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October 1, 2015 by dailybolusoflr
By: Casey Wilson, MD
Incidence: no mandatory reporting system, 1 in 604 flights is likely under-estimation
On Board Resources:
- Remember this is an austere environment! Vitals signs, H&P, BLS skills
- Ground-based medical consult services can be consulted by on board health professionals
- FAA mandates US airlines to carry first aid kids and at least 1 AED, flight attendants trained in CPR and AED use
- Once physician provides assistance: doctor-patient-relationship established
- Liability determined by country where aircraft is registered, but laws of country where incident occurs or patient is a citizen might apply
- Aviation Medical Assistance Act: passed by Congress in 1998. Protects providers on domestic flights and most claims on international flights involving US carriers or residents
- Some countries such as Australia, and many European countries, impose a legal obligation to assist
- Documentation: must document, use required airline-specific documentation
- Are you capable to provide assistance? i.e. how many Southwest drink coupons did you use?
- Syncope/Pre-syncope: 37% of in flight emergencies, arid environment leads to dehydration. Lay pt on floor and elevate feet, consider IVF, check Dexi if available (some flights have glucometer).
- Respiratory Symptoms: 12%, consider hypoxemia in any altered patient. Oxygen and Albuterol MDI available, can descend (permits higher partial pressure of oxygen). Rule out spontaneous PTX àneedle thoracostomy!
- Psychiatric Symptoms: 3.5%, check Dexi, might need to physically restrain
- Suspected CVA: 2%, check Dexi if possible, give oxygen, do NOT give ASA (?ICH), request diversion
- Seizures: seizure threshold lowered by hypoxemia and altered circadian rhythms, check Dexi
- Trauma: common but usually minor 2/2 turbulence, offer cold compresses and analgesia, splint, etc. Frequent reassessments in flight, if any concern for intracranial hemorrhage, request diversion.
- Contagious diseases: prevent movement around cabin, relocate neighbors, PPE if available
- ACS: Aspirin and SLNTG (caution with inferior STEMI à IV access and fluid bolus available), request diversion
- Cardiac arrest: uncommon, 0.3% of emergencies but 86% of in flight deaths, BLS
Communication with Captain
- Safety of crew and passengers takes precedence
- Descent causes greater fuel consumption
- Choice to divert based on fuel, next available landing, etc.
Reference: Noble JV; Tupe CL; Gehle BD; Brady WJ . In flight medical emergencies during commercial travel. N Eng J Med. 2015; 373: 939-945.
|Reference: Noble JV; Tupe CL; Gehle BD; Brady WJ . In flight medical emergencies during commercial travel. N Eng J Med. 2015; 373: 939-945.|