Safety of early air travel after treatment of traumatic pneumothorax

T raumatic pneumothorax (PTX) is a commonly encountered injury seen by trauma services and emergency departments on a regular basis. It often occurs in patients who are travelling or vacationing far from home or who have been transferred by air to a higher level of care for treatment for their injuries. The Aerospace Medical Association has presented guidelines stating that PTX is an absolute contraindication to air travel and that air travel is generally safe 2 3 weeks after successful drainage of PTX (1). Current guidelines from the Orlando Regional Medical Center and the British Thoracic Society also recommend delaying air travel for 14 days after radiographic resolution of PTX (2,3). This imposed waiting period can cause significant financial and emotional hardship on patients who have sustained a traumatic PTX and are not permitted to fly home for the recommended 14 days. The Alaska Native Medical Center (ANMC) in Anchorage, AK, is a 150-bed tertiary referral facility and level II trauma centre. The centre serves 140,000 Alaska native people living in an area twice as large as the state of Texas. ANMC is part of the larger tribal health system that provides primary care at over 200 small villages with facilities ranging from clinics to small regional hospitals staffed by primary care providers. Aeromedical transport is the prime means of moving seriously injured patients to definitive care in Anchorage or Seattle. ANMC is a contained system and is able to follow up patients after discharge to the primary care system. Many of the patients treated at this facility live in ‘‘Bush’’ Alaska, small, remote villages off the road system accessible only by boat, snowmobile or bush plane. Regional commercial jet service to and from Anchorage with bush plane links to the smaller villages is the primary means of long distance travel throughout the state. Efficient, safe, discharge and follow-up of these patients is very challenging and can be quite expensive. Due to these logistics as well as patients’ desires to get home as soon as possible, ANMC has routinely allowed patients to fly home sooner than the recommended 14-day waiting period. As ANMC is part of a closed health system, it was possible to determine when patients flew and if there were any complications in this group of patients allowed to fly early.