The USAF Patient Movement Request must state the type of regional anesthesia being utilized. All individuals participating in the care of the patient should have up-to-date training and experience with regional anesthesia, techniques, medications, and equipment. All equipment associated with the use of regional anesthesia must be approved for flight. The current infusion pump system that has been approved by the USAF for air evacuation is the small portable Ambit pump. Ambit pumps should be used for epidural, peripheral nerve catheters, ketamine infusions, narcotic infusions, and patient controlled anesthesia. For all patients receiving regional anesthesia/analgesia, coordinate with the Trauma Chief, Theater Validating Flight Surgeon, and Theater CCATT Director prior to any planned fixed-wing tactical (Intratheater) or strategic (Intertheater) transport to ensure patient safety during flight operations.

Patients undergoing prolonged air evacuation are exposed to a multitude of austere environments over a relatively short period of time. CCATT providers recognize that turbulence, weather, temperature, limited patient access and monitoring constraints make it inherently difficult to maintain sedation and analgesia. It may be necessary to empirically increase sedation and pain regimens to maintain a safety margin that protects endotracheal tubes and other invasive devices. This clouds a patient’s neurologic exam. Therefore patients with potential intracranial injury (TBI or stroke) who cannot be serially, neurologically evaluated should have intracranial pressure monitors.

In terms of peripheral nerve blocks or epidural catheters, no narcotics will be added to the infusions; the addition of narcotics to these regional therapies changes the validation for air transport by the USAF.