By Mark A. Merlin, DO, EMT-P, FACEP, Joshua Schwarzbaum, MD, EMT, Sim Shain, MICP, EMT-P, NRP, Mark Chapman, RN, Ammundeep Tagore, MD, MSHA, MBA, Navin Ariyaprakai, MD, EMT-P, FAEMS, Jodi Pritchard, RN, BSN, CCRN, CFRN, Joseph E. DiCorpo, BSC, MMSc, PA and Alexander Torres, DO, MBA | 3.6.19 The need to move ill or injured patients from one location to another by air isn’t a new concept. Injured soldiers were among the first patients in history to be transported by air to a medical facility, beginning with the use of hot air balloons in 1784.1 Since fixed-wing aircraft were developed in 1903, the use of these engineering marvels for patient transport has seen incredible advances. Although an invaluable resource, in addition to the medical care required on the ground, there are important physiologic changes that occur at higher altitudes and must be considered by the transport personnel. Some of the physiologic changes include, but aren’t limited to, development of hypoxia, potential for gas expansion, and effects of gravitational forces. These impacts on patient homeostasis must be addressed prior to patient movement to ensure patient safety and provide for the best patient outco...