Jennifer Serres

Assessment of Pain in Less Severely Ill and Injured Aeromedical Evacuation Patients: A Prospective Field Study

Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U.S. military patients being evacuated on Aeromedical Evacuation (AE) missions from Ramstein Air Field, Germany, to Andrews Air Force Base, Maryland, was conducted. Data were collected before and during 12 AE flights in December 2012 and May 2013. Acceptable pain intensity was a median of 6/10 (range 2-9), with 76% of patients indicating an acceptable pain intensity greater than 4. During AE transport, 75% of patients reported at least one pain score≥4. Despite these high pain ratings, there was documentation of administration for only 58% of routine and 48% for as-needed analgesics/adjuvants. Over 47% of patients experienced pain that exceeded their acceptable intensity level, but of those patients with pain that was more severe than acceptable, only 10% rated their satisfaction with their pain management as poor or fair. This is the first study to provide real-time concurrent assessment of pain and pain management during en route care. The worst pain was reported for the hospital to aircraft arrival, suggesting the need for interventions to safely optimize pain management during this handoff period.

Factors That Affect Pain Management in Aeromedical Evacuation: An Ethnographic Approach

&NA; Background Pain management is a challenge in the transport setting, but actual factors that influence pain have not been assessed systematically. Objective To describe the environmental factors and social context that affect pain management in military aeromedical evacuation. Methods Field notes were taken throughout flight, including observational measures of pain, environmental factors, and interactions between the patient and crew. Data collection was completed on 8 missions and 16 patients; common themes were identified that should be considered in the management of pain in aeromedical evacuation. Results Communication was a key problem primarily to aircraft noise, the reluctance of patients to speak with crew members while they were wearing headsets, and limited time to assess for pain and provide patient education. Seating and litters appeared to be uncomfortable for ambulatory and litter patients, and preparatory guidance on pain management did not address the stressors of flight or transportation phases. Another compounding factor was the psychological distress, particularly among those leaving a combat zone before the anticipated end of a deployment. Throughout the flight, the military culture of independence, stoicism, and camaraderie also was clearly evident. Conclusions Barriers to communication, comfort, and patient education are well known to transport nurses, but it is important to understand the overall effect they have on the management of pain. Developing solutions to address these factors should be a priority to ensure pain is adequately managed throughout transport. (Critical Care Nurse. 2018;38[2]:46‐51)

Investigation of Self-Reported Musculoskeletal Injuries on Post-Deployment Health Assessment Forms for Aeromedical Evacuation Personnel

Musculoskeletal injuries (MSIs) are a concern for the military community because of medical expenses, possible disability, and separation from the military. This study investigated the prevalence of MSIs in deployed aeromedical evacuation (AE) populations reported on Post-Deployment Health Assessment (PDHA) forms. A secondary aim was to examine the relationship between the occurrence of self-reported MSIs on PDHAs and a subsequent medical diagnosis. Flight nurses (Air Force Specialty Code [AFSC] 46F) and AE technicians (AETs) (AFSC 4N0 with a flight duty badge) who completed a PDHA during 2008-2010 were investigated. Data from the test population were compared with a control group of deployed ground-based counterparts. During this time period, 1,366 and 1,959 PDHAs were completed by the AE nursing and AET groups, respectively. At least 1 MSI was reported by 18% of AE nurse and 19% of AET compared with 23% of non-AE nurse and 25% of non-AET PDHAs. Of these individuals with reported MSIs, 35% and 44% of AE nurse and AET PDHAs, respectively, had a diagnosis matching their MSIs. Identifying the prevalence of MSIs in the unique AE environment can lead to the development of preventative and ergonomic solutions, minimizing the risk of MSIs and improving mission success.

Records review of musculoskeletal injuries in aeromedical evacuation personnel.

BACKGROUND Aeromedical evacuation providers care for patients during air transport. By applying standard medical practices, oftentimes developed for ground care, these practitioners perform their mission duties under additional physical stress in this unique medical environment. Awkward postures and excessive forces are common occurrences among personnel operating in this domain. Additionally, anecdotal reports highlight the risk of developing musculoskeletal injuries for these providers. Currently, there is limited research focusing on musculoskeletal injuries in aeromedical evacuation providers. PURPOSE To determine the prevalence of musculoskeletal injuries and associated symptoms in aeromedical evacuation providers to understand the risk and burden of these injuries to military personnel. METHODS This study utilized a retrospective review of military medical records containing ICD-9 codes to investigate the incidence of musculoskeletal injuries within flight nurses and medical technicians compared to their non-flying counterparts from 2006 through 2011. Data were analyzed from 2013 through 2014. RESULTS Although musculoskeletal injuries were identified within the test populations, results showed fewer injuries for aeromedical evacuation populations compared to non-aeromedical evacuation counterparts. CONCLUSIONS One contributing factor may be a potential under-reporting of musculoskeletal injuries resulting from the fear of being placed on limited flying status. As flyers, aeromedical evacuation personnel must undergo yearly medical examinations and complete training courses that emphasize proper lifting techniques and physical requirements necessary for the safe and efficient transport of patients on various platforms. These additional requirements may create a healthy worker effect, likely contributing to lower musculoskeletal injuries.