Page 194 - PJ MED OPS Handbook 8th Ed

15. Flight Operations

AE Concerns, Flight Stressors

1. Reduced partial pressure of oxygen – can worsen all aspects of pathophysiology.
2. Barometric pressure change – allows all air filled body cavities and medical devices to expand on
ascent (e.g., pneumothorax can worsen). Gastric distension can worsen and impact ventilation.
3. Decreasing temperature – contributes to hypothermia, patient discomfort, and energy loss from
shivering.
4. Reduced humidity – contributes to dehydration, thickened secretions, dry lips, and dry eyes.
5. Noise – contributes to difficulty communicating and is annoying to the patient.
6. Vibration and banking – may impact performing medical procedures, may increase pain from
injuries, motion sickness, one of the stresses that contributes to increased patient fatigue.
7. G-forces – increase intracranial pressure, decrease venous return to heart, increase pain from
fractures and severe soft tissue injuries.
8. Cumulative detrimental effect of the above stressors in conscious and unconscious patients is
an important intangible, especially on a prolonged flight (e.g., may need to adjust maintenance
pain med doses).
9. Vibration and movement affect reliability of monitors, especially BP and EKG. Finger pulse oxim-
etry devices are often better for pulse oximetry than most market monitors.

Preparation:

1. Configure and load HH-60 cabin ensuring each team member knows where every item of gear
is located.
2. Assign routines for exit and re-entry.
3. Assign and define roles of PJs depending on 1, 2 or 3 Cat A patients.
4. Do drills on these roles 1–2 × per week during deployments.
5. Re-check all electric and battery operated gear.
6. Have a checklist to use at the beginning of each alert.
7. Prep IV/blood lines/bags for missions based on Intel. Have IV and IO gear in immediately acces-
sible locations, as well as emergency airway gear.
8. Have sharps shuttle in same place always.
9. Pre-load ketamine or other meds as operations dictate only when anticipated use is near. Consider
for direct action, POI, CASEVAC scenarios. Put tape on syringe with sharpie noting time, day and
medication dosage. Discard unused medication at 24 hours. Document with IDMT or logistics.

Loading patients:

1. If possible, assess VS and all prior interventions on ground outside rotor disc. Apply second Tq’s
as needed.
2. Consider having all patients who are not US or coalition “trauma naked”, must check for explo-
sives and weapons, remove all blankets and clothes to replace with our blankets.
3. Search PUCs for weapons, cell phones (trauma naked if any questions prior to boarding aircraft).
Examine oral cavity, skin folds, etc. There has been one case of a PUC who kept a phone sim card
in his mouth and tried to spit it out at some point later in flight.

192 n Pararescue Medical Operations Handbook / 8th Edition