Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom.
Abstract
Our understanding of the expertise and equipment required to air transport injured
soldiers with severe traumatic brain injuries (TBIs) continue to evolve.We conducted
a retrospective chart review of characteristics, interventions required and short-term
outcomes of patients with severe TBI managed by the US Air Force Critical Care Air
Transport Teams (CCATTs) deployed in support of Operation Iraqi Freedom and Operation
Enduring Freedom between 1 June 2007 and 31 August 2010. Patients were cared for based
on guidelines given by the Brain Trauma Foundation and the Joint Theater Trauma System
by non-neurosurgeon physicians with dedicated neurocritical care training. We report
basic characteristics, injuries, interventions required and complications during transport.Intracranial
haemorrhage was the most common diagnosis in this cohort. Most injuries were weapon
related. During this study, there were no reported in-flight deaths. The majority
of patients were mechanically ventilated. There were 45 patients who required at least
one vasopressor to maintain adequate tissue perfusion, including four patients who
required three or more. Some patients required intracranial pressure (ICP) management,
treatment of diabetes insipidus and/or seizure prophylaxis medications.Air transport
personnel must be prepared to provide standard critical care but also care specific
to TBIs, including ICP control and management of diabetes insipidus. Although these
patients and their potential complications are traditionally managed by neurosurgeons,
those providers without neurosurgical backgrounds can be provided this training to
help fill a wartime need. This study provides data for the future development of air
transport guidelines for validating and clearing flight surgeons.
Type
Journal articleSubject
HumansTreatment Outcome
Transportation of Patients
Critical Care
Retrospective Studies
Military Medicine
Air Ambulances
Female
Male
Afghan Campaign 2001-
Iraq War, 2003-2011
Brain Injuries, Traumatic
Permalink
https://hdl.handle.net/10161/16694Published Version (Please cite this version)
10.1136/jramc-2016-000743Publication Info
Boyd, L Renee; Borawski, J; Lairet, J; & Limkakeng, AT (2017). Critical Care Air Transport Team severe traumatic brain injury short-term outcomes
during flight for Operation Iraqi Freedom/Operation Enduring Freedom. Journal of the Royal Army Medical Corps, 163(5). 10.1136/jramc-2016-000743. Retrieved from https://hdl.handle.net/10161/16694.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joseph Brian Borawski
Assistant Professor of Surgery
Alexander Tan Limkakeng Jr.
Professor of Surgery
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers
from many fields spanning global health, innovation, clinical trials, basic discovery,
and translational research. The
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