AEROMEDICAL EVACUATION CONSIDERATIONS

1. Aeromedical Evacuation (AE) from any area of responsibility to continental U.S. can require multiple flights over the course of days before the patient arrives at his or her final destination.

2. There is a clear association between long-distance travel and an increased risk of VTE, even in a “healthy traveler.”

3. Stresses of flight such as prolonged immobility and decreased humidity may contribute to VTE formation, especially in groups who already carry a high risk (trauma patients, recent surgeries, long bone fractures, smokers, pregnancy or post-partum, recent Myocardial Infarction, active cancer, presence of splint or cast, etc.).

4. Prophylaxis is essential to reduce the risk of VTE associated morbidity and mortality in all AE patients.

a. AE crews will encourage patient ambulation every 2 hours for patients whose condition allows.

b. SCD use should be universal for inpatients unless contraindicated by injury pattern. The Kendal SCD Express compression system is approved for use on military aircraft.

c. Chemical VTE prophylaxis is also recommended as above for all trauma or medical inpatients unless specifically contraindicated by the medical condition such as ongoing bleeding or coagulopathy.

5. AE Patients with KNOWN acute VTE should be treated prior to flight unless there is a clear contraindication.

a. Treatment depends on the clinical situation, but may include low-molecular-weight Heparin, Fondaparinux, oral Xa inhibitors, or Unfractionated Heparin.

b. Oxygen and continuous pulse-oxygenation monitoring should be available during AE for patients with known VTE in case supportive measures are needed.

c. In the case of known or suspected Pulmonary Embolism, a Cabin Altitude Restriction should be considered to mitigate the effects of altitude on oxygenation and respiration.

d. Addition of a Critical Care Air Transport Team should also be considered in cases of PE with significant respiratory or hemodynamic compromise.