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Hinkelbein J, Schmitz J, Kerkhoff S, Eifinger F, Truhlář A, Schick V, Adler C, Kalina S. On-board emergency medical equipment of European airlines. Travel Med Infect Dis 2021; 40:101982. [PMID: 33545394 DOI: 10.1016/j.tmaid.2021.101982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medical emergencies frequently occur in commercial airline flights, but valid data on causes and consequences are rare. Therefore, optimal extent of onboard emergency medical equipment remains largely unknown. Whereas a minimum standard is defined in regulations, additional material is not standardized and may vary significantly between airlines. METHODS European airlines operating aircrafts with at least 30 seats were selected and interviewed with a 5-page written questionnaire including 81 items. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted up to three times by email and/or phone. Descriptive analysis was used for data interpretation. RESULTS From a total of 305 European airlines, 253 were excluded from analysis (e.g., no passenger transport). 52 airlines were contacted and data of 22 airlines were available for analysis (one airline was excluded due to insufficient data). A first aid kit is available on all airlines. 82% of airlines (18/22) reported to have a "doctor's kit" (DK) or an "Emergency Medical Kit" (EMK) onboard. 86% of airlines (19/22) provide identical equipment in all aircraft of the fleet, and 65% (14/22) airlines provide an automated external defibrillator. CONCLUSIONS Whereas minimal required material according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in availability of the additional material. The equipment of most airlines is not sufficient for treatment of specific emergencies according to published in-flight medical guidelines (e.g., for CPR or acute myocardial infarction).
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Working Group "Standards, Recommendations, and Guidelines", German Society of Aviation and Space Medicine, Munich, Germany.
| | - Jan Schmitz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Working Group "Standards, Recommendations, and Guidelines", German Society of Aviation and Space Medicine, Munich, Germany.
| | - Steffen Kerkhoff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Frank Eifinger
- Department of Paediatrics, Krankenhaus Porz, Cologne, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University Prague, Faculty of Medicine Hradec Králové, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Volker Schick
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Christoph Adler
- Department of Cardiology, University Hospital of Cologne, Cologne, Germany; Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany.
| | - Steffen Kalina
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
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Nadir NA, Cook CJ, Bertino RE, Squillante MD, Taylor C, Dragoo D, Podolej GS, Svendsen JD, Fish JL, McGarvey JS, Bond WF. Impact of an Electronic App on Resident Responses to Simulated In-Flight Medical Emergencies: Randomized Controlled Trial. JMIR MEDICAL EDUCATION 2019; 5:e10955. [PMID: 31199299 PMCID: PMC6594212 DOI: 10.2196/10955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/29/2018] [Accepted: 03/12/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Health care providers are often called to respond to in-flight medical emergencies, but lack familiarity with expected supplies, interventions, and ground medical control support. OBJECTIVE The objective of this study was to determine whether a mobile phone app (airRx) improves responses to simulated in-flight medical emergencies. METHODS This was a randomized study of volunteer, nonemergency resident physician participants who managed simulated in-flight medical emergencies with or without the app. Simulations took place in a mock-up cabin in the simulation center. Standardized participants played the patient, family member, and flight attendant roles. Live, nonblinded rating was used with occasional video review for data clarification. Participants participated in two simulated in-flight medical emergencies (shortness of breath and syncope) and were evaluated with checklists and global rating scales (GRS). Checklist item success rates, key critical action times, GRS, and pre-post simulation confidence in managing in-flight medical emergencies were compared. RESULTS There were 29 participants in each arm (app vs control; N=58) of the study. Mean percentages of completed checklist items for the app versus control groups were mean 56.1 (SD 10.3) versus mean 49.4 (SD 7.4) for shortness of breath (P=.001) and mean 58 (SD 8.1) versus mean 49.8 (SD 7.0) for syncope (P<.001). The GRS improved with the app for the syncope case (mean 3.14, SD 0.89 versus control mean 2.6, SD 0.97; P=.003), but not the shortness of breath case (mean 2.90, SD 0.97 versus control mean 2.81, SD 0.80; P=.43). For timed checklist items, the app group contacted ground support faster for both cases, but the control group was faster to complete vitals and basic exam. Both groups indicated higher confidence in their postsimulation surveys, but the app group demonstrated a greater increase in this measure. CONCLUSIONS Use of the airRx app prompted some actions, but delayed others. Simulated performance and feedback suggest the app is a useful adjunct for managing in-flight medical emergencies.
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Affiliation(s)
- Nur-Ain Nadir
- Department of Emergency Medicine, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
- Jump Simulation, OSF Healthcare, Peoria, IL, United States
| | - Courtney J Cook
- Department of Radiology, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | - Raymond E Bertino
- Department of Radiology, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | - Marc D Squillante
- Department of Emergency Medicine, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | - Cameron Taylor
- Department of Radiology, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | - David Dragoo
- Department of Radiology, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | - Gregory S Podolej
- Department of Emergency Medicine, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
| | | | - Jessica L Fish
- Jump Simulation, OSF Healthcare, Peoria, IL, United States
| | | | - William F Bond
- Department of Emergency Medicine, University of Illinois Peoria, OSF St Francis Medical Center, Peoria, IL, United States
- Jump Simulation, OSF Healthcare, Peoria, IL, United States
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Hinkelbein J, Böhm L, Braunecker S, Genzwürker HV, Kalina S, Cirillo F, Komorowski M, Hohn A, Siedenburg J, Bernhard M, Janicke I, Adler C, Jansen S, Glaser E, Krawczyk P, Miesen M, Andres J, De Robertis E, Neuhaus C. In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM). Intern Emerg Med 2018; 13:1305-1322. [PMID: 29730774 DOI: 10.1007/s11739-018-1856-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/21/2018] [Indexed: 01/08/2023]
Abstract
By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.
