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Air Med J. 2018 Mar - Apr;37(2):115-119. doi: 10.1016/j.amj.2017.12.002. Epub 2018 Feb 21.

In-Flight Pharmacological Management of Patients with Acute Mental Health Disturbance.

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Royal Flying Doctor Service (Western Operations), Jandakot, WA, Australia.
Royal Flying Doctor Service (Western Operations), Jandakot, WA, Australia; Plymouth Hospitals NHS Trust, Anaesthetics Department, Derriford Hospital, Derriford Rd, Crownhill, Plymouth, Devon, United Kingdom.
Royal Flying Doctor Service (Western Operations), Jandakot, WA, Australia. Electronic address:



Patients can be transferred many hundreds of kilometers with acute mental health disturbance for specialist mental health services in Western Australia.


A retrospective notes review of Royal Flying Doctor Service Western Operations records was undertaken over a 4-month period. Patients were identified from the transfer database by mental health diagnosis. Benzodiazepine and antipsychotic doses were converted into a reference drug per class for comparison.


One hundred ten patients underwent air transfer in a total of 130 flights. Over 80% of patients were involuntary patients being transferred for specialist psychiatric evaluation and management in an inpatient mental health unit. Over half of the patients required no in-flight sedation, and around 80% of patients were managed with standard doses of first-line agents (haloperidol, midazolam, and diazepam). A small number of patients required alternative agents for refractory sedation, most commonly ketamine and propofol. There were no statistically significant differences for in-flight medication by sex, ethnicity, or substance misuse status.


The rate of in-flight incidents including violence remained low. Transfers of patients with acute mental health disturbance are challenging, and quality preflight assessment and in-flight care are required to minimize the associated risks.

[Indexed for MEDLINE]

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