In-Flight Pharmacological Management of Patients with Acute Mental Health Disturbance.

Objective: Patients can be transferred many hundreds of kilometers with acute mental health disturbance for specialist mental health services in Western Australia.

Methods: A retrospective notes review of Royal Flying Doctor Service Western Operations records was undertaken over a 4-month period. Patients were identified from the transfer database by mental health diagnosis. Benzodiazepine and antipsychotic doses were converted into a reference drug per class for comparison.

Results: One hundred ten patients underwent air transfer in a total of 130 flights. Over 80% of patients were involuntary patients being transferred for specialist psychiatric evaluation and management in an inpatient mental health unit. Over half of the patients required no in-flight sedation, and around 80% of patients were managed with standard doses of first-line agents (haloperidol, midazolam, and diazepam). A small number of patients required alternative agents for refractory sedation, most commonly ketamine and propofol. There were no statistically significant differences for in-flight medication by sex, ethnicity, or substance misuse status.

Conclusions: The rate of in-flight incidents including violence remained low. Transfers of patients with acute mental health disturbance are challenging, and quality preflight assessment and in-flight care are required to minimize the associated risks.