Aeromedical Evacuation Considerations

Patients who receive REBOA at a Role 2 and need to be evacuated to a higher level of care should have hemorrhage control addressed and balloon deflated prior to transfer. Under no circumstance should a Zone 1 REBOA remain inflated during transport. In rare situations when a short-distance rotary-wing evacuation to higher level of care is possible, a Zone 3 REBOA inserted at Role 2 may remain inflated during transport however this requires exceptional communication and planning to avoid undue risk of ischemic injury.

If rotary-wing transport is available, a medical provider trained in hemodynamic monitoring and manipulation of the occlusion balloon should accompany the casualty at all times. If a REBOA sheath is in place in a trauma patient, re-placement/re-inflation of the balloon during transport is an option for trained providers in the event of sudden profound hypotension. Simultaneous blood transfusion is needed and balloon inflation time should not exceed 15 min in Zone I.

The essential equipment for REBOA is provided in Appendix D while the appropriate technical steps and considerations are summarized in Appendix E.