The support of severe respiratory failure beyond the hospital and during transportation

Purpose of review: Given the number and variety of calamities in the past few years, providing support for critically ill and injured casualties has become a global priority. This article reviews and describes the challenges faced in providing critical care and respiratory support in an austere environment and during medical transport. The primary focus to be discussed is mechanical ventilation. Recent findings: The United States Air Force has developed a programme called the Critical Care Aeromedical Transport Teams. These teams provide dynamic and sophisticated critical care in austere environments, including during medical transport. The Critical Care Aeromedical Transport Teams programme provides a framework for the discussion of supporting respiratory failure in these settings. We will discuss the team concept of operations, the equipment assemblage, methods and techniques of intensive care unit patient care in this setting, and caveats and pitfalls as they pertain to respiratory failure, mechanical ventilation, and respiratory monitoring. Summary: The support of respiratory failure with mechanical ventilation during a disaster is complex and challenging. The key to success is pre-planning, flexibility, and portability. Programmes such as the Critical Care Aeromedical Transport Teams can be a useful model for the development of appropriate civil response capabilities in critical care for use during a disaster.