History of Air Medical Transport

• The hot air balloon period.
• Transport by bi-plane without observation.
• Multi transport by remodeled military airplanes.
• Transport by helicopter during war times.

Operations

• Important insurances to have.
• Choice of medical personnel according to qualification and scope of care.
• Medical crew introduction.
• Initial training programme.
• Necessary medical equipment.
• Medication. How much to order, how to stock, how to check easily.
• Fit-to-Fly or Evacuation? Impact on choice of aircraft and composition of crew
• Familiarisation with pilots' workload and duty times.
• Familiarisation with airplane and emergency equipment.
• Loading of the equipment. What to keep where.
• Safe loading and unloading of a patient.
• Procedures in the cabin. Your role in between of cabin crew and medical passenger.
• Communication with the office, the insurance/assistance company, the referring and receiving hospitals, and the ground ambulance companies.
• Documentation requirements.
• Travel documents, visa, vaccinations, health checks.

Altitude Physiology

• The atmosphere.
• The gas laws with calculations.
• The gas laws and the human body.
• The gas laws and your equipment.
• The stressors of flight influencing your functionality.
• The stressors of flight influencing patient health.
• Pressurisation and (rapid) decompression, TUC.
• The different types of hypoxia.
• Decompression sickness.
• How to counteract the negative effects of flying on your patient.
• The different environmental conditions for patients in bigger airplanes compared to smaller jets.

Intensive Care / Critical Care Transfers

• Necessary qualification of personnel for safe transfers.
• Necessary equipment.
• The importance of working space.
• Which information to collect before flying?
• Which communication to be done before flying?
• Which medical procedures to be done at which phase of the transfer.
• Necessary standard of ground ambulances.
• Documentation.
• Legal aspects.

Mechanical Ventilation

• Basics of oxygenation and ventilation.
• Basic settings of a mechanical ventilator.
• Advanced settings of a mechanical ventilator.
• Different (international) ventilator modes and how they differ.
• Actual ICU ventilation modes.
• What you can see from ventilation curves and loops.
• The importance of capnography, even in non-ventilated patients.
• Critical care transport ventilators and their specifications.
• Which critical care transport ventilators function well at altitude?
• Which critical care transport ventilators can ventilate a sick lung?

Flight Nursing and Flight Physiotherapy

• Procedures to be done frequently.
• Physiotherapy even in small cabins.
• How to fight the effects of third spacing.
• How to perform procedures without losing lines.
• The positive effect on yourself working on and with the patient.

Hygiene - Precautions

• Which vaccinations are a must, which are recommended?
• The problem with Malaria and chemoprophylaxis.
• The actual travel medical situation for Malaria.
• The actual travel medical situation for Yellow Fever.
• The actual travel medical situation for Typhoid Fever, Meningitis, Dengue, Chikungunya, Zika, MERS, and the dangers for us.
• Professional behaviour to prevent food poisoning while on a mission.

Hygiene - Flying an Infectious Patient

• Ways of transmission.
• Proper procedures for hand hygiene.
• Procedures to minimise the risk of getting infected or spreading the germ.
• Are the pilots at risk?
• Personal Protective Equipment (PPE).
• How to protect yourself and the pilots and still have a workable situation.
• Disinfection of equipment and cabin.
• Documentation.
• Communication (personnel, hospitals, ground ambulances, airport employees).

Hygiene - Multi Resistant Germs

• Classification of bacteria, spores and toxins.
• Colonisation location and precautions.
• How are they transmitted? Specific necessary PPE to prevent transmission.
• Survivability of germs on surfaces.
• Dangers to transfer personnel depending on situation in referring hospital.
• Countries with high rates of and specific strains of multi resistant germs.

Resuscitation (including First Aid Training for Pilots)

• The latest guidelines from October 2021
• Basic Life Support
• Advanced Life Support
• Automated External Defibrillator
• The incapacitated pilot
• (Near) drowning
• Allergic shock
• The typical signs of myocardial ischaemia during flight compared to on the ground.

Trauma Management

• Initial assessment and stabilisation.
• Difficult airway and helpful equipment.
• The danger of ARDS and how to ventilate the trauma patient.
• Thoracic drainage placement for pneumothorax or hematothorax.
• Dealing with traumatic brain injury.
• Trauma induced coagulation disorders.
• Basics on fracture stabilisation.
• Lab results and what to correct before flight.
• The importance of blood gas analysis even in non-ventilated patients.
• What is still in some national guidelines but harms the patient?

Burns Management

• Estimation of degree and surface percentage.
• When breathing difficulties must be expected.
• Wound cover.
• Fluid management.
• Pain management.
• Positioning during flight.
• Choice of hospital (flight time vs expertise).

Medical Diagnoses and Air Medical Transfer

• Depending on the diagnosis, the treatment and the time since onset or treatment, a patient should not be flown, may have to be flown by air ambulance or may be flown by commercial airliner with or without a medical escort. We point out the options.

The Psychiatric Patient

• Which are the "trouble" diagnoses?
• When do you need a legal guardian?
• Correct way of consenting to air medical transfer.
• What are the laws when you want to sedate a patient?
• What are your rights?
• When is physical or pharmacologic fixation legally allowed?
• Who is responsible at selective locations? 

Ground Ambulance Transport

• The most dangerous part of the patient transfer.
• What to check when ordering a ground ambulance?
• What to check before entering a ground ambulance?
• What to check after having boarded a ground ambulance?

Air Medical Resource Management

• The history of CRM and its' limitations.
• The evolution of CRM.
• Cultural differences in CRM - aviation compared to medicine.
• The evolution to Air Medical Resource Management
• The single steps towards a good functioning team.
• No team player? No flight!

Quality System

• How to install a quality system?
• Who should participate in which stage?
• Which medical data to collect?
• Which operational data to collect?
• Feedback from whom and how?
• Case review and analysis.
• Written procedures and their necessity for quality.
• How to analyse the data?
• Quality meetings and the aim of improving.
• The circle of improvement.

Ditching and Surviving in the Cold

• How to prepare the cabin before ditching?
• Where to position necessary safety equipment?
• How to prepare the patient?
• How to position yourself before ditching?
• What to do when after ditching?
• How to find the exit?
• How to stay as warm as possible in the water?
• How to enter the life raft?
• How to use survival equipment?

Smoke and Fire in the Cabin

• How to detect and find a fire in the cabin?
• What is the main origin of fire and smoke in the cabin?
• Specific roles of the medical team in case of fire.
• What to prepare before attempting to fight the fire?
• How to approach a fire?
• How to use the axe?
• How to use the fire extinguisher?
• Different kinds of fire extinguishers and important things to know.

Hazardous Materials

• Different classes of hazardous materials and examples.
• What are the hazardous materials we encounter during our work?
• What are the health threats of the hazardous materials we encounter?
• What is the treatment when exposure occured?
• How to deal with biological and potentially infectious waste?

Aviation

• Aerodynamics.
• Parts of the airplane.
• Function of a jet engine.
• Air intake and pressurization.
• Pitot tube and static vent.
• Instruments in the cockpit.

Meteorology

• The climatic zones of the earth.
• Low pressure and high pressure areas and the generation of wind.
• The Coriolis effect.
• Fronts and specific weather phenomena.
• Local weather phenomena.
• Cloud types and their specifications.
• Where to expect turbulences, including CAT.
• Aviation weather reports and forecasts explained (METAR, TAF).

Legal Aspects

• National medical certification
• Registration of aircraft
• Countries underneath
• Departure & arrival country
• Who is responsible for the patient at which location?
• Consenting, legal guardian
• Aviation laws