Aeromedical repatriation
This educational algorithm presents the key challenges and approaches in the field of anesthesiology and overall patient care during air repatriation. It refers to transporting a patient on a commercial airline flight. Its creators draw from their own experiences with air repatriation from overseas countries. The participant has the opportunity to step into the role of a doctor going through the entire process of repatriating a patient from Australia. They will have the chance to learn how to prepare for such an event and what complications may arise during it. They will face specific situations that must be addressed under non-standard conditions — on an airplane. Are you ready for the flight?
Review
This educational tool addresses the highly specific topic of air medical repatriation of a critically ill patient on a commercial airline. Although this represents an uncommon situation in routine clinical practice, proper management requires comprehensive knowledge of intensive care medicine, altitude physiology, and healthcare organization. The interactive scenario systematically guides physicians through the entire decision-making process from assessing patient transportability, through flight preparation, to managing potential complications during transport. The authors correctly emphasize key factors affecting flight safety - particularly the physiological impacts of barometric pressure changes, partial oxygen pressure variations, and the effects of vibrations on a patient with tracheostomy and mechanical ventilation. The individual steps logically connect and are supplemented with important theoretical background explaining physiological changes during flight in a pressurized cabin. The creators appropriately highlight the need for specialized equipment, coordination with airlines, and preparation for unpredictable complications during long-haul flights. The presented model case is based on an actual event and very realistically depicts the complexity of the decision-making process. Even though this represents a rare situation, this educational resource provides valuable insights into the principles of critical patient transport and interdisciplinary collaboration. Practicing the correct approach can be highly beneficial for physicians who may encounter similar situations, while simultaneously expanding general awareness of the possibilities and limitations of medical transport.
Sources
KUMAR, Narender and Ajay KUMAR. Aeromedical Transportation of Critically Ill COVID-19 Patients: Indian Experience. Journal of Anaesthesiology Clinical Pharmacology [online]. 2021, vol. 37, no. 3, pp. 430–436. [cited 2025-02-15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180199/
EMIRATES. Medical Information Form (MEDIF). Emirates [online]. [cited 2025-02-15]. Available from: https://www.emirates.com/english/before-you-fly/health/medical-information-form/
KAISER PERMANENTE. Clinical Review Criteria: Emergency Room and Post-Stabilization Care. Kaiser Permanente[online]. Reviewed by Cynthia Horak, MD (RTMC); Kathryn Kelly, MD (Pediatrics). [cited 2025-02-15]. Available from: https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/coverage-information/clinical-review-er-and-post-stabilization-care-nw.pdf
ŠTĚRBA, Bohumil. Repatriation of Patients. VSZdrav [online]. 2024. [cited 2025-02-15]. Available from: https://is.vszdrav.cz/th/trx45/Repatriace_pacientu_31.3.2024.pdf?kod=ZZNPP6798
U.S. AIR FORCE MOBILITY COMMAND. Mechanical Ventilation during Critical Care Air Transport. Clinical Practice Guideline [online]. December 14, 2021 [cited 2025-02-15]. Available from: https://jts.health.mil/assets/docs/cpgs/Mechanical_Ventilation_during_CCAT_14_Dec_2021_ID48.pdf
INTERNATIONAL AIR TRANSPORT ASSOCIATION. Medical Manual, 12th Edition. Montreal – Geneva: International Air Transport Association, 2020. ISBN 978-92-9264-250-1. [cited 2025-03-24]. Available from: https://www.iata.org/en/publications/medical-manual/
Learning targets
2.The student understands the specifics of aeromedical repatriation.
3. The student is familiar with patient care during aeromedical repatriation.
Key points
2. Before the repatriation begins, the patient must be fit for transport, meet the "fit to fly" criteria.
3. The repatriation team must be informed about the patient’s condition, adequately prepare for it, and secure all equipment (hygiene supplies, medical devices, medications, etc.).
4. Air repatriation involves certain specifics, such as the air expandation due to changes in atmospheric pressure at higher altitudes.
