Factors That Affect Pain Management in Aeromedical Evacuation: An Ethnographic Approach.

Background: Pain management is a challenge in the transport setting, but actual factors that influence pain have not been assessed systematically.

Objective: To describe the environmental factors and social context that affect pain management in military aeromedical evacuation.

Methods: Field notes were taken throughout flight, including observational measures of pain, environmental factors, and interactions between the patient and crew. Data collection was completed on 8 missions and 16 patients; common themes were identified that should be considered in the management of pain in aeromedical evacuation.

Results: Communication was a key problem primarily to aircraft noise, the reluctance of patients to speak with crew members while they were wearing headsets, and limited time to assess for pain and provide patient education. Seating and litters appeared to be uncomfortable for ambulatory and litter patients, and preparatory guidance on pain management did not address the stressors of flight or transportation phases. Another compounding factor was the psychological distress, particularly among those leaving a combat zone before the anticipated end of a deployment. Throughout the flight, the military culture of independence, stoicism, and camaraderie also was clearly evident.

Conclusions: Barriers to communication, comfort, and patient education are well known to transport nurses, but it is important to understand the overall effect they have on the management of pain. Developing solutions to address these factors should be a priority to ensure pain is adequately managed throughout transport.