In-Flight Medical Emergencies during Commercial Travel

Nable, Jose V.; Tupe, Christina L.; Gehle, Bruce D.; Brady, William J.

doi:10.1056/nejmra1409213

Cited by 96 publications

(66 citation statements)

References 31 publications

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“…Similarly, severe allergic reactions can occur on commercial aircraft, sometimes requiring diversion 38. Currently, the Federal Aviation Administration (FAA) does not require that airplane emergency medical kits contain epinephrine for the treatment of anaphylaxis, and the FAA recommends the use of oral antihistamines for the treatment of anaphylaxis 39,40. Ready availability of EAIs in school settings is also a major public health concern, as the prevalence of food allergies among children is increasing 25.…”

Section: Overview Of Anaphylaxismentioning

confidence: 99%

Update on the usage and safety of epinephrine auto-injectors, 2017

Posner

Camargo

2017

DHPS

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Anaphylaxis is a serious, potentially fatal allergic reaction. Guidelines recommend prompt intramuscular injections of epinephrine as the first-line therapy for anaphylaxis. Delayed epinephrine treatment may cause undesirable clinical outcomes, including death. In the community, epinephrine auto-injectors (EAIs) are commonly used to treat anaphylaxis. This literature review examines several recent concerns regarding the safety of EAIs that may prevent the timely administration of epinephrine. Reports of cardiovascular complications are linked with epinephrine administration, although recent studies suggest that these events are much more commonly associated with intravenous epinephrine rather than with EAIs. Recent studies have also highlighted accidental injections of EAIs in patients’ or caregivers’ fingers and lacerations associated with the use of EAI in children. However, the data suggest that both accidental injections and lacerations are rare and require limited medical intervention. In addition, patients may receive conflicting information on the safety and efficacy of using expired EAIs. Overall, it is believed that the benefits of using EAIs far outweigh the potential risks of not administering an EAI. Although legitimate safety concerns are associated with EAIs, adverse events are rare. Continued training of medical providers, caregivers, and patients may be beneficial to address these concerns and reduce EAI-associated injuries while ensuring that patients receive necessary medical care.

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Section: Overview Of Anaphylaxismentioning

confidence: 99%

Update on the usage and safety of epinephrine auto-injectors, 2017

Posner

Camargo

2017

DHPS

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“…A number of reasons are proposed to explain the incidence of medical and allergic events during air travel, and those are summarized in Table 1. The most common in-flight medical events include syncope, gastrointestinal and cardiac problems [2, 7, 8]. …”

Section: Medical Emergencies During Air Travelmentioning

confidence: 99%

In-flight allergic emergencies

Sánchez‐Borges

Cardona

Worm

et al. 2017

World Allergy Organization Journal

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Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have concerns that this subject has not received the attention it warrants. There is a need to provide passengers at risk and airlines with the necessary measures to prevent and manage these emergencies. A review of the epidemiology, management and approaches to prevention of allergic and asthma emergencies during air travel is presented with the goal of increasing awareness about these important, potentially preventable medical events.

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“…1 On-board stroke has been reported in several scientific studies, although most were retrospective case series focusing on economy class stroke syndrome (ECSS). 2,3 This subtype of stroke results from paradoxical embolism through a patent foramen ovale or other right-to-left shunt, most likely in the context of deep vein thrombosis because of prolonged immobilization.…”

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confidence: 99%

Stroke in Commercial Flights

Álvarez-Velasco

Masjuán

DeFelipe

et al. 2016

Stroke

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Background and Purpose— Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. Methods— A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Results— Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. Conclusions— We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis.

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In-Flight Medical Emergencies during Commercial Travel

Cited by 96 publications

References 31 publications

Update on the usage and safety of epinephrine auto-injectors, 2017

Update on the usage and safety of epinephrine auto-injectors, 2017

In-flight allergic emergencies

Stroke in Commercial Flights

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