Air medical retrieval of acute psychiatric patients.

Background: The aim of this study is to review the characteristics of acute psychiatric patients requiring air medical retrieval across the Northern Territory (NT) of Australia, to assess the sedation requirements and incidence of in-flight complications when retrieving such patients, and to review the optimal flight crew composition required for safe retrieval.

Methods: Retrospective data were collected for all psychiatric patients retrieved by an air medical retrieval service of the NT of Australia over a 12-month period between February 1, 2012, and January 31, 2013.

Results: Two hundred sixty-two patients were retrieved using fixed wing transport; 90% were indigenous. Eighty-one percent of retrievals occurred during the day, averaging approximately 4.5 hours. A flight doctor was tasked with a nurse to retrieve 79% of patients. Eighty-nine percent of patients received sedation in the health care center before flight, whereas 39% of total patients required further in-flight sedation. Only 8 patients required intubation before transport. The only in-flight complication was hypotension occurring in 6% of patients; these cases predominantly involved the use of propofol, and the hypotension was rapidly corrected without further incident.

Conclusions: This review highlights the characteristics of psychiatric patients retrieved by an air medical retrieval service in the NT of Australia. The majority of patients retrieved had a background psychiatric history and also a history of violence. Given the nature of the retrieval and the risk to crew and aircraft, a flight doctor was tasked on a high number of cases. The complication rate was negligible. Further analysis of patient history and characteristics of violence could lead to a risk assessment tool for the retrieval of such patients.