Combating Flight Stress In The Air Medical Transport Environment

Combating The Effects Of The Stressors Of Flight

ASTNA - Patient Transport: Principles & Practice Chapter 5 – Objective 3: Identify Specific Management Strategies For Dealing With Stresses That May Occur During Flight:

• Hypoxia – Flight (Altitude) induces hypoxia can be managed in a number of way. Initial management should include the addition, or increase, in FiO2 provided to the patient. The FiO2 required to maintain baseline oxygenation once at altitude can is calculated using the formula (Starting FiO2 x Starting Air Pressure) / Air Pressure at Altitude = FiO2 Requirements at Altitude. A little complicated.

The easy solution is to just turn the FiO2 up a little bit. Crew members are required to be on oxygen if flying over 10,000 ft for greater than 30 minutes over 12,000 ft for any length of time in an unpressurized cabin. Maintaining adequate hydration, sleep, and nutrition also help combat the effects of hypoxia.

• Barometric Pressure Changes – Boyle’s Law is at play here. Complications can arise during both assent and descent, depending on body cavity affected. The most critical complications arise when gas trapped in body cavities (head, chest, GI) expands during ascent. The most immediate solution is to request the pilot fly at the lowest possible safe altitude. Other options are to decompress the cavity (chest) if possible, or consider alternative mode of transport. In the case of GI distension, gastric tube should be placed and vented to air or placed to low suction. Mild vasodilators can be effective for clearing sinuses and ears.

• Thermal – Protect the patient from both hypothermia and hyperthermia. Use blankets, aircraft heater / air conditioning, heating or cooling packs, space blankets, warm fluids. Crews should ensure proper clothing for weather conditions.

• Low Humidity - Crews should maintain proper hydration. Humidified oxygen should be administered during extended flights.

• Noise – Proper hearing protection is required for all crew members and patients during rotor-wing transport. Ear plugs and/or ear muffs for patients and properly fitting helmets with ear cups for crew members.

• Vibration – Ensure aircraft is being properly maintained to minimized airframe vibration. Ensure seat cushions and transport stretcher cushions are in good condition to insulate from airframe vibration. Secure and ensure proper positioning of patient and crews to minimized contact with airframe.

• Fatigue – Consider, and take proper measures to eliminate DEATH. Don’t use drugs, OTC or others. Maintain proper rest. Avoid alcohol before work. Don’t smoke or use other tobacco products. Maintain proper nutrition.

• G-Forces – Seldom a problem during air medical transport, the effects on certain patient populations, i.e. head injury, can have an impact. Considerations must be given to the positioning of a patient during take-offs and landings, especially for fixed wing transport, to prevent adverse effects on patients. Other factors to consider how fast the pilot changes direction of flight.