Critical Care Air Transport Teams care for 5% to 10% of injured patients who are transported on military aircraft to definitive treatment facilities. Little is known about how the aeromedical evacuation environment affects care.


To determine the effects of 2 stressors of flight, altitude-induced hypoxia and aircraft noise, and to examine the contributions of fatigue and clinical experience on cognitive and physiological performance of the Critical Care Air Transport Team.


This repeated measures 2 × 2 × 4 factorial study included 60 military nurses. The participants completed a simulated patient care scenario under aircraft cabin noise and altitude conditions. Differences in cognitive and physiological performance were analyzed using repeated measures analysis of variance. A multiple regression model was developed to determine the independent contributions of fatigue and clinical experience.


Critical care scores (P = .02) and errors and omissions (P = .047) were negatively affected by noise. Noise was associated with increased respiratory rate (P = .02). Critical care scores (P < .001) and errors and omissions (P = .002) worsened with altitude-induced hypoxemia. Heart rate and respiratory rate increased with altitude-induced hypoxemia; oxygen saturation decreased (P < .001 for all 3 variables).


In a simulated military aircraft environment, the care of critically ill patients was significantly affected by noise and altitude-induced hypoxemia. The participants did not report much fatigue and experience did not play a role, contrary to most findings in the literature.

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