Aeromedical Evacuation

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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