1. A difficult airway on the ground will NOT be easy to maintain en route. Secure the airway and ventilator support as needed prior to transport.
2. Decrease FiO2 requirements on the ground in a controlled setting to ensure proper O2 levels and allocation of limited resources en route.
3. Predrawn/premixed medications, primed blood tubing, taping of reinforcement bandages near wound, pelvic binders, and preplaced tourniquets are all examples of time saving measures to be optimized on the casualty prior to transport. Time is an enemy in the provider resource constrained transport environment.
4. Early antibiotics can prevent long-term complications, ensure your casualty has antibiotic coverage or have a plan to initiate coverage when appropriate.
5. Dedicate an intravenous line for medication administration. Separate, mark, and place the administration port somewhere accessible to all team members during the transport.
6. During assessment, ensure that the casualty is rolled, all junctional areas are investigated for injuries, and that all team members auscultate lung fields, palpate chest for expansion, and assess compliance of bag valve mask ventilation.
7. Establish a solid baseline assessment with your team using the MARCH acronym. This will act as supporting problem solving battle rhythm for your team en route.
8. Keep it simple! Use practical and manageable interventions to optimize your casualty en route.
9. Use separate securing straps and devices for the casualty and any monitors. Remember casualty safety and security is the priority.