Critical Care Air Transport Teams Research Articles

Evolution of Burn Resuscitation in Operation Iraqi Freedom

Abstract : Burns are common in all military conflicts, comprising approximately 10% of all casualties. Of these, nearly 20% are categorized as severe, or involving greater than 20% TBSA, and require significant intravenous resuscitation. A unique set of challenges have emerged during the present conflict associated with global evacuation of burned soldiers, adding a new dimension to the already complex and often-controversial topic of the burn resuscitation. Critical advances in air evacuation of the war wounded, thorough prewar planning, and sustained burn care education of deployed personnel have proven vital in the optimal care of our injured soldiers. During the Vietnam conflict, burned soldiers were evacuated to an Army Hospital in Japan (Camp Zama) and were treated for up to 6 months before they were evacuated to the United States. Since that time, the transfer of the patient to the burn center for definitive care has been expedited by the Army Burn Flight Team's ability to transport the most severely burned patients within the first several days after injury. With the emergence of the U.S. Air Force Critical Care Air Transport Team (CCATT) program in the 1990s, global air evacuation of burn patients became even more rapid, maximizing available U.S. Air Force aircraft for patient evacuation. The doctrine has shifted from aeromedical transport of the stable to aeromedical transport of the stabilized. In burn patients, evacuation presents a unique problem because it usually takes place while resuscitation in the first 24 to 48 hours after burn injury is ongoing. In addition to the innate complexity involved in global evacuation, war burn patients often exhibit multisystem traumatic injuries further complicating and augmenting resuscitation fluid needs above and beyond standard burn resuscitation formulas. The presence of smoke inhalation injury, occurring in 5% to 15% of patients with severe burns, also increases fluid requirements.

Critical Care Nursing Expertise during Air Transport

The purpose of this study was to describe the practical knowledge possessed by registered nurses that are part of the Air Force's Critical Care Air Transport Team (CCATT) and distinguish salient features of CCATT knowledge to critical care nursing in the hospital. This research study used descriptive, exploratory methods. Twelve CCATT nurses, identified as experts, were included in the study. Data were collected using written narratives by each participant; group interviews in which nurses discussed the written narratives; and individual interviews. Data were analyzed using interpretive phenomenology. Four major themes developed from the data. The knowledge embedded in CCATT nursing included: preflight preparation, in-flight assessment and environment, characteristics of CCATT nurse, and hospital vs. in-flight nursing practice. CCATT nurses improvise and provide nursing care based on past experiences using a broad critical care knowledge base. This has led to the development of a unique body of knowledge for nursing care. The areas of assessment and preparation described by the CCATT nurses can serve as a template for the Air Force's CCATT training program and CCATT orientation checklists. This study also identified several topics for future research.