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Affiliation(s)
- Jochen Hinkelbein
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany.
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany.
| | - Lennert Böhm
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Stefan Braunecker
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Critical Care, King's College Hospital, London, UK
| | | | - Steffen Kalina
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | - Fabrizio Cirillo
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Matthieu Komorowski
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | | | - Michael Bernhard
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Ilse Janicke
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department for Cardiology and Angiology, Heart Center Duisburg, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - Christoph Adler
- Department of Internal Medicine III, Heart Center of the University of Cologne, Cologne, Germany
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Eckard Glaser
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- , Gerbrunn, Germany
| | - Pawel Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Janusz Andres
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Christopher Neuhaus
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
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International Flight Considerations. IN-FLIGHT MEDICAL EMERGENCIES 2018. [PMCID: PMC7121449 DOI: 10.1007/978-3-319-74234-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Combined with the rising number of passengers, and increased capacity of larger airplanes with more long-distance domestic and international flights, with long-haul aircrafts—such as the Airbus A380 and Boeing 777 LR now capable of extending flight times to 18–20 h—it is likely that the incidence of in-flight medical emergencies will continue to increase in the coming years. International air travel in particular combines long-haul, extended flight times with unique exposures and an even more austere, secluded environment for passengers with acute and/or chronic illnesses, and suggests unique medical challenges for recognition, stabilization, treatment, diagnosis, and disposition.
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Hinkelbein J, Neuhaus C, Böhm L, Kalina S, Braunecker S. In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment. Open Access Emerg Med 2017; 9:31-35. [PMID: 28260956 PMCID: PMC5328610 DOI: 10.2147/oaem.s129250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society. Materials and methods Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (p<0.05 was considered significant). Results Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers. Conclusion Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training.
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne; Working group "Emergency Medicine and Air Rescue", German Society for Aviation and Space Medicine (DGLRM), Munich
| | - Christopher Neuhaus
- Working group "Emergency Medicine and Air Rescue", German Society for Aviation and Space Medicine (DGLRM), Munich; Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lennert Böhm
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne
| | - Steffen Kalina
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne
| | - Stefan Braunecker
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne; Working group "Emergency Medicine and Air Rescue", German Society for Aviation and Space Medicine (DGLRM), Munich
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Hinkelbein J, Bernhard M. Wir brauchen dringend ein internationales Register. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Neuhaus C, Hinkelbein J. Notfälle an Bord von Linienflugzeugen. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hinkelbein J, Spelten O, Wetsch WA, Schier R, Neuhaus C. Emergencies in the sky: In-flight medical emergencies during commercial air transport. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sand M, Bechara FG, Sand D. Similar data collected. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:191. [PMID: 23555324 DOI: 10.3238/arztebl.2013.0191b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sand M, Morrosch S, Sand D, Altmeyer P, Bechara FG. Medical emergencies on board commercial airlines: is documentation as expected? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R42. [PMID: 22397530 PMCID: PMC3681367 DOI: 10.1186/cc11238] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 01/25/2012] [Accepted: 03/07/2012] [Indexed: 11/22/2022]
Abstract
Introduction The purpose of this study was to perform a descriptive, content-based analysis on the different forms of documentation for in-flight medical emergencies that are currently provided in the emergency medical kits on board commercial airlines. Methods Passenger airlines in the World Airline Directory were contacted between March and May 2011. For each participating airline, sample in-flight medical emergency documentation forms were obtained. All items in the sample documentation forms were subjected to a descriptive analysis and compared to a sample "medical incident report" form published by the International Air Transport Association (IATA). Results A total of 1,318 airlines were contacted. Ten airlines agreed to participate in the study and provided a copy of their documentation forms. A descriptive analysis revealed a total of 199 different items, which were summarized into five sub-categories: non-medical data (63), signs and symptoms (68), diagnosis (26), treatment (22) and outcome (20). Conclusions The data in this study illustrate a large variation in the documentation of in-flight medical emergencies by different airlines. A higher degree of standardization is preferable to increase the data quality in epidemiologic aeromedical research in the future.
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Affiliation(s)
- Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr, 56, 44791 Bochum, Germany.
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Emergency medical kits on board commercial aircraft: a comparative study. Travel Med Infect Dis 2010; 8:388-94. [PMID: 21075689 DOI: 10.1016/j.tmaid.2010.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 09/26/2010] [Accepted: 10/18/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND In cases of critical medical situations on board commercial aircraft, access to emergency medical kits can be lifesaving. Thus, this comparative study investigated acute care medication and equipment supplied in emergency medical kits on board both low-cost carriers and full-service carriers. METHODS Thirty-two European airlines (sixteen low-cost carriers and sixteen full-service-carriers) were asked to provide anonymous data on the contents of their emergency medical kits. All emergency medical equipment and medication carried on board were subject to a descriptive analysis with regards to International Civil Aviation Organization (ICAO) standards for emergency medical kits, as well as variation and differences between low-cost carriers and full-service carriers. RESULTS A total of twelve airlines (seven full-service carriers and five low-cost carriers) participated in this study. None complied with ICAO standards. Emergency medical kits from both full-service carriers and low-cost carriers exhibited a high degree of variability. Two European low-cost carriers were assessed as being insufficiently equipped for a medical emergency requiring acute care. CONCLUSIONS This study demonstrates the high degree of variability in the contents of emergency medical kits. Additionally, some airlines were equipped insufficiently for a critical medical situation on board their aircraft. Frequent checks of national authorities and further evaluation of acute care equipment are required to prepare for potentially life-threatening critical conditions occurring in special environments, such as in airplane during flight.
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