When air medical transport is considered elective (eg, repatriation of patients from foreign countries where quality medical care is available), the risks and benefits should be considered. The social benefit of returning patients to their country is treatment in their language near their family and support system. For patients with travel insurance, if the anticipated cost of hospitalization exceeds the cost of air medical transport, insurance companies may prefer to repatriate patients to local health-care systems as soon as possible.
Although the apparent benefits often justify the cost of air medical transport (whether paid for by the patient or an insurance company), the potential risks are less clearly defined. The transport of a patient with a recently stabilized coronary syndrome, in a hypoxic environment without possibility of surgical backup, is a potentially hazardous situation that demands rigorous patient selection.
This article aims to review the subject of air medical transport of patients with cardiac disease. The issues to be discussed include the history of air medical transport, the physiology and potential risks of flight, the data available regarding air transport of cardiac patients, the present state of technology available in an air ambulance, and the current guidelines regarding air travel for cardiac patients.
The origins of rotary-wing air medical transportation date back to 1944 when the US military first used helicopters for air medical evacuation of the injured in Burma. US military helicopter evacuation dramatically expanded during the Vietnam War in the 1960s. The success of US military helicopter evacuation in Vietnam established the foundation for, and acceptance of, helicopter transport in hospital systems. Civilian helicopter emergency medical services have their roots in military air medical evacuation programs.
In 1966, the US Highway Safety Act allowed for the transfer of military helicopter technology for civilian use. US civilian air emergency medical services began in Denver in 1972. With the increasing availability of cardiac catheterization laboratories in tertiary care hospitals in the 1980s, the demand for emergency air medical transport of cardiac patients increased rapidly. Emergency helicopter transport was a faster and more efficient way to transport patients from rural settings for reperfusion techniques such as thrombolysis or angioplasty following acute MI. The number of civilian air medical transport programs rapidly grew to a total of 280 by 1995.