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Transparency in documentation requires late entries clearly marked with time, medication, and reason for delay in entry. Omitting data risks continuity of care. Erasure or falsification is unethical and legally dangerous. Creating unexplained entries compromises chart integrity. Late entries protect accuracy, accountability, and ensure downstream providers are fully informed. In flight medicine, documentation integrity is critical for legal, clinical, and quality assurance purposes.

Brownout occurs when rotor wash stirs dirt/dust, obscuring pilot visibility during approach or landing. Whiteout is similar but in snow. Dynamic rollover involves tipping. Vortex ring state involves airflow dynamics causing uncontrolled descent. Brownout is particularly dangerous in desert or rural scenes. Ground crews should secure the LZ, mark hazards, and wear eye protection. Pilots may use steep approaches and NVGs to mitigate.

Long-range missions often cross time zones and extend duty hours, disrupting circadian rhythms. Fatigue impairs judgment, reaction times, and safety. Pressurization maintains physiology but does not reduce fatigue. Rest periods and noise-canceling devices mitigate stress but do not address circadian disruption. Aviation safety systems emphasize crew rest, duty-hour limits, and fatigue management training to reduce risk during extended fixed-wing transports.

Venous outflow obstruction from neck flexion, rotation, or an overly tight cervical collar elevates intracranial venous pressure and ICP. Ensuring neutral head/neck alignment and loosening or replacing a restrictive collar (when safe) improves venous drainage and can promptly lower ICP. Lowering the head of bed worsens venous congestion. High PEEP can increase intrathoracic pressure, impeding cerebral venous return and raising ICP. High-frequency ventilation is specialized and not an initial step for suspected intracranial hypertension in transport. Combine positioning with adequate sedation/analgesia, normocapnia (PaCO₂ 35–40), and hemodynamic targets to optimize cerebral perfusion pressure while arranging definitive neurosurgical care.

Parkland formula = 4 mL × kg × %TBSA. For 70 kg × 60% = 16,800 mL (16.8 L) over 24h. Half (8.4 L) is given in first 8 hours post-injury, remainder over 16 hours. Actual resuscitation should be titrated to urine output (0.5–1 mL/kg/hr) and hemodynamic response to avoid “fluid creep.” In flight, monitor for pulmonary edema and airway compromise. Early burn center notification and use of fluid warmers reduce complications.