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Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom
  1. L Renee Boyd1,
  2. J Borawski1,
  3. J Lairet2 and
  4. A T Limkakeng Jr1
  1. 1Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr J Borawski, Emergency Medicine, Duke University Medical Center, DUMC BOX 3096, 2301 Erwin Road, Durham, NC 27710, USA; joseph.borawski{at}


Introduction 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.


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  • Contributors LRB—conceived study and abstracted data, drafted first draft of manuscript. JB— revised and reviewed manuscript for critical content, conducted submission and revisions helped analyse and interpret data, final approval of manuscript. JL—reviewed manuscript for critical content, helped analyse and interpret data. AL—reviewed manuscript for critical content, helped analyse and interpret data, final approval of manuscript.

  • Competing interests None declared.

  • Ethics approval Study was exempted from review by local IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.