The first step leading to the assigning of an air ambulance is the decision by the medical authority, usually a physician or nurse, to move the patient by air. The changes associated with flying, however, may constitute an additional hazard for some patients. It is important that medical personnel are aware of the effect of the aviation environment on various conditions and make their decision based on an established set of criteria. Health Canada has produced a manual "Patient Care in Flight" for the guidance of its Medical Services Personnel and this publication, or a similar one, should be available to those charged with initiating air ambulance service requests.
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