TRANSPORT CONSIDERATIONS

Goal: Safely prepare TBI patients for ground and/or air transportation to higher levels of care.

- Minimum: Dose sedative/analgesic medications, osmotic agent, and/or benzodiazepine before any significant ground or air transportation, as resources permit.

Neuromuscular blocking agents will mask seizures and clinical examination changes; therefore, the risk versus benefit of use during transport must be considered.

- Best: Ensure transport assets are aware of the patient’s brain injury in advance so appropriate accommodations and/or alterations to the travel plan can be made.
  - Most patients are transported in a supine position. Every effort should be made to transport TBI patients with the HOB elevated to at least 30°.
  - For fixed-wing transport, TBI patients should be loaded with their head toward the front of the aircraft to minimize G-forces transmitted to the brain.
  - Air transport of TBI patients requires additional considerations. For air movements that involve altitudes >8,000 ft, TBI patients are at risk for additional complications that may worsen brain injury, such as hypobaric hypoxia and high-altitude cerebral edema.29 Preplanning with air assets is highly recommended.
- Recommended Packing List. See Appendix D.
- Management of Traumatic Brain Injury Summary Table. See Appendix E.