Improving Pilot Response to In-Flight Strokes: A Randomized Controlled Trial

Abstract

Background: When a passenger suffers an in-flight stroke (IFS), the pilot decides when to expedite access to ground care. Pilot pro-activeness towards IFS could improve outcome and should be promoted. Unfortunately, little is known about a pilot’s stroke pro-activeness or limiting factors. Methods: Randomized controlled trial of an educational intervention (American Stroke Association, 30-slide stroke awareness lecture) through an internet-based computer system using pilot students and instructors as subjects. Pilots completed pre-intervention and post-intervention tests of 25 simulated in-flight scenarios that describe strokes and other neurological and medical symptoms. Outcomes chosen were the percentage of pilots that would use a medical radio service, declare an emergency on board, or divert to the nearest airport for each scenario. Results: Participant pilots (n = 104) were less likely to respond to IFS than to myocardial infarction (p < 0.001). Fear of retaliation by an employer was the most important modifiable limitation. The educational program increased the simulated rate of emergency declarations for in-flight vertebrobasilar strokes (p < 0.001) and subarachnoid hemorrhage (p < 0.001). Conclusions: Pilot-simulated response to certain IFS improves immediately after this educational intervention, which should be disseminated in schools and airlines. Further studies are needed to determine the long-term benefits of this intervention and the impact on actual diversion rates. Companies should also review their policies to shield pilots from retaliation when altering the flight plan for patients.

Headache During Air Travel: An Unusual Cause of Reversible Cerebral Vasoconstriction Syndrome

“…This results in reduced barometric pressure with a concomitant decrease in partial pressure of oxygen. This relative hypobaric/hypoxic environment is suggested to precipitate ischemic in-flight stroke 4 and cause further deterioration in those people with established cardiovascular disease. 5 We speculate that the hypoxic and hypobaric milieu of the airplane causing failure in the regulation of cerebral vasomotor tone had precipitated the RCVS in our patient, who has none of the other known risk factors.…”

Neurology at the airport

“…It has been suggested that the hypobaric and hypoxic environment inside the aircraft may cause ischaemia in patients with reduced vascular reserve or arterial dissection 5. Even if the number of cases in our series is too low, we suggest that neurologists give some words of caution to patients with known high-grade stenosis who plan to fly, because of the potentially increased risk of stroke linked to air travel.…”

“…Recognition of symptoms and signs of neurological disease is critical for the airplane crew and medical volunteers, especially regarding time-dependent pathologies as stroke. Furthermore, flight diversions are costly for airplane companies, and cerebrovascular symptoms commonly misrecognised 5. This has led to increasing effort in airplane personnel training and implementation of telemedicine devices.…”

The safety of aeroplane travel in patients with symptomatic carotid occlusion

“…(2, 3) Some authors have speculated that the relatively hypobaric and hypoxic in-flight environment can precipitate ischemic symptoms. (4–7) Owing to this rationale, some authors have advocated counseling patients with atherosclerotic cerebrovascular disease to avoid commercial airplane travel. (5)…”