A new study, Insulin Administration Safety Profile During Military En Route Critical Care Transports, published in Military Medicine, is raising important questions about insulin administration practices during Critical Care Air Transport (CCAT) missions. This collaborative effort, involving researchers from the Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, the En route Care Research Center (ECRC), 59MDW, Science & Technology, Defense Health Agency, Joint Base San Antonio, and the Department of Surgery, University of Cincinnati College of Medicine, analyzes a decade’s worth of data and reveals critical insights into potential risks and areas for improvement in this challenging environment. The study, conducted by researchers at the En Route Care Research Center (ECRC) in San Antonio, retrospectively reviewed 2,998 patient records from CCAT missions between 2012 and 2022. Focus was placed on the 59 patients (2%) who received insulin during air transport. The aeromedical evacuation setting presents unique logistical and physiological stressors from confined spaces and low-light conditions to persistent aircraft noise and resource limitations. These factors can significantly increase the risk of adverse drug events (ADEs), making medication safety a paramount concern. 

The findings revealed a concerning trend: while insulin infusions were relatively infrequent, administered in only 13 cases, they were associated with a notably high rate of hypoglycemia, at 23%. This underscores the inherent difficulty in precisely managing insulin infusions in the dynamic and often unpredictable air transport environment. Furthermore, the study highlighted inadequate glucose monitoring practices, particularly during intravenous push (IVP) insulin administration. A staggering 60% of IVP administrations lacked a documented glucose check within one hour, potentially leaving patients vulnerable to undetected and untreated hypoglycemia. 

These findings highlight the need for reevaluating current CCAT practices. The current model relies heavily on individual healthcare provider expertise, but this study reveals significant vulnerabilities in the consistency and accuracy of medication management.  

The research team suggests that these vulnerabilities stem from the unique challenges of en route critical care, which demand heightened awareness and standardized protocols. 

Considering these findings, the study's authors recommend a shift towards prioritizing subcutaneous (SQ) insulin as the first-line treatment for hyperglycemia during ERCC missions. This recommendation is based on the increased predictability and ease of administration associated with SQ injections compared to infusions and IVP. However, the researchers emphasize that if CCAT teams opt for intravenous insulin administration, they must implement robust glucose monitoring protocols to ensure patient safety. 

The researchers hope that the study will catalyze change, informing pre-deployment readiness training for CCAT personnel and guiding the development of updated clinical care practice guidelines. By implementing standardized protocols, prioritizing SQ insulin administration where appropriate, and emphasizing rigorous glucose monitoring, the aim is to mitigate the risk of hypoglycemia and ultimately improve patient outcomes in the challenging ERCC environment. Further research is planned to investigate the effectiveness of specific interventions in enhancing medication safety during air transport.