Air Med J. 2026 Nov-Dec;45(6):543-549. doi: 10.1016/j.amj.2026.07.001. Epub 2026 Aug 12.
ABSTRACT
OBJECTIVE: As international travel rises globally, particularly among older adults with chronic conditions, illness or injury abroad may require air medical repatriation. Contemporary data describing patient characteristics, transport practices, and in-flight events are limited. The objective of this study is to describe the patient demographics, clinical indications, transport characteristics, and in-flight events associated with international fixed-wing air medical repatriation by a single Canadian provider.
METHODS: We conducted a retrospective observational cohort study of all international repatriations completed by Fox Flight Air Ambulance Inc. between 2009 and 2024. Extracted chart data included demographics, diagnoses, transport modality, team composition, interventions, and in-flight events. Outcomes included repatriation completion, mortality, and in-flight events that required intervention. Multivariable logistic regression identified factors associated with in-flight events.
RESULTS: A total of 3,905 transports were included. Patients were predominantly older adults (61.5 ± 21.5 years), with orthopedic/trauma, cardiovascular, neurovascular, and infectious disease diagnoses comprising most repatriations. In-flight events occurred in 26.7% of transports; major events represented 15.0% of all events (3.9% of transports). Subgroup analyses demonstrated significant associations (P < .001) between in-flight interventions and mechanical ventilation, team composition, age group, and transport era. Over time, patients required stretchers and oxygen therapy more frequently, consistent with increasing acuity. In multivariable analysis, independent predictors of in-flight events included age, orthopedic/trauma and neoplasm-related diagnoses, oxygen therapy, invasive mechanical ventilation, and year of transport.
CONCLUSION: Serious in-flight events were infrequent and occurred within transports staffed by experienced teams, although causality cannot be inferred. The findings support risk-informed planning, team composition decisions, and operational strategies to optimize safety and resource utilization.
PMID:42946509 | DOI:10.1016/j.amj.2026.07.001