Due to the requirement to move the coalition patient with traumatic amputation to Role 4 facilities usually out of theater, early and safe transport of these patients should involve consideration of the following factors.

1. Concomitant injury management is crucial during flight. Additional orthopedic injuries should be stabilized and structurally sound for transport. Limbs should be splinted or ex-fixed and positioned to decrease the possibility of post traumatic contractures.
2. If adequate tissue perfusion is a concern, supplemental oxygen should be given to increase oxygen tissue delivery. Assess amputation wound in flight. Liberal use of ABGs to look at pAO2. O2 saturations can be normal in flight, but O2 delivery may still be marginal. If substantial decrease in pAO2 at altitude, consider increasing supplemental oxygen.
3. Large wounds or wound vacuums can add an area of increased heat loss. Take preventive measures to reduce risk of hypothermia.
4. Flight stresses include movement and vibration which can increase pain during transport. It is likely pain medication requirements will increase during these times. Evaluate analgesia protocols as well as the patient’s analgesia needs and response to pain medications.
5. Do not remove drains or NPWT dressings in the immediate period prior to aeromedical evacuation. Coordinate dressing change timing with the patient movement schedule. Consider placement of antibiotic beads in amputation wounds being managed with NPWT during transport to convert the dressing into an antibiotic bead pouch in the event of NPWT vacuum failure.8 Refer to the Negative Pressure Wound Therapy - CCAT, 11 Feb 2020 CPG on the JTS CPG website.
6. Patients with poly-trauma require deep vein thrombosis prophylaxis if anatomically feasible and not contraindicated. Refer to the JTS Prevention of Venous Thromboembolism, 29 Mar 2024 CPG for specific guidance.