Physicians Should Prepare for In-Flight Medical Emergencies

Jenni Laidman

May 30, 2013

In-flight medical emergencies occur on 1 in every 604 flights worldwide. Airline passengers who are healthcare professionals should be prepared to respond, advise the authors of a study published in the May 30 issue of in the New England Journal of Medicine.

"Medical emergencies during commercial airline travel, although rare when considered on a per-passenger basis, occur daily; traveling physicians and other health care providers are often called on to aid ill passengers. A basic knowledge of in-flight medical emergencies and awareness of resources available can help them be effective volunteers," write Drew C. Peterson, MD, from the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania, and colleagues.

The researchers reviewed records of 11,920 in-flight medical emergency calls to a medical communications center from 5 airlines from January 1, 2008, through October 31, 2010. The study period covered an estimated 744 million passengers and more than 7 million flights, with 16 medical emergencies per 1 million passengers. Overall, the researchers estimated that 44,000 in-flight emergencies occur worldwide each year.

Physician passengers provided assistance in 48.1% of all in-flight emergencies. Nurses were the most highly trained medical person available 20.1% of the time. Emergency medical service providers were the most highly trained person available 4.4% of the time, and other healthcare professionals filled the medical care role 3.7% of the time.

Flight attendants are well-versed in available medical equipment and operational procedures and, in collaboration with the ground-based medical consultants, can manage many medical incidents. "When the need for evaluation or intervention exceeds their capabilities, flight attendants may seek health care professionals on the flight," the authors write.

An emergency medical kit available on every commercial airliner regulated by the Federal Aviation Administration is generally sufficient to initiate treatment for serious medical problems, and airlines often have enhanced medical supplies. Many airlines require consultation with a ground-based physician before the emergency medical kit is used. Further, medical professionals responding to in-flight emergencies are advised to act in collaboration with ground-based medical assistance.

The most frequent in-flight medical emergencies are syncope or presyncope (37.4%), respiratory symptoms (12.1%), and nausea or vomiting (9.5%), the authors found. The most common medications and medical therapies administered were oxygen (49.9%), intravenous 0.9% saline (5.2%), and aspirin (5.0%).

Only rarely (875 times [7.3%]) did in-flight medical emergencies result in aircraft diversion.

Factors most strongly associated with diversion in a multivariable analysis were use of an automated external defibrillator (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.89 - 4.83) and on-board assistance by an emergency medical service provider (OR, 2.82; 95% CI, 1.87 - 4.24). The OR for diversion in physician-assisted cases was 2.32 (95% CI, 1.76 - 3.04). Cardiac symptoms were most likely to result in diversion (OR, 2.75; 95% CI, 2.07 - 3.66), as were possible strokes (OR, 2.52; 95% CI, 1.61 - 3.96). The researchers adjusted for the type of medical problem, aircraft type, automated external defibrillator use, volunteer provider training, whether the patient was an airline employee, airline company, and flight distance.

The authors write that diverting a commercial airliner requires both operational and medical considerations, including an assessment of the time sensitivity of the medical condition, the ability to stabilize the patient onboard, availability of needed supplies, and likelihood of time savings given the time involved in landing and proximity of sufficient medical help on landing. Operational factors include weather, fuel load, the potential need to drop fuel before landing, and the availability of specific aircraft services at airports, as well as air-traffic control.

The medical conditions of 3402 (31.2%) passengers resolved sufficiently before landing, so that emergency services were not requested. Of the patients for whom emergency medical services were requested on landing, 37.3% were taken by ambulance to hospital emergency departments. Of the 10,914 passengers for whom follow-up data was available, 901 (8.6%) were admitted to the hospital or left the emergency department against physician advice.

In-flight emergencies resulted in 36 deaths, 30 of which occurred during flight.

The authors have disclosed no relevant financial relationships.

N Engl J Med. 2013;368:2075-2083. Full text

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