Transport Safety, Equipment, and Operations
Safety is a system, not a slogan
Every transport begins with a go/no-go decision: patient acuity, crew competence, vehicle capability, weather, and distance. Know the safety framework - checklists, briefings, sterile cockpit during critical phases, closed-loop communication, and a designated safety officer when roles allow. In aircraft the hazards are noise, vibration, fatigue, and unsecured equipment; anything that can become a projectile in turbulence must be strapped down, including monitors, pumps, and oxygen cylinders.
Equipment: verify battery charge and spares, oxygen supply plus a reserve, suction, bag-valve-mask, airway kit, defibrillator, and drug bag before every trip. Cylinder duration is (psi × cylinder factor) ÷ flow. An E cylinder (factor 0.28) at 2,000 psi running 15 L/min gives roughly 37 minutes - always plan for the worst case plus reserve.
Gas laws matter in flight: Boyle's law means gas in endotracheal cuffs, pneumothoraces, and air emboli expands as cabin pressure falls. Check and adjust cuff pressures, avoid overinflation of air splints, and keep a high index of suspicion for barotrauma.
Trap: computing oxygen duration from the gauge with no reserve, or assuming a cylinder is full because it feels heavy.
Worked example: a 90-minute flight with the patient on 10 L/min requires 900 L. An M cylinder (factor 1.56) at 2,000 psi holds about 3,120 L; plan two cylinders for margin, plus a bag-valve-mask backup.