Medical Evacuation using MedCon levels described in Appendix A is one example.

- 1) Patient movement should be anticipated for COVID-19 PUIs categorized as MedCon 2 or higher. There is no reason to delay notification request for evacuation.
- 2) Ground and Air Medical Transport will depend on local CASEVAC/MEDEVAC notification plan and CASEVAC/MEDEVAC platforms available for transport.
- 3) When clinically and operationally feasible and within the provider’s scope of practice, obtain central venous access in anticipation of need for multiple infusions, including vasopressors, during transport. Obtain at least two peripheral IV’s or one peripheral plus one central line access prior to transport, if possible.
- 4) Early placement of arterial line for invasive pressure monitoring is recommended, if available.
- 5) If there is evidence or suspicion for acute coronary syndrome or myocarditis, coordinate the medical management via teleconsultation prior to transport, if possible.
- 6) Patients requiring >3 Lpm oxygen support to maintain oxygen saturations >93% may not tolerate the hypoxic environment of aeromedical evacuation even with cabin altitude restrictions:
  - Given concerns surrounding risk associated with procedures done emergently during transport, consider the need endotracheal intubation prior to transport.
  - The most experienced provider should perform the procedure to secure the airway. Use a video laryngoscope (if available) and rapid sequence induction.
  - Minimize people in the room during the procedure. Verify all staff have the best available PPE. (See Appendix B.)
  - Consider consulting the Advanced Critical Care Evacuation Team (ACCET) DSN 312-429-BURN (2876) before transporting patients on moderate to high ventilator settings (PEEP > 14 and FiO2 > 70%). Refer to JTS CPG for Acute Respiratory Failure.
  - If prone ventilation is to be utilized in-flight, it should be initiated on the ground with adequate time to document patient stability before transport.
- 7) If intubated, an NG/OGT should be placed pre-flight and attached to intermittent suction.
- 8) Pre-drawn and pre-mixed medications with primed tubing are examples of time saving measures to be optimized on the patient prior to transport.
- 9) Prepare patient records for handoff including medical notes, ECGs, laboratory results, and imaging results (if available).
- 10) Prepare patient belongings and ID/passport to accompany the patient.
- 11) Place PPE for flight on patient including eye protection and ear protection, and DO NOT forget face covering if not intubated.