• Temple EM

In-Flight Medical Emergencies during Commercial Travel

The Article:

In-Flight Medical Emergencies During Commercial Travel Nable et al. n engl j med 373;10 nejm.org September 3, 2015

The Idea:

In-flight medical emergencies are more common than one may think. A study quotes that medical emergencies occur in 1 out of every 604 flights, which is likely an underestimate given that simple issues are probably underreported. Healthcare providers should be aware of the most common in flight medical emergencies, their roles during these situations and potential liabilities that they may suffer while offering to help.

The Review:

This was a review article that begins by describing the resources available to healthcare providers in a plane: an AED and a first aid kit. It was surprising to find the limitations of the first aid kit, since it does not contain some basic essentials such as a glucometer. The article also outlines the liability involved with offering assistance. Healthcare providers are subjected to the law of the country where the incident occurs or the country from which the patient is a citizen. If flying in an American carrier or domestic flight healthcare providers are essentially protected from liability by the Aviation Medical Assistance Act of 1998. However, one can be held grossly negligent if intoxicated while volunteering to help in an in-flight medical emergency. The article then depicts several different patient presentations and emergencies such as acute coronary syndrome, syncope, dyspnea and altered mental status. The least common emergency is cardiac arrest, which accounts for the biggest number of airplane diversions, and the most common is syncope secondary to dehydration. The article also provides some key treatment strategies such as recommending descent to a lower altitude in order to increase the partial pressure of oxygen in cases of ACS or dyspnea. It is important to note that the health care provider’s role is to advise the crew of the medical issue, severity, need for treatment, and outcomes if no diversion occurs. The provider is often in contact with a medical base command on ground and it is not the healthcare provider’s decision to divert the plane as this can lead to extreme consequences and cost to the airline.

The Takeaway:

In-flight medical emergencies occur commonly. Therefore physicians and other healthcare providers should understand their roles, responsibilities, and the liability involved with offering assistance. The Aviation Medical Assistance Act offers a great deal of protection to healthcare providers in order to encourage qualified individuals to rise to the challenge of delivering medical care in such an austere and limited environment. One should not volunteer after consumption of alcohol as it can be considered negligent. Airlines ultimately use the healthcare provider’s medical expertise to make decisions regarding whether the flight should be diverted for more expedient and thorough medical care of the patient.

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