When flying, it's usually comforting to know there's a physician of some stripe on the plane with you, and even more comforting to know that those physicians had a basic knowledge of in-flight medical emergencies and available resources. "Most medical emergencies encountered on commercial aircraft can be handled with the equipment available on board," researcher Christian Martin-Gill, MD, an assistant professor of emergency medicine at the University of Pittsburgh School of Medicine, told CardioSource WorldNews: Interventions.

In a recent study in the New England Journal of Medicine, Dr. Martin-Gill and colleagues examined records of all calls to medical communications centers for five domestic and international commercial airlines, focusing on on-board assistance and the outcomes of events. Of the 11,920 flights that were included in the study, medical emergencies occurred at an average of 1 emergency every 604 flights. Although relatively rare when considered on a per-passenger basis, these emergency events do occur every day.

Presyncope or syncope were the most common events (4,463/37.4%), followed by respiratory symptoms (1,447/12.1%), nausea or vomiting (1,137/9.5%), and cardiac symptoms (920/7.7%). More serious emergencies that resulted in aircraft diversion, like cardiac arrest or possible stroke, were uncommon. On-board assistance was delivered by physicians (48.1%), nurses (20.1%), EMS providers (4.4%), or other health care professionals (3.7%). Aircraft-diversion and hospitalization rates differed according to provider, with physicians and EMS providers most likely to result in both. "In half of cases, doctors volunteered to assist fellow passengers and physicians should be aware of the most common emergencies, as well as the contents of the onboard medical kit, which includes an automated external defibrillator," Dr. Martin-Gill said.

Given the constraints of limited space and equipment on-board, the authors noted, establishing a protocol for the most common in-flight emergencies would be beneficial, with the added advantage of reducing the risk of medical liability. In most of the cases, flight attendants' familiarity with on-board equipment was sufficient, but when the need for evaluation or intervention exceeds their capabilities, traveling health care professionals could/can assist.

"Physicians on board can consult experts on the ground for assistance in how to manage specific emergencies, as well as when it is appropriate to divert an aircraft," Dr. Martin-Gill said. The decision to divert a commercial aircraft is a complicated one, with many medical and operational issues to be considered. For instance, the potential medical benefit of diverting the aircraft to transport a patient with an uncomplicated medical event to a hospital would likely be outweighed by the time needed to land and the subsequent operational delays.

"Passengers who are health care professionals should be aware of their potential role as volunteer responders to in-flight medical emergencies," the authors wrote. "Although there is no legal obligation to intervene, we believe that physicians and other health care providers have a moral and professional obligation to act as Good Samaritans."

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Reference

Peterson DC, Martin-Gill C, Guyette FX, et al. N Engl J Med. 2013;368:2075-83.

Keywords: Volunteers, Nausea, Vomiting, Stroke, Defibrillators, Health Personnel, Syncope, Heart Arrest, Emergencies, Liability, Legal, Emergency Medicine, Hospitalization

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