Clinical Impact of Cabin Altitude Restriction Following Aeromedical Evacuation

Combat medical care relies on aeromedical evacuation (AE). Vital to AE is the validating flight surgeon (VFS) who warrants a patient is "fit to fly." To do this, the VFS considers clinical characteristics and inflight physiological stressors, often prescribing specific interventions such as a cabin altitude restriction (CAR). Unfortunately, limited information is available regarding the clinical consequences of a CAR. Consequently, a dual case-control study (CAR patients versus non-CAR patients and non-CAR patients flown with a CAR versus non-CAR patients) was executed. Data on 1,114 patients were obtained from TRANSCOM Regulating and Command and Control Evacuation System and Landstuhl Regional Medical Center trauma database (January 2007 to February 2008). Demographic and clinical factors essentially showed no difference between groups; however, CAR patients appeared more severely injured than non-CAR patients. Despite being sicker, CAR patients had similar clinical outcomes when compared with non-CAR patients. In contrast, despite an equivocal severity picture, the non-CAR patients flown with a CAR had superior clinical outcomes when compared with non-CAR patients. It appeared that the CAR prescription normalized severely injured to moderately injured and brought moderately injured into a less morbid state. These results suggest that CAR should be seriously considered when evacuating seriously ill/injured patients.