Aeromedical Transport

Aeromedical transportation includes any fixed-wing or rotor-wing aircraft used for patient treatment and transport. Evacuation by air was first performed during World War I to transfer wounded soldiers from the battlefield to hospitals. Medical air evacuations continued during World War II when over 1 million patients were transported by fixed-wing transport (FWT). During the Korean War, helicopters were implemented to access rugged terrain, although their benefits were unclear. Rotor-wing transport (RWT) use expanded during the Vietnam War when more advanced field hospitals performed stabilization before further evacuation. Today, the civilian and military sectors depend on FWT and RWT to respond to medical and trauma emergencies that may not be well served by ground ambulances. Approximately 3% of all ambulance transports in the United States are performed by aeromedical assets, requiring over 300 air ambulance services, 1000 bases, and 1400 registered aircraft, according to the 2017 Atlas and Database of Air Medical Services (ADAMS, https://aams.org/page/industry-resources). As aircraft have improved, patient care by aeromedical providers has changed drastically over the past 60 years. Technology and field care advancements now allow emergency medical service (EMS) to provide critical care while moving the patient toward definitive care, including diagnostics such as focused assessment with sonography in trauma (FAST) and therapeutics, including whole blood and tranexamic. This expansion has led to questions about whether helicopter emergency medical services (HEMS) is overutilized, too expensive and dangerous. This activity reviews basic information regarding air and ground transportation comparisons, medical care provided in aircraft, different mission profiles, safety, cost considerations, preparing patients for transport, and the potential clinical impact of air medical services.