Knowledge, confidence and attitude of primary care doctors in managing in-flight medical emergencies: a cross-sectional survey

Abstract

INTRODUCTION Medical emergencies occur at a rate of one in 604-753 flights. Doctors travelling on commercial flights may encounter an in-flight medical emergency requiring their assistance. There is a paucity of studies on how confident primary care doctors are in managing in-flight medical emergencies. This study aimed to determine the knowledge, confidence and attitude of primary care doctors in managing in-flight medical emergencies. METHODS A cross-sectional study was conducted on all primary care doctors working in government health clinics in Kuala Lumpur, Malaysia, from October 2016 to November 2016. A self-reported questionnaire was used, which included questions on demographic information, knowledge of in-flight medicine, and the attitude and confidence of primary care doctors in managing in-flight medical emergencies. RESULTS 182 doctors completed the questionnaire (92.9% response rate). The mean knowledge score was 8.9 out of a maximum score of 20. Only 11.5% of doctors felt confident managing in-flight medical emergencies. The majority (69.2%) would assist in an in-flight medical emergency, but the readiness to assist was reduced if someone else was already helping or if they were not familiar with the emergency. Total knowledge score was positively associated with confidence in managing in-flight medical emergencies (p = 0.03). CONCLUSION Only one in ten primary care doctors in this study felt confident managing in-flight medical emergencies. A higher total knowledge score of in-flight medical emergencies was positively associated with greater confidence in managing them. Educational programmes to address this gap in knowledge may be useful to improve doctors' confidence in managing in-flight medical emergencies.

“Is there a doctor on board?”: willingness and confidence of physicians in the Kingdom of Saudi Arabia in assisting with in-flight medical emergencies

“…Moreover, the vast majority of participants in our study reported that they will identify themselves as doctors in the event of IMEs. This finding agreed with a study among 182 primary health care physicians in Malaysia which reported that about 70% of participants were willing to help during IMEs [3].…”

“…This study showed that nearly half of the participants were concerned about the medico-legal implications which may arise from their assistance in IMEs. This was lower than reported by Ng et al among 182 primary care doctors in Malaysia in which 62.6% of participants were afraid and 21.4% were unsure of the medico-legal consequences of their help in such a condition [3]. A physician who volunteers to provide medical assistance creates a doctor-patient relationship, and with it comes its obligations and liability risk.…”

“…However, the readiness to help was reduced if someone else already provided assistance or if they were not familiar with the case. Moreover, a higher knowledge score of IMEs was positively associated with higher confidence in managing these cases [3].…”

“…The survey has two main parts; the first part covers questions on sociodemographic, occupational, and travel profiles. The second part contains questions about willingness and confidence towards IMEs that were used by Katzer et al and Ng WL et al studies [3,6]. This part had 11 items and responses to each item were reported on a 5-point Likert scale.…”

Advancing research in the exciting field of emergency medicine

“…While stratifying patients by the acuity of their needs is important, understanding the level of knowledge and confidence of primary care doctors in managing various medical urgencies is also crucial in the delicate balance to right-site patients. Meanwhile, Ng et al (4) highlighted a lack of confidence among primary care doctors in Kuala Lumpur when managing in-flight emergencies, suggesting that building primary physicians' confidence and improving their management of common medical conditions would address some of the gaps we currently face. By reducing inappropriate attendances and allowing ED physicians to focus on the sickest patients, Ibrahim et al (5) demonstrated in their work on acute aortic dissection that we can better target our resources so as to minimise the occurrence of missed diagnoses among critically ill patients.…”