Aeromedical Evacuation of Psychiatric Casualties

Abstract

Psychiatric causalities are one of the most common reasons for aeromedical evacuation (AE) during combat operations. Mental health conditions were the fourth most common AE diagnostic category for US military personnel in Afghanistan between 2001 and 2012 and in Iraq between 2003 and 2011. The proportion of medical evacuations for psychiatric conditions increased between 2003 and 2010. As battle injuries declined, mental disorders became the most common evacuation diagnostic category. During 2013–2015, mental disorders emerged as the most common diagnostic category for AE out of the US Central Command (Afghanistan, Iraq, and surrounding countries) for both males (18.2%) and females (25.5%). The majority of psychiatric patients are evacuated with an inpatient classification code (Classification Codes 1A, 1B, 1C, and 3C). Patients in the Severe (1A) and Intermediate (1B) classifications should be transported on a litter and stabilized with tranquilizers or sedative medications prior to evacuation to reduce agitation, anxiety, and sleep symptoms. These medications may also help prevent self-harm to the patient; injury to the medical attendant, flight crew, or other patients; and damage to the aircraft. Most psychiatric casualties, however, are classified as 1C and are ambulatory but still may need sedation for the long flights. This chapter describes the need for AE of military and civilian patients with a psychiatric diagnosis, the psychiatric categories used for the AE, and the special treatment considerations required for psychiatric patients during AE. The guidelines outlined in this chapter are intended to help prevent injuries to the psychiatric patient, attendant, flight crew, and other patients and to avoid aircraft damage and in-flight emergencies during AE.