US Flights Count on Volunteers
While some countries have duty-to-respond regulations that will apply to their airline carriers, US carriers depend on volunteers. A physician needn't be trained in emergency medicine to provide valuable assistance, says Dr Martin-Gill. A podiatrist or a pathologist might not be comfortable starting an IV, he says, and that's okay. She is still better trained to assess a patient and provide care in ways that a typical passenger wouldn't be. Most patients don't require major interventions; simply laying them down and providing oxygen and hydration helps most.
"The care you can provide as a medical authority on board is generally what is needed," he says. "Healthcare providers in the air need to feel comfortable with what they have experience in."
Dr Margaux Lazarin, who practices family medicine in the Bronx, New York, wishes she'd known that medical support was available when she responded to her first in-flight emergency in 2013. Although the patient in that situation recovered quickly after passing out, Dr Lazarin says it would have been reassuring to know she had backup had she needed it. "You feel completely out of your environment when you respond," she says. "And you feel very much alone. You're in vacation mode, not doctor mode, and you feel a lot of pressure to make an accurate assessment, because diverting a flight could really impact a lot of people."
While on-board physicians may feel that weight, Dr Martin-Gill underscores that pilots guided by dispatchers—not physicians responding to a page—are ultimately responsible for deciding whether to divert an airplane, as they must consider numerous factors, such as fuel load, proximity of the nearest airport, and the types of medical facilities located there. "There is collaboration," he says, "but it's the pilot's ultimate decision."
Likely Scenarios and Resources
Physicians who do respond to the request for assistance need to know the situations they're likely to face and the resources available to them.
Of the nearly 12,000 in-flight medical emergencies that UPMC researchers analyzed, more than a third (37.4%) were syncope or presyncope. Respiratory symptoms accounted for 12.1% of medical emergencies, followed by nausea or vomiting (9.5%), cardiac symptoms (7.7%), seizures (5.8%), and abdominal pain (4.1%).
Beyond that, "it's really a smattering of anything that can show up in an ED," says Dr Martin-Gill, with emergencies including infectious disease, psychiatric symptoms, allergic reactions, possible stroke, trauma, diabetic complications, obstetric symptoms, and lacerations. Only a small fraction (7.3%) of medical emergencies resulted in an aircraft being diverted, and less than 1% (.3%) resulted in death. Of the patients who died, the vast majority (31 of 36) suffered cardiac arrest.
While in-flight medical resources may be Spartan compared with those of a metropolitan ED, Dr Martin-Gill says the analysis shows that flight crews and the volunteers assisting them generally have the resources they need to address most emergencies.
Since April 2004, the FAA has required airlines with a capacity of more than 7500 pounds—typically those accommodating 30 passengers or more and at least one flight attendant—to carry an AED, a basic first-aid kit for wound care, and an emergency medical kit. The FAA mandates that at least one kit on board must include a sphygmomanometer, stethoscope, three sizes of oropharyngeal airways, a self-inflating manual resuscitation device with three mask sizes, CPR masks, IV equipment, alcohol sponges, adhesive tape and scissors, a tourniquet, saline solution, gloves, syringes and needles of varying size, analgesics, antihistamine tablets and injectables, atropine, aspirin, a bronchodilator, injectable dextrose, epinephrine and lidocaine, nitroglycerine tablets, and basic instructions for use of the drugs in the kit.
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Cite this: Shelly Reese. 'Is There a Doctor on Board?' Keeping Quiet vs Stepping Up - Medscape - Sep 17, 2015.