1. Aeromedical Evacuation from any AOR to CONUS can require multiple flights over the course of days before the patient arrives at his or her final destination.

2. All patients, including those on mechanical ventilation, will experience a decrease in PaO2 as ambient pressure decreases.

3. All ventilated patients should have the head of bed elevated at least 30° unless there is a contraindication.

4. All ventilated patients require gastric decompression prior to flight. Barring specific surgical indications for nasal placement, orogastric tube is preferred to nasogastric tube to prevent sinusitis.

5. If NPO or not tolerating fluids, consider adding IV fluids to help prevent dehydration during flight. Consider increasing maintenance IV rate due to dry air at altitude and increased rate of insensible loss.

6. Consider repeat CXR prior to flight if > 12 hours has elapsed since most recent one or clinical condition has changed significantly.

7. Do not extubate patient less than 4 hours prior to take off.

8. Consider enteral nutrition according to JTS Nutritional Support Using Enteral and Parenteral Methods CPG.15 Tube feeds not administered through a small bowel feeding tube should be discontinued prior to flight.

9. Patients with decreased mobility require routine Deep Venous Thrombosis prophylaxis. See the JTS CPG The Prevention of Deep Venous Thrombosis – Inferior Vena Cava Filter, 02 Aug 2016.16

10. Gastric ulcer prevention should be provided if indicated