U.S. Air Force aeromedical evacuation of obstetric patients in Europe.

U.S. Air Force (USAF) regulations do not recommend the routine movement of obstetrical patients greater than 34 weeks gestation. However, U.S. Department of Defense and embassy physicians throughout Europe continually request aeromedical movement of obstetrical patients greater than 34 weeks gestation. Therefore, a year-long prospective review of obstetric patient movement within the military aeromedical system in Europe was undertaken to evaluate the need for and safety of transporting pregnant women over 34 weeks gestation. Civilian studies demonstrate the safety of transporting these patients, but these studies generally address short-range transport by helicopter. By contrast, the USAF operates a high-volume, long-range aeromedical evacuation system with large fixed-wing aircraft. Of the 13,095 patients reported for military aeromedical movement within the study time frame, 329 patients were uneventfully airlifted for obstetrical reasons. This study suggests that long distance movement by fixed-wing aircraft of obstetric patients at any gestational age can be done safely in the USAF military aeromedical system.

Increased flight surgeon role in military aeromedical evacuation.

BACKGROUND: Physicians were involved in the development of aeromedical evacuation (medevac) and flight surgeons flew as crewmembers on the first U.S. military medevac flights. However, since World War II flight surgeons have not been routinely assigned to operational medevac units. The aeromedical literature addressing the role of physicians in medevac is controversial. Recent contingencies involving the U.S. Air Force (USAF) have required the augmentation of medevac units with flight surgeons. RECENT CHANGES IN THE EUROPEAN THEATER: Beginning in 1992, the United States Air Forces Europe (USAFE) assigned three flight surgeons to the medevac squadron. Between 2 February 1993 and 24 March 1994 USAFE moved 241 patients on 29 missions out of the former Yugoslavia--most of these missions had a flight surgeon on the crew. Because advance medical information on the status of these patients is often nonexistent, the presence of a physician on the crew proved life-saving in some instances. In peacetime operations, there has been a recent trend in the European theater for the USAF to move more unstable patients. OBSERVED BENEFITS OF PHYSICIANS IN MEDEVAC: Dedicated medevac flight surgeons have proven to have the specific experience and training to perform effectively in the role of in-flight medical attendant. In addition, they are effective in negotiating with referring physicians about the urgency of movement, required equipment, the need for medical attendants, etc. These flight surgeons also provide medical coverage of transiting patients in the Aeromedical Staging Flight (ASF), thus providing needed continuity in the medevac system. CONCLUSION: Dedicated medevac flight surgeons fill a unique and valuable role in medevac systems. Agencies with medevac units should consider assigning flight surgeons to these units.

A review of United States Air Force aeromedical evacuation of acute myocardial infarction patients in Europe.

United States Air Force regulations currently do not recommend the routine movement of recently stabilized patients diagnosed with acute myocardial infarctions. However, U.S. Department of Defense and embassy physicians throughout Europe continually request aeromedical movement of these patients. Therefore, a year-long prospective case review of acute myocardial infarction (AMI) patient movement within the military aeromedical system in Europe was undertaken to evaluate the need for and safety of transporting these patients. This case review, combined with the literature, suggests that recently stabilized AMI patients, with appropriate pre-flight preparation and in-flight care, can tolerate exposure to the stresses of flight and can be safely airlifted.

Accuracy of drug infusion pumps under computer control.

Prototype systems implementing algorithms for automated drug infusions are typically constructed by coupling a microcomputer to a drug infusion pump through a serial communications interface. Infusion rates demanded of the infusion pump in many computed-controlled drug delivery applications are made to change at intervals much shorter than those encountered under routine clinical use. Because the ability of infusion pumps to maintain accurate flow rates during high frequency rate changes has not been documented, the purpose of this study was to validate the volumetric accuracy of three commercially available infusion pumps operating in a demanding computer-controlled application. In independent 2-h evaluations, the infusion rate demanded of each pump changed as often as every 5, 10, or 15 s using an algorithm for computer-controlled pharmacokinetic model-driven intravenous infusion. Accuracy of the infusion devices was determined gravimetrically. At all measurement times, each of the infusion pumps was accurate to within approximately +/- 5% of the expected volumetric output under each of the infusion rate intervals tested. Flow rate accuracy of +/- 5% is equal to the nominal expected accuracy of these infusion pumps in conventional clinical use.