The need for multiple vascular access or preemptive central venous catheterization in patients requiring planned interhospital helicopter transport: a flight doctor’s suggestion

Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.