Nociception testing during fixed-wing ambulance flights. An interventional pilot study on the effects of flight-related environmental changes on the nociception of healthy volunteers.

Johannes Prottengeier,Michael Meyer,Joachim Schmidt,Andreas Moritz,Stefan Elsner,Andreas Wehrfritz

doi:10.1371/journal.pone.0217530

Johannes Prottengeier, Michael Meyer + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0217530

Copy DOI

Abstract

BackgroundThe effects of environmental changes on the somato-sensory system during long-distance air ambulance flights need to be further investigated. Changes in nociceptive capacity are conceivable in light of previous studies performed under related environmental settings. We used standardized somato-sensory testing to investigate nociception in healthy volunteers during air-ambulance flights.MethodsTwenty-five healthy individuals were submitted to a test compilation analogous to the quantitative sensory testing battery–performed during actual air-ambulance flights. Measurements were paired around the major changes of external factors during take-off/climb and descent/landing. Bland-Altman-Plots were calculated to identify possible systemic effects.ResultsBland-Altman-analyses suggest that the thresholds of stimulus detection and pain as well as above-threshold pain along critical waypoints of travel are not subject to systemic effects but instead demonstrate random variations.ConclusionsWe provide a novel description of a real-life experimental setup and demonstrate the general feasibility of performing somato-sensory testing during ambulance flights. No systematic effects on the nociception of healthy individuals were apparent from our data. Our findings open up the possibility of future investigations into potential effects of ambulance flights on patients suffering acute or chronic pain.

Highlights

Inter-hospital transfers are common medical procedures, that are sometimes carried out using fixed-wing air-ambulances
We provide a novel description of a real-life experimental setup and demonstrate the general feasibility of performing somato-sensory testing during ambulance flights
No systematic effects on the nociception of healthy individuals were apparent from our data

Summary

Introduction

Inter-hospital transfers are common medical procedures, that are sometimes carried out using fixed-wing air-ambulances. Noise, and restricted patient access must be considered in other means of transportation, such as ground-ambulances and mobile ICUs, the rapid alterations in atmospheric pressure, oxygen partial pressure and air humidity that occur during airplane flights are environmental changes that are unique to this mode of transfer. Despite this distinctiveness, most in-flight medical measures are extrapolated from what we know and do when on solid ground. During transfers, analgesia is typically applied as if the patient were in a hospital–regardless of any of the possible effects, the profound environmental changes caused by flying in an airplane might have on human nociception

Methods

Results

Discussion

Conclusion