Report Gives Advice for In-flight Medical Emergencies

By Will Boggs MD

December 26, 2018

NEW YORK (Reuters Health) - Physicians can play an important role during in-flight medical emergencies and can help prevent them through patient education, according to a review.

"I recommend that any healthcare provider should feel comfortable providing medical assistance on board and know that resources such as the ground-based medical experts at UPMC are available to provide specific recommendations to the flight crew and healthcare volunteers," Dr. Christian Martin-Gill from the University of Pittsburgh Medical Center told Reuters Health by email.

Dr. Martin-Gill's team provides "a review of over 700 articles in the medical literature related to in-flight medical emergencies and related medical aspects of flying aboard commercial airlines. We also provide practical recommendations from our experience at the University of Pittsburgh Medical Center, where our physicians provide medical consultations for 20 U.S. and international airlines."

According to their review, in-flight medical emergencies occur in about one flight out of 604, or 24 to 130 in-flight medical emergencies per million passengers.

The review provides useful summaries of the management of conditions likely to be encountered as in-flight emergencies. The most common in-flight medical emergency is syncope or near-syncope (32.7%), followed by gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. In-flight cardiac arrest accounts for only 0.2% of in-flight emergencies.

Only 4.4% of in-flight medical emergencies require diversion, an expensive proposition ($20,000-$725,000), the ultimate decision for which is made by the pilot after consultation with ground-based experts.

When airlines request aid from trained medical professionals, potential volunteers must honestly consider their own capability of providing medical care. The primary role of a medical volunteer in this setting is to gather information, assess an ill or injured passenger, aid with communications with any ground-based support, and potentially administer medications or perform procedures.

A consulting ground-based physician usually makes final recommendations about care, according to the December 21st online report in JAMA.

"Healthcare providers who may be asked to render assistance on board a flight may be concerned about the potential for legal liability," Dr. Martin-Gill said. "In our article we review the Good Samaritan protection afforced by the Aviation Medical Assistance Act of 1998, which protects volunteers and the airlines when rendering assistance to passengers in good faith except in cases of gross negligence. In some countries, physicians may encounter both an ethical and legal duty to respond to an in-flight medical emergency."

While the Federal Aviation Administration has minimum requirements for contents of an emergency medical kit aboard US airlines, individual airlines vary widely in the contents of their emergency medical kits. Nonetheless, current kits contain sufficient equipment to handle most in-flight medical emergencies, according to the report.

Physicians and nurses at home can play an important role in preventing in-flight emergencies by educating patients on the effects of altitude, need for routine medications, and potential occurrence of medical emergencies.

In addition, the International Air Transport Association provides useful information for patients with acute or other specific medical conditions at http://bit.ly/2SqngqM.

Dr. Mohamud A. Verjee from Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar recently reviewed medical issues in flight and the emergency medical kit. He told Reuters Health by email, "Flying and taking responsibility for volunteering professional or 'Samaritan Help' is a deliberate undertaking. I think that it is only ethical to offer help if requested. However, those with faint hearts have no obligation."

SOURCE: http://bit.ly/2Si8nXK

JAMA 2018.

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