San Antonio, TX, USA Commander 445th Aeromedical Staging Squadron Wright-Patterson AFB Dayton, OH, USA Cover illustration: Litter bearers carry a patient up the ramp of a C-9 Nightingale medical transport aircraft. (US Air Force photo by Staff Sgt. Gary R. Coppage). (Figure 7.4 in text) Library of Congress Cataloging-in-Publication Data Aeromedical evacuation : management of acute and stabilized patients / [edited by] William W. Hurd, John G. Jernigan. p. ; cm Includes bibliographical references and index. ISBN 0-387-98604-9 (h/c : alk. paper) 1. Airplane ambulances. 2. Emergency medical services. I. Hurd, William W. II. Jernigan, John J. [DNLM: 1. Air Ambulances. 2. Emergency Medical Services. 3. Rescue Work. WX 215 A252 2002] RA996.5 .A325 2002 616.02¢5—dc21 2002021045 ISBN 0-387-98604-9 Printed on acid-free paper. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Air Force, or the Department of Defense. The use of brand names is for illustrative purposes and does not imply endorsement by the Departments of the Army, Navy, or Air Force, or the Department of Defense. The authors have no finan- cial interest in any commercial device mentioned herein. © 2003 Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, expressed or implied with respect to the material contained herein. Printed in the United States of America. 987654321 SPIN 10689440 www.springer-ny.com Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science+Business Media GmbH Foreword As Surgeon General of the United States Air Force, it is a real plea- sure to write this foreword for the first modern textbook describing the medical aspects of aeromedical evacuation (AE). This textbook would not only have proven invaluable to me and my colleagues as we served our nation in Europe and Southeast Asia during the 1980s and early 1990s, but today it will provide an absolutely invaluable resource for all medics in the Department of Defense. I would like to say a special thanks to Bill Hurd, whose idea it was to publish this textbook and whose persistence was crucial to making it a reality. As described in chapter 2, AE has always been a vital link in the chain of medical care provided for all our soldiers, sailors, Marines, and airmen. Without AE, neither I nor any of my fellow Surgeons General could guarantee proper “full-spectrum” medical care to our military men and women around the globe. This is our collective responsibility, regardless of where in the world disease or injury occurs. Because of the huge distances involved in moving many of our patients, AE has always been a challenge, but never more so than today. Beginning with Operation Just Cause in Panama (1989), it became apparent that our troops would, at times, suffer injury in a location where only minimal stabilizing medical care is available. In such situations, AE is absolutely critical to assure we can quickly move patients to state-of-the-art trauma centers, even though such centers are hundreds or thousands of miles away. During Operation Desert Shield/Desert Storm (1990 to 1991), the amount of sealift required to move “mobile hospitals,” together with the time required to set them up, mandated that the medical services of all military branches find a new way to deliver medical care to combat troops. My predecessors and I, together with the Surgeons General of the Army and Navy, worked throughout the 1990s to streamline our medical forces. The end result is a truly light, lean, mobile, and capable array of medical forces that can arrive quickly on-scene for medical support of virtually any deployment anywhere in the world. However, such forces are equipped only for stabilization-type procedures and are far less capable than the old fixed facilities we had deployed in Europe during the Cold War. We simply must have the capability to v vi Foreword move our casualties out of the theater of operations as quickly as pos- sible, and AE is the key to making that happen. In fact, today we can aeromedically evacuate patients who are stabilized but not stable— providing critical care in the air—greatly enhancing the speed and capability of our AE service. Currently, the only people with more than a mere casual under- standing of the issues involved in moving patients are those USAF Reserve and Air National Guard forces (mostly nurses and adminis- trators) assigned to AE units, together with a handful of active-duty personnel who have served in one or two AE-related assignments during their careers. This textbook is rich with invaluable information that captures that experience and supplements Air Force guidelines and publications on AE. This textbook will also prove a valuable resource to civilian physicians as they make decisions regarding the medical factors they must consider as they move their patients back to or around the United States. As the world’s economy has become more integrated, American companies are stationing ever more Americans in foreign countries where medical care is often far substandard to expectations. The result is an increasing number of civilian patients who also need AE back to the United States. Further, even within the United States, subspeciality centers such as pediatric cardiothoracic surgery and burn centers often require the movement of patients over thousands of miles. I heartily congratulate the editors and chapter authors of Aeromed- ical Evacuation: Management of Acute and Stabilized Patients.I am confident it will become a much used resource by the thousands of physicians, nurses, and technicians charged with the responsibility of moving patients over long distances using aircraft. These individuals include members of all branches of the military and the many civil- ians involved in the commercial AE industry. For them, this book may be, quite literally, a “lifesaver.” Paul K. Carlton, Jr., MD Lt Gen, USAF, MC, CFS USAF Surgeon General Contents Foreword, by Paul K. Carlton, Jr. v Contributors . xi Part 1 The Need 1 Introduction . 3 William W. Hurd and John G. Jernigan 2 Aeromedical Evacuation: A Historical Perspective . 6 Kathleen Vanderburg 3 Indications and Considerations for Emergent Evacuation of the Peacetime Casualty . 13 J.D. Polk and William F. Fallon, Jr. 4 Combat and Operational Casualties . 27 Robert A. De Lorenzo Part 2 The Means 5 Military Casualty Evacuation: MEDEVAC . 45 Robert A. De Lorenzo 6 Aeromedical Triage Support to Mass-Casualty Events . 60 Frederick M. Burkle, Jr., Richard Brennan, and Victoria Garshnek 7 Patient Staging for Aeromedical Evacuation . 75 William W. Hurd, Anthony M. Rizzo, Eunice K. Taylor, and John M. McNamara 8 Aircraft Considerations for Aeromedical Evacuation . 88 John G. Jernigan vii viii Contents 9 Critical-Care Air Transport: Patient Flight Physiology and Organizational Considerations . 111 Thomas E. Grissom 10 Nursing Care In-Flight . 136 Susan B. Connor 11 Aeromedical Evacuation of Patients with Contagious Infections . 147 Mark R. Withers, George W. Christopher, Steven J. Hatfill, and Jose J. Gutierrez-Nunez 12 In-Flight Emergencies: Capabilities and Limitations . 160 R.T. Ross and M. Gage Ochsner, Jr. Part 3 The Patients 13 General Surgical Casualties: Abdominal Wounds, Urogenital Traumas, and Soft-Tissue Injuries . 173 J.D. Polk, Charles J. Yowler, and William F. Fallon, Jr. 14 Air Evacuation of the Neurosurgical Patient . 184 Mick J. Perez-Cruet and Rose Leary 15 Otorhinolaryngology Head and Neck Surgery Patients . 203 David G. Schall and John R. Bennett 16 Ophthalmic Patients . 215 Douglas Joseph Ivan 17 Peripheral Vascular Casualties . 225 David L. Dawson 18 Aeromedical Evacuation of Cardiothoracic Casualties . 241 Kenton E. Stephens, Jr. 19 Patients Requiring Mechanical Ventilation . 256 Steven L. Chambers and Thomas G. Ferry 20 Orthopedic Patients .
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