In this Q&A, Dr Ben Powell shares insights into in-flight deterioration and aeromedical trauma care.

For Dr Ben Powell, an emergency physician working across Retrieval Services Queensland and Ipswich Emergency Department, his research started with a question from practice: how can we better predict which patients will deteriorate during aeromedical transfer?

That question grew into a Master of Philosophy examining in-flight deterioration in trauma patients, drawing on a large statewide dataset and supported by EMF funding for statistical expertise. His work explored whether commonly used trauma scores could be applied in the aeromedical setting and uncovered important insights about when deterioration occurs, and why hospital-based tools don’t always translate to retrieval medicine.

In this Q&A, Dr Powell shares his pathway into research, key findings from his MPhil, and practical advice for clinicians looking to get started.

My MPhil, completed between 2022 and 2025, focused on in-flight deterioration in aeromedical trauma patients. One of the first things I looked at was whether commonly used hospital-based trauma scores could be applied in the aeromedical setting. These included tools like the Triage Revised Trauma Score, GAP score and shock index.

We found that none of these scores performed well enough to be clinically useful in aeromedical retrieval. That was somewhat surprising, particularly given that some are used effectively in other settings like ground transport. It reinforces the broader point in retrieval medicine, tools that work in hospital don’t always translate to pre-hospital environments.

How did EMF funding support the work?

EMF funding played a key role in enabling the project. Early on, I identified that statistics and data analysis would be a major challenge as I had a dataset of around 4,000 patients but didn’t have the expertise to analyse that on my own. The grant allowed me to work with a statistician, which was essential to completing the research in a meaningful way.

One of the more unexpected findings was around when deterioration actually occurs. We found that most clinically significant deterioration happens very early, within the first 10 minutes of a primary flight and the first 15 minutes of an inter-hospital transfer.

I initially expected deterioration to occur later, after time for physiological processes to progress, but the data showed otherwise. It highlights how different the aeromedical environment can be, and the importance of understanding those early phases of care.

It was critical. A lot of this project was shaped by mentors, collaborators, and colleagues, who helped guide the process. One of the biggest lessons for me was the importance of team selection. Having the right people involved, particularly a statistician who understands your thinking but is also willing to challenge your interpretation, makes a huge difference.

One key takeaway is that hospital-based tools shouldn’t be assumed to work in retrieval medicine. That’s already something well recognised in practice, and this research reinforces it. The finding around early deterioration may also influence how clinicians approach the initial phase of a flight. The first 10-15 minutes, when clinicians might otherwise be focused on documentation, is actually when vigilance needs to be highest. It also raises questions about whether patients could be better optimised prior to departure.

I’m currently working on further research focused on telehealth-supported resuscitation in the retrieval setting. There is still a lot of work in this space, and ongoing opportunities to improve how data and systems can support patient care.

The biggest thing is to build your team early. One of the mistakes I made was starting data collection before fully engaging with my statistician, which cost me a significant amount of time. It’s important that everyone involved, including those analysing the data, is engaged from the beginning and clear on the plan. In terms of grant applications, clearly communicating how the funding will be used is really important. Be specific, outline what the money is for, how you’ve estimated costs, and why it’s necessary.

Explore outputs from this research on in-flight deterioration, including Dr Powell’s Thesis, Predicting in-flight deterioration and need for critical care interventions in Australian aeromedical trauma patients (2026), and peer-reviewed publication, In-Flight Deterioration Occurs Early in Aeromedical Trauma Patients (2025)