Emergencies in the air

A survey on dogs with valvular disease flying to Japan for operation

In small-breed dogs, myxomatous mitral valve disease (MMVD) is a common disease which may lead to chronic heart failure. Mitral valve repair is an optimal surgical treatment that is currently available in limited veterinary facilities globally because it requires a special surgery team and specific devices. Therefore, some dogs must travel overseas to undergo this surgery. However, a question arises regarding the safety of dogs when traveling by air with a heart disease. We aimed to evaluate the effect of flight journey on dogs with mitral valve disease, including survival rates, symptoms during the trip, laboratory test results, and operational outcomes. All dogs stayed near the owner in the cabin during the flight. The survival rate after the flight was 97.5% in 80 dogs. The surgical survival rates (96.0% and 94.3%) and hospitalization periods (7 days and 7 days) were similar between overseas and domestic dogs. This report shows that taking air flights in the cabin may not have a significant effect on dogs with MMVD, on the premise that their overall conditions are stable under cardiac medication.

In-flight medical emergencies during commercial travel

BACKGROUND

Growing number of passengers travelling by air is associated with increased in-flight emergency medical events (IEMEs). However, there are scarce data regarding IEMEs during commercial travels. In this study, analysis of IEMEs occurring among adult and paediatric passengers during commercial international and domestic flights of a major airline company was targeted.

METHODS

Data regarding IEMEs recorded in all international and domestic flights of a major airline company between 1 January 2018 and 31 December 2020 were collected. Demographics, adult and paediatric IEMEs, in-flight deaths and aircraft diversions (ADs) were analysed.

RESULTS

Total number of passengers was 177 400 748 and a number of 22 541 (0.012%) IEMEs occurred. The frequency of IEMEs per 1 million passengers was 127. The number of male patients suffering from IEMEs was 8387 (37.2%), while the number female patients was 10 853 (48.1%). Median age of adult and paediatric patients were 43, [32-57], 4, [2-10], respectively. The most common cause of IEMEs in adult patients was headache (3424 IEMEs, 15.1%) and it was fever in paediatric patients (688 IEMEs, 3.05%). Multiple symptoms were present in 8449 IEMEs (37.4%). On-board doctors managed events in more than half of IEMEs (13 295 IEMEs, 58.9%). AD was required in 255 (1.13%) IEMEs. The most common reason for AD was chest pain (45 IEMEs, 17.6%) in adult patients. The most common reason for AD in paediatric patients was epileptic seizures (nine IEMEs, 3.5%). A total of 46 (0.2%) patients, including 2 (0.008%) paediatric patients, died.

CONCLUSIONS

Majority of IEMEs are not life-threatening conditions, which can be easily managed by cabin crew or on-board doctors without AD. Multiple symptoms can be present in a patient suffering from IEME. Ground-to-air medical assistance may help optimization of diagnosis and decision for AD.

The global incidence of in-flight medical emergencies: A systematic review and meta-analysis of approximately 1.5 billion airline passengers

BACKGROUND

Medical emergencies during short- or long-haul commercial airline flights have become more commonplace due to the aviation industry's contemporary growth, the popularization of commercial flights, and an increased aging of air travelers with significant comorbidities. However, the precise incidence of onboard medical events on commercial airlines and the most common medical conditions is unclear.

METHODS

In this systematic review and meta-analysis, we explored the incidence of in-flight medical emergencies among airline passengers and estimated the incidence rate by physiological body system, or organ class/syndrome for emergencies that may be associated with different body systems. We limited our search to cohort studies published between 1945 to October 31, 2020 in MEDLINE, Embase, Cochrane Library and official reports from the Federal Aviation Administration/International Air Transport Association, regardless of the language of publication. Only studies that evaluated the overall frequency of onboard medical events on commercial air carriers (in which they also presented the total number of annual revenue passengers) and the frequency of events by physiological body systems or organ class/syndrome were included. We excluded case reports and case series, systematic or narrative reviews, and studies addressing specific health-related conditions. Two independent investigators performed first- and second-phase study screening, abstracted data, and appraised risk of bias. We rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Using a quality effect model, we meta-analyzed data associated with the incidence of in-flight medical emergencies, all-cause fatality, incidence of medical events by medical condition category, frequency of en-route diversion, presence of medical personnel on board, and the use of an automatic external defibrillator. We also extracted data regarding the cost of flight diversion.

