It is not an ambulance in the sky. It is a critical care environment shaped by altitude, vibration, noise, acceleration, limited space, and limited access.
CORE PRINCIPLE Clinical operations · Flight medicine
Critical care
without borders.
Operational knowledge for clinicians who deliver safe, precise patient care in the most dynamic transport environment.
✚→
ALTITUDE18,500 FT
CABIN PRESSURE8,000 FT
PATIENT STATUS STABLE
24.7136° N
46.6753° E
SCROLL TO BRIEFING
01 / 08
THE DISCIPLINE
Care in motion.
Aeromedical evacuation is the coordinated transport of patients by fixed-wing or rotary-wing aircraft, with continuous clinical care from origin to destination.
Clinical
Anticipate deterioration and complete high-risk interventions before loading.
Aviation
Understand cabin physiology, aircraft limits, weather, range, and loading.
Coordination
Align sending, transport, aviation, and receiving teams around one plan.
02 / 08
MISSION & WORKFLOW
From call to handover.
A successful mission is a chain of deliberate decisions. Every stage protects the patient, the crew, and the aircraft.
- 01ACTIVATE
Receive & triage
Mechanism, diagnosis, acuity, weight, location, destination, time sensitivity.
- 02PLAN
Match resources
Aircraft, crew mix, range, weather, equipment, oxygen, and contingencies.
- 03PREPARE
Stabilize & package
Secure airway, lines, drains, analgesia, monitoring, and transport documentation.
- 04TRANSFER
Load & fly
Brief, secure, reassess, trend, communicate, and manage cabin threats.
- 05COMPLETE
Handover & reset
Structured report, documentation, debrief, restock, clean, and readiness check.
MISSION RULEIf a problem is difficult to manage on the ground, it will be harder in flight.
03 / 08
AIRCRAFT & CABIN
Choose the platform.
The mission profile determines the aircraft. Clinical capability must fit safely within its physical and operational envelope.
✚
ROTARY WINGFast access. Short range.
- Scene and interfacility missions
- Rapid point-to-point access
- Higher noise, vibration, and space constraints
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FIXED WINGDistance with capability.
- Long-range and international transfer
- More payload and clinical workspace
- Airport transfers and cabin-altitude exposure
↓BAROMETRIC PRESSUREFalls as altitude increases
↔GAS EXPANSIONTrapped gas expands during ascent
≈NOISE & VIBRATIONMask alarms and impair assessment
↗ACCELERATIONChanges physiology and equipment forces
04 / 08
ASSESSMENT & STABILIZATION
Fix before flight.
Use a systematic primary survey, then convert findings into interventions that remain secure, visible, and manageable throughout transport.
A
AIRWAY
✓Patency · Protection · Position
Definitive plan, tube depth marked, cuff checked, suction ready
B
BREATHING
✓Ventilation · Oxygenation
Chest injury managed, ventilator tested, reserve calculated
C
CIRCULATION
✓Perfusion · Hemorrhage
Bleeding controlled, access secured, blood and pumps prepared
D
DISABILITY
✓Neurology · Glucose · Pain
GCS/pupils trended, seizures treated, sedation and analgesia set
E
EXPOSURE
✓Temperature · Packaging
Full exam complete, heat loss prevented, all devices accessible
TREND, DON’T SNAPSHOT.Repeat assessments after every move, intervention, altitude change, and change in patient condition.
05 / 08
OXYGEN & HYPOXIA
Altitude changes the equation.
As barometric pressure decreases, the partial pressure of oxygen falls—even when the oxygen percentage remains 21%. Patients with limited reserve may deteriorate before a healthy crew member notices symptoms.
CORE RELATIONSHIPPartial pressure ∝ Barometric pressure
EARLY SIGNSLATE SIGNS
- Tachycardia
- Tachypnea
- Anxiety / euphoria
- Impaired judgment
- Confusion
- Cyanosis
- Bradycardia
- Loss of consciousness
RECOGNIZE → OXYGENATE → DESCEND / PRESSURIZE
O₂ PLANNING
Need = flow × mission time
Add contingency reserve. Account for ventilator consumption, leaks, delays, patient deterioration, and cylinder changeover.
06 / 08
EQUIPMENT
Pack for failure.
Every device must be flight-approved, secured, powered, accessible, and paired with a workable backup.
Airway
Video laryngoscope, suction, surgical airway kit, capnography
Breathing
Transport ventilator, oxygen reserve, BVM, thoracic kit
Circulation
Monitor-defibrillator, pumps, blood products, IV/IO access
Specialty
Neonatal, obstetric, burn, isolation, or ECMO modules
Protection
Hearing, eye, restraint, survival, and infection-control gear
Redundancy
Charged batteries, backup oxygen, spare circuits, manual options
BEFORE LOADINGPower on→Function test→Secure→Backup ready
07 / 08
SAFETY & HUMAN FACTORS
The crew is the system.
Technical skill matters. Shared awareness, disciplined communication, and the confidence to stop an unsafe act matter just as much.
Communicate clearly.
Use closed-loop communication. Name the person, state the request, receive confirmation, verify completion.
“Alex, give 50 mcg fentanyl IV.”“50 mcg fentanyl IV.”“Correct.”
Sterile cockpit
Limit nonessential conversation during takeoff, landing, and critical patient events.
Three-way brief
What is happening? What could change? What will we do next?
Stop the line
Every crew member has authority to identify and halt an unsafe condition.
I’M SAFEIllnessMedicationStressAlcoholFatigueEating
08 / 08
TRAINING RESOURCES
Build operational fluency.
Use these learning tracks to structure study, simulation, and continuing professional development.
Flight Physiology
Gas laws, hypobaric hypoxia, acceleration, thermal stress, fatigue.
Review module →Transport Critical Care
Airway, ventilation, shock, trauma, neurologic and specialty transport.
Review module →CRM & Aviation Safety
Risk assessment, communication, situational awareness, survival.
Review module →EDUCATIONAL USE
This guide supports learning and professional development. It does not replace local protocols, medical direction, aircraft procedures, or certified training.
CONTACT
training@aeromed.guide↗Keep the conversation moving.
Questions, teaching collaboration, or feedback on this field guide?