In-Flight Medical Emergencies

Abstract

n-flight medical emergencies (IMEs) are unique events for which traveling physicians, nurses, and other health care professionals may render medical assistance. Cruising at 35 000 ft with limited medical equipment, often hours away from the closest medical facility, creates an unfamiliar care challenge for many health care professionals. This clinical review focuses on IME data and offers guidance to assist medical professionals who may encounter these events using both literature and the authors' insights providing airline care guidance for IMEs. MethodsA literature search was conducted in MEDLINE using PubMed for English-only articles published between January 1, 1990, and June 2, 2018, using the terms air emergency, air emergencies, air passenger, air travel, aircraft, airline, aviation, commercial air, flight, and fitness to fly (n = 14 842). Scanning the titles to identify appropriateness and searching bibliographies yielded the final list of relevant articles (n = 765). Each article was assessed for completeness of data reporting and importance to management and prevention of IMEs. Based on this assessment, a total of 317 articles were included in the review. Frequency data were extracted and means and 95% confidence intervals were calculated when appropriate. Observations EpidemiologyThe estimated prevalence of IMEs is 1 in 604 flights based on a review of 11 920 requested ground consultations from 5 large IMPORTANCE In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment.OBSERVATIONS In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical vol...

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