En Route Care

  • Joel Elterman
  • Daniel Cox
  • Jay JohannigmanEmail author


The history of aeromedical evacuation parallels that of manned flight. The first fixed wing aeromedical evacuations occurred on limited basis during the First World War with a significantly increased experience occurring during the Second World War. The Korean War introduced the role of rotary-wing transport in decreasing transport time from the forward area of battle to medical care units. Vietnam expanded on this rotary-wing evacuation experience and introduced a limited set of medical interventions for the casualty during the transport process. The experience of aeromedical evacuation in the military during Vietnam was largely responsible for the subsequent proliferation of civilian aeromedical evacuation services in the trauma system of the United States during the latter part of the twentieth century.

The last 15 years of conflict as a result of the Global War on Terrorism has provided an extended experience in the art and medical science of aeromedical evacuation. The scope of this chapter will focus on current concepts of aeromedical evacuation as it evolves into a process of en route care. The evolution from safe transport via the air to a continuous process of medical care and continuous resuscitation marks the pivotal changes that have emerged over the last decades of care in the air. The evolution of terminology from aeromedical evacuation to en route care highlights the focus on principles of care rather than mode of transportation.

This chapter will focus on the challenges of the aeromedical environment, the composition of the advanced care teams (Critical Care Air Transport Teams), and the processes of provision of care in this uniquely challenging space. The current team composition and equipment sets will be discussed along with opportunities for new technologies to positively impact on the provision of en route care.



We are pleased to participate in the publication of this important work by contributing this chapter regarding Enroute Care. The authors have been asked to contribute similar contributions to many other publications over the past twelve months. In preparation for this chapter the authors began from their text of a similar contribution to Eastridge et al (citation). This chapter has been edited in its entirety, and, as appropriate, updated.


  1. 1.
    Lam DM. To pop a balloon: aeromedical evacuation in the 1870 siege of Paris. Aviat Space Environ Med. 1988;59:988–91.PubMedGoogle Scholar
  2. 2.
    Ingalls N, Zonies D, Bailey J, Martin K, Iddins B, Carlton PK, Hanseman D, Branson R, Dorlac W, Johannigman J. A review of the first 10 years of critical care aeromedical transport during Operation Iraqi Freedom and Operation Enduring Freedom: the importance of evacuation timing. JAMA Surg. 2014;149(8):807–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Goodman MD, Makley AT, Lentsch AB, Barnes SL, Dorlac GR, Dorlac WC, Johannigman JA, Pritts TA. Traumatic brain injury and aeromedical evacuation: when is the brain fit to fly? J Surg Res. 2010;164:286–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Johannigman JA, Branson R, Lecroy D, Beck G. Autonomous control of inspired oxygen concentration during mechanical ventilation of the critically injured trauma patient. J Trauma. 2009;66(2):386–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Cincinnati College of Medicine, United States Air Force Center for Sustainment of Trauma and Readiness Skills (CSTARS)CincinnatiUSA
  2. 2.University of Cincinnati College of Medicine, Office of the Command Surgeon, Air Mobility CommandCincinnatiUSA
  3. 3.University of Cincinnati College of MedicineCincinnatiUSA

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