Medical Minute Recap: In- Flight Emergencies During Commercial Travel

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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

Legal Ramifications:
  • 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?

 Common Emergencies
  • 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.

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