The attending physician and crew must assess whether compelling reasons for transport exist and that these outweigh the risks of transport. Indications for transport vary but most revolve around bringing the patient to a higher and more sophisticated echelon of care. With the development of regional trauma systems, trauma patients comprise most of the critically ill patients transported. Ground and air medical helicopter ambulances, using a crew comprising nurses and paramedics, provide the majority of these transports. Specialized equipment used during transport must be self-contained, rugged, battery powered, and able to operate without interfering with the helicopter's electronic instrumentation. Transport distances over 150 miles require fixed-wing transport at an altitude which entails attention to changes in atmospheric oxygen tension which can lead to hypoxia, decreases in barometric pressure which can lead to dysbarism, and changes in gas volume which can lead to difficulties with endotracheal tubes and Foley catheters and exacerbation of a pneumothorax.

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