Body temperature change and outcomes in patients undergoing long-distance air medical transport

Published:April 30, 2018DOI:



      Short-distance air medical transport for adult emergency patients does not significantly affect patients' body temperature and outcomes. This study aimed to examine the influence of long-distance air medical transport on patients' body temperatures and the relationship between body temperature change and mortality.


      We retrospectively enrolled consecutive patients transferred via helicopter or plane from isolated islands to an emergency medical center in Tokyo, Japan between April 2010 and December 2016. Patients' average body temperature was compared before and after air transport using a paired t-test, and corrections between body temperature change and flight duration were calculated using Pearson's correlation coefficient. Multivariable logistic regression models were then used to examine the association between body temperature change and in-hospital mortality.


      Of 1253 patients, the median age was 72 years (interquartile range, 60–82 years) and median flight duration was 71 min (interquartile range, 54–93 min). In-hospital mortality was 8.5%, and average body temperature was significantly different before and after air transport (36.7 °C versus 36.3 °C; difference: −0.36 °C; 95% confidence interval, −0.30 to −0.42; p < 0.001). There was no correlation between body temperature change and flight duration (r = 0.025, p = 0.371). In-hospital death was significantly associated with (i) hyperthermia (>38.0 °C) or normothermia (36.0–37.9 °C) before air transport and hypothermia after air transport (odds ratio, 2.08; 95% confidence interval, 1.20–3.63; p = 0.009), and (ii) winter season (odds ratio, 2.15; 95% confidence interval, 1.08–4.27; p = 0.030).


      Physicians should consider body temperature change during long-distance air transport in patients with not only hypothermia but also normothermia or hyperthermia before air transport, especially in winter.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Frakes M.A.
        • Duquette L.
        Body temperature preservation in patients transported by air medical helicopter.
        Air Med J. 2008; 27: 37-39
        • Hatfield M.L.
        • Lang A.M.
        • Han Z.Q.
        • Proksch M.
        The effect of helicopter transport on adult patients' body temperature.
        Air Med J. 1999; 18: 103-106
        • Sookram S.M.
        • Barker S.
        • Kelly K.D.
        • Patton W.
        • Sosnowski T.
        • Neilson K.
        • et al.
        Can body temperature be maintained during aeromedical transport?.
        CJEM. 2002; 4: 172-177
        • Miller M.
        • Richmond C.
        • Ware S.
        • Habig K.
        • Burns B.
        A prospective observational study of the association between cabin and outside air temperature, and patient temperature gradient during helicopter transport in New South Wales.
        Anaesth Intensive Care. 2016; 44: 398-405
        • Hardy B.M.
        • Chan S.
        • Martin A.B.
        • Brieva J.
        • Gallagher A.
        • Sokolowsky A.
        • et al.
        Temperature change in the helicopter transport of trauma patients.
        ANZ J Surg. 2013; 83: 894-895
        • Fiege A.
        • Rutherford W.F.
        • Nelson D.R.
        Factors influencing patient thermoregulation in flight.
        Air Med J. 1996; 15: 18-23
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Moffatt S.E.
        Hypothermia in trauma.
        Emerg Med J. 2013; 30: 989-996
        • Kushimoto S.
        • Gando S.
        • Saitoh D.
        • Mayumi T.
        • Ogura H.
        • Fujishima S.
        • et al.
        The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.
        Crit Care. 2013; 17: R271
        • Laupland K.B.
        • Zahar J.R.
        • Adrie C.
        • Schwebel C.
        • Goldgran-Toledano D.
        • Azoulay E.
        • et al.
        Determinants of temperature abnormalities and influence on outcome of critical illness.
        Crit Care Med. 2012; 40: 145-151
        • Wheeler R.
        • von Recklinghausen F.M.
        • Brozen R.
        Blood administration in helicopter emergency medical services patients associated with hypothermia.
        Air Med J. 2013; 32: 47-51