The complexities of aeronautical transfer of acutely unwell neurosurgical patients.

Objective: Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors which deserve special consideration in the preparation of these patients for transfer.

Methods: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (MJ) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en-route.

Results: Several criteria must be met for a transfer to be considered. The safe transfer of patients with cranio-spinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en-route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions which can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended, and is included below. The timing of transfer concerning the postoperative patient deserves special consideration.

Conclusions: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.