In-Flight Medical Emergencies During Commercial Travel

Nable JV, Tupe CL, Gehle BD, Brady WJ.
In-Flight Medical Emergencies During Commercial Travel. N Engl J Med 2015;373:939-945.

The following are 10 points to remember about in-flight medical emergencies during commercial travel:

  1. Health care providers should understand which in-flight medical emergencies occur commonly as well as the roles the providers can play and the liabilities they may incur when offering assistance.
  2. A study of a ground-based communications center that provides medical consultative service to airlines estimated that medical emergencies occur in 1 of every 604 flights. This is likely to be an underestimate, however, because uncomplicated issues are probably under-reported.
  3. A physician who provides assistance creates a doctor–patient relationship, with its attendant obligations and liability risk. Liability is generally determined under the law of the country in which the aircraft is registered, but the law of the country in which the incident occurs or in which the parties are citizens could arguably apply.
  4. In 1998, Congress passed the Aviation Medical Assistance Act (AMAA), which protects providers who respond to in-flight medical emergencies from liability and thus encourages medical professionals to assist in emergencies. The AMAA does allow for liability of providers if the patient can establish that the provider was “grossly negligent” or intentionally caused the alleged harm.
  5. After the event, the provider should document the care that was provided and the treatment that was delivered and should use airline-specific documentation as required. Providers should be mindful of the patient’s privacy rights and should not discuss the patient’s care with third parties (e.g., media) without appropriate authorization from the patient.
  6. A volunteer physician can advise the crew of the medical issue, its severity, the potential need for treatment, and the possible outcomes if a recommended diversion is not pursued.
  7. “Cardiac symptoms” represent 8% of medical emergencies on commercial airliners; other manifestations of an acute coronary syndrome that may occur include syncope or presyncope (37% of in-flight medical emergencies), “respiratory symptoms” (12%), and cardiac arrest (0.3%).
  8. During flight, the most appropriate and probably the only possible approach to the management of cardiac arrest is a basic approach. Thus, recognition of cardiac arrest, compression-only cardiopulmonary resuscitation, and defibrillation with the use of an automated external defibrillator represents the interventions that the volunteer physician should consider applying.
  9. Reduced oxygenation can put passengers at risk for exacerbations of underlying respiratory diseases. Indeed, an estimated 12% of in-flight medical emergencies involve a respiratory complaint. Clinicians assisting passengers with dyspnea should consider providing supplemental oxygen. In fact, passengers with respiratory illnesses and resting oxygen saturation lower than 92% at sea level are advised to fly with additional oxygen; permission to travel with additional oxygen can be arranged with the airline with advance notice.
  10. Physicians should be prepared to render care while traveling; physicians must also be aware of the medically austere environment, its related limitations on prudent practice, and the associated liabilities surrounding the delivery of in-flight medical care.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Acute Coronary Syndrome, Aircraft, Aviation, Cardiopulmonary Resuscitation, Defibrillators, Dyspnea, Emergencies, Heart Arrest, Physician-Patient Relations, Syncope

< Back to Listings