Medical Emergencies during a flight

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Medical Emergencies during a flight

28 May 2014 Energency Fainting Flight Medical 0
02/04/14 14:28
While as many as 2.75 billion people fly on commercial airlines each year, medical emergencies occur only once in every 604 flights, and fewer than 1 percent result in death, according to the retrospective look at nearly 12,000 in-flight medical cases, published today in the New England Journal of Medicine.

For some people, fear of getting sick on a plane — or sitting next to a sick person — ranks right up there with fear of flying. But surprisingly few people get sick on airplanes, and very few die, finds a new analysis of data from January 2008 to October 2010.While as many as 2.75 billion people fly on commercial airlines each year, medical emergencies occur only once in every 604 flights, and fewer than 1 percent result in death, according to the retrospective look at nearly 12,000 in-flight medical cases, published today in the New England Journal of Medicine. Most often, the data showed, in-flight medical emergencies involved fainting, breathing problems, gastrointestinal distress, or chest pain.37 percent fainting
12 percent respiratory symptoms
10 percent nausea or vomiting
8 percent heart symptoms
Doctors who happened to be passengers on the flights handled passenger emergencies in 48 percent of the cases studied. Nurses provided volunteer emergency care in an additional 20 percent of cases.

Edward Geltman, MD, Director of the Heart Failure Program at Barnes-Jewish Hospital & Washington University School of Medicine in St. Louis, is one of those doctors who dealt with a medical emergency in flight.

“I was on a flight from St. Louis to Dallas and a patient had chest discomfort and then passed out,” recalled Dr. Geltman. “We responded and got the emergency medical kit, were able to give sublingual nitroglycerine and to give fluids. It wasn’t a whole [emergency] cart like we would have in the hospital, but it was an appropriate kit. With that, we felt very good about what we could do for the patient. We didn’t have to divert the flight and the patient did very well. An emergency team was waiting for us on the ground when we got there.”

Cardiac arrests or heart attacks were the most common cause of death on planes — 36 people died over the period of the study, and 31 were from cardiac arrest.

The most common symptom, fainting, wasn’t a big deal in most cases, said said study author Christian Martin-Gill, M.D., M.P.H. “The majority of cases when a person faints resolve quite well,” he said. “A person may pass out and have low blood pressure. This is helped by raising the legs, and providing fluids for hydration.” Dr. Martin-Gill is assistant professor of emergency medicine at the University of Pittsburgh School of Medicine.

Will Your Flight Be Diverted Because Someone Is Ill?

If someone gets sick on a flight, your trip won’t necessarily be interrupted: Diversion of flights due to medical emergencies happened in only 7 percent of cases studied. One in four cases was evaluated at a hospital, but only about one in 10 passengers who had in-flight emergencies was actually admitted.

Hospital admissions were most often for patients with symptoms of stroke, chest pain, or trouble breathing, according to the new study. Out of 11,920 emergency cases over two years, 61 were due to obstetric or gynecologic symptoms, and most of the patients were at less than 24 weeks of pregnancy, well within the current recommendations for air travel up to the 36th week of pregnancy. Eleven cases were women who went into labor at a time beyond 24 weeks.

When there is no doctor or nurse on a flight, airline personnel often called health care institutions for real-time telemedicine advice from doctors trained to handle emergencies, according to the study. Healthcare providers and flight attendants then worked collaboratively with emergency physician by phone or radio, and used the emergency medical kit, which is required on all flights. In addition to having an emergency medical kit complete with oxygen and medications, all commercial airliners carry an AED (automated external defibrillator) for cardiac arrest.

The most common medications and therapies used in in-flight emergencies were oxygen, IV saline solution, and aspirin. Flights were less likely to be diverted for passengers with nausea or vomiting.

In some cases, other passengers shared their medications, or the patients themselves were carrying their own.

“We recognise that passengers find themselves taking care of other passengers,” said Dr. Martin-Gill added. “Assistance can be very valuable, and multiple people may offer their help. For the rare instances where there is a cardiac arrest, it may take a team of people to respond.” He emphasised that healthcare professionals and other passengers who volunteer for emergencies are legally protected by the Aviation Medical Assistance Act’s Good Samaritan provision.

Planning Ahead for Medical Emergencies on Planes

Patients who are aware they have health problems should be sure to take their medications with them in carry-on luggage, said Dr. Geltman. “Take at least two days of extra medications along. Diabetics should also bring glucose monitoring equipment with them. There’s no risk to letting another patient use your diabetic monitor if needed on a flight, but to give medications that were not prescribed to the patient by a doctor would be wrong.”

Here is a rundown of what you can expect during a medical emergency on a flight:

A healthcare provider or airline personnel will ask you about the medical problem and how long you have had it.
The provider may ask about chest pain, shortness of breath, nausea or vomiting, or weakness on one side of your body.
Your pulse and blood pressure will probably be taken.
Your mental status may be assessed.
The healthcare provider and team will use an emergency medical kit if needed.
You may receive oxygen.
You may receive medications or IV fluids.
The care team will coordinate with ground-based medical care for the appropriate transfer of your care.