COMMENTARY

Three Must-Read Emergency Medicine Articles of 2015

Amal Mattu, MD

Disclosures

January 07, 2016

In-flight Medical Emergencies During Commercial Travel

Nable JV, Tupe CL, Gehle BD, Brady WJ
N Engl J Med. 2015;373:939-945

My final selection for must-read articles of 2015 is a fantastic review of the all-too-common and uncomfortable scenario of in-flight emergencies. Physicians in general do plenty of traveling, whether for conferences or vacation, and the majority of us have heard those words over the airline speakers, "If there's a doctor on board, please ring your call bell." Ugh! Though I'm sure we all feel the moral imperative to step forward and help, we also feel the discomfort of being outside our usual comfort zone of the emergency department.

The authors of this article are clearly able to relate to our sense of discomfort and provide some very simple and reasonable recommendations. They begin by discussing legal issues and Good Samaritan protection, which usually depends on the state or country in which the plane lands. Fortunately, physicians are typically held to a gross negligence standard. However, be wary of requesting or accepting any form of remuneration for your services!

The authors discuss the typical contents of an airline medical kit, which usually contains an automatic external defibrillator, gloves, stethoscope, blood pressure cuff, IV needle and small amount of IV fluid, and some very basic resuscitation medications that might get you through one round of advanced cardiac life support. They also discuss flight path diversion in medical emergencies and remind us that the airline captain makes the final decision on diversion, not you.

The authors then discuss basic responses to a potpourri of specific conditions, including cardiac arrest, ACS, stroke, altered mental status, syncope, trauma, dyspnea, acute infections, and psychiatric emergencies. Discussions of each of these are beyond the scope of this summary, but the write-ups in the article are simple, practical, and brief.

The good news is that life-threatening emergencies on-board are actually quite rare, but like most emergency physicians, I truly believe that you only avoid disasters if you are prepared to deal with them—so read this article.

With that, I conclude this year's summary and recommendations for the must-read articles of 2015. I look forward to reading your comments, critiques, and especially your own recommendations for your favorite emergency medicine articles of 2015. Best wishes in 2016!

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