Air transport of paediatric trauma patients in Brazil

Trauma is one of the most common causes of mortality and morbidity in the paediatric population, which has special requirements and more rapid decompensation. Therefore, the ‘golden hour’, known as the second peak of the trimodal death distribution, is assumed to have even greater importance in this age group. In this context, the use of an air ambulance helps to shorten the time from injury to definitive treatment.

In July 2024, a traffic accident involving two cars and a truck occurred in Montividiu, in the state of Goiás, Brazil, resulting in two deaths – an adult and a child – at the scene of the accident, and four other children were injured. The victims were treated at the scene and taken to the nearest hospital, where they were stabilised in the initial assessment.

The youngest child, four years old, showed signs of abdominal and thoracic trauma, as well as fractures in the lower limbs. The condition worsened, requiring endotracheal intubation. The oldest child, six years old, showed signs of moderate traumatic brain injury with otorrhagia, a fluctuating level of consciousness, and fractures of the arm, pelvis, and femur.

Due to the distance from the site of the injury to the trauma centre, the collision kinetics, and the severity of the victims, the city hall contacted our team for transportation from Montividiu to Goiânia, the state capital, where the trauma centre is located. Thus began the logistics for transporting the two children, involving considerations of time and location, as the air strip closest to the hospital of origin was privately owned.

Our team took off from Goiânia to Montividiu with two aircraft, both staffed with a physician specialised in aerospace medicine and an intensive care nurse. Upon arrival, two ambulances were waiting to transport the children from the hospital due to the severity of their conditions. The team evaluated them according to Advanced Trauma Life Support (ATLS) protocols, and Extended Focused Assessment with Sonography for Trauma (e-FAST) was also used to ensure greater safety during transport. The children were then prepared for air medical transport.

The flight duration was around 45 minutes, covering 224 kilometres; in contrast, by land, the estimated travel time would have been almost four hours. The children were monitored throughout the journey, and there were no complications in-flight. In Goiânia, two other ambulances were waiting for us, supported by the military police, to escort us to the trauma centre. The patients arrived in good clinical condition and remain in excellent hospital recovery.

Several studies demonstrate that shorter times to definitive care result in better patient outcomes, especially in the paediatric age group. This case corroborates the importance of aeromedical support in a large country with challenges in accessing the best resources.