Psychiatric Aeromedical Evacuations: Clinical Characteristics of Deployed U.S. Military Personnel During Operation Iraqi Freedom

Considerations for Acute and Emergent Deployed Mental Health Patient Management and Theater Transports: A Scoping Review

“…The primary purpose of 31% (n = 19) of review articles was to describe the characteristics of patients evacuated from a deployed setting. 7 , 19–35 Studies revealed that typically young, male, Army enlisted, 7 , 24 , 29 , 31 , 33 , 34 , 36 first-time deployers 29 described most psychiatric AE patients, who were most often categorized by patient movement precedent code of Routine 20 , 28 (vs. Priority or Urgent) AEs.…”

“…The most common AE diagnoses included adjustment disorder, depression, anxiety, personality disorder, and PTSD. 7 , 19 , 20 , 22 , 23 , 28 , 29 , 35 Despite more males were transported out of theater, there was an overrepresentation of females and ethnic minorities. 36 Suicide-related events were common 20 , 21 , 23 and individuals evacuated for mental health diagnoses were four times more likely to be discharged or separated upon returning home, as compared to medical AE patients.…”

“…Researchers address the need for education and training, standard guidelines, and protocols for managing mental health patients in deployed and transport environments in 11 articles (18%). 19 , 23 , 27 , 43 , 45 , 49–54 These studies found or suggested that guidelines and protocols decrease safety issues and adverse outcomes 19 , 23 , 24 , 45 , 50 , 54 , 55 and that specific practice models and clear roles for deployed mental health staff potentially contribute to improved outcomes. 27 Study conclusions advocate for utilizing experienced mental health staff for emergency management.…”

“…A total of nine articles included content related to mental health management in deployed settings. 19 , 27 , 53 , 61–66 A review by Glass (1954) was retained, despite its age, due to the extraordinary relevance and timelessness of the contents, which recounts the evolution of frontline psychiatry and novel strategies to prevent massive mental health evacuations through combat operational stress treatment principles of: brevity, immediacy, centrality, expectancy, and proximity (BICEP), a mainstay of current in-theater management. 61 Similarly, a recent exhaustive three-part review by Russell and Figley (2017) discussed the role of deployed mental health providers, as a primary administrative function, returning as many patients to duty as possible to prevent mission degradation; the Command approving only the most severe patients for psychiatric evacuation.…”

“… 63 Several authors advocated for embedded mental health staff, 66 specific practice models and inpatient consultations, 27 potential benefits of deploying psychiatric mental health nurse practitioners, 27 the concept of stabilizing mental health patients for 3-7 days before transport, 7 and standardized operational CPG definitions to decrease variance in diagnostic criteria. 19 …”