title: Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom.
abstract: BACKGROUND
  Our understanding of the expertise and equipment required to air transport injured soldiers with severe traumatic brain injuries (TBIs) continue to evolve.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: L Renee
authors.initials: LR
authors.lastname: Boyd
authors.affiliation: Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: J
authors.initials: J
authors.lastname: Borawski
authors.affiliation: Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lairet
authors.affiliation: Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Limkakeng
mesh_terms: D055826:Afghan Campaign 2001-; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000628:therapy; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: AVIATION MEDICINE; TRAUMA MANAGEMENT