RESULTS

Of 18 individual studies with approximately 1.5 billion passengers, 11 reported the overall incidence of in-flight medical emergencies. Low certainty of evidence suggested that the global incidence of in-flight medical emergencies was 18.2 events per million passengers (95% CI 0.5 to 53.4 per million; I² = 100%, P < 0.001, very low certainty), and an all-cause mortality rate was 0.21 per million passengers (95% CI 0 to 0.76 per million; I² = 99%, P < 0.001, low certainty). The four most common categories of medical conditions or syndromes during flight were syncope, gastrointestinal events, respiratory and neurological diagnostic groups. The diversion rate was 11.1 per 100,000 flights (95% CI 5.9 to17.6 per 100,000 flights; I² = 97%, P < 0.001), with an average cost ranging from $15,000 to $893,000 per unplanned emergency landing across studies which examined this outcome.

CONCLUSIONS

In-flight medical events on commercial travels are extremely low with a corresponding very low in-flight mortality rate. Associated costs derived from en-route diversion might significantly influence airlines' budgetary equilibrium. Novel and modern standardized reporting systems or platforms should be internationally provided and enforced by health and aviation authorities to obtain higher quality patient-passengers datasets. Onboard volunteer medical providers must be aware of everyday life-threatening events during commercial flights and should consider the establishment of a connection between the aircraft and ground-based medical advisory services while assisting in-flight medical events.

Medical Events on Board Aircraft: Reducing Confusion and Misinterpretation in the Scientific Literature

INTRODUCTION: A topic in aviation medicine that attracts much attention from the scientific community as well as from the media concerns medical incidents on board commercial airline flights. It was noticed that many papers on the subject were written by authors whose specialization was outside that of aviation medicine and that they sometimes made basic errors concerning the application of scientific principles of the subject. A review was undertaken to determine if there were any patterns to the observed errors and, if so, to consider whether recommendations might be provided that could reduce their frequency.METHOD: A literature search was undertaken of MEDLINE using PubMed for English-only articles published between January 1, 1974, and February 1, 2019, employing the following search terms: air emergency, air emergencies, air passenger, air travel, aircraft, airline, aviation, commercial air, flight, and fitness to fly. In addition, other relevant papers held in the personal collection of the authors were reviewed.RESULTS: Many cases of misinterpretation or misunderstanding of aviation medicine were found, which could be classified into eight main categories: references; cabin altitude; pressure/volume relationship; other technical aspects of aircraft operations; regulations; medical events; in-flight deaths; and automated external defibrillator.CONCLUSION: Papers were identified as having questionable statements of fact or of emphasis. Such instances often appeared to result from authors being unfamiliar with the subject of aviation medicine and/or the commercial aviation environment. Simple steps could be taken by authors to reduce the future rate of such instances and recommendations are provided.Thibeault C, Evans AD. Medical events on board aircraft: reducing confusion and misinterpretation in the scientific literature. Aerosp Med Hum Perform. 2021; 92(4):265273.

On-board emergency medical equipment of European airlines

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).

High-altitude Illnesses and Air Travel: Pediatric Considerations

Healthy children may present acute mountain sickness (AMS) within a few hours after arrival at high altitudes. In few cases, serious complications may occur, including high-altitude pulmonary edema and rarely high-altitude cerebral edema. Those with preexisting conditions especially involving hypoxia and pulmonary hypertension shall not risk travelling to high altitudes. Newborn from low altitude mothers may have prolonged time to complete postnatal adaptation. The number of children and adolescents traveling on commercial aircrafts is growing, and this poses a need for their treating physicians to be aware of the potential risks of hypoxia while air traveling.

In-Flight Medical Events and Cabin Crew First Aid Response

INTRODUCTION: In-flight medical events (IMEs), although rare, are challenging due to the limited onboard resources and the time needed to reach an airport. Cabin crewmembers (CCMs) are trained to provide first aid, but their effectiveness has not been appropriately studied.METHODS: IMEs occurring in the biggest airline of Greece were prospectively recorded during a 5-yr period (20142018) and categorized according to a symptom-based taxonomy.RESULTS: During the study period 990 IMEs were recorded corresponding to 16 IMEs for each million passengers or 1.8 IMEs for every thousand flights. The most frequent events were loss of consciousness (38.4%) followed by injuries (8.6%), gastrointestinal problems (8.3%), respiratory symptoms (7.3%), anxiety (5.7%), and burns (5.9%). Diversion was decided in 3% of the cases while death on board was rare (0.3% of events). CCMs responded in 33.5% of IMEs without assistance by a volunteer health professional, achieving a 97% success rate.DISCUSSION: IMEs are rare events and the majority can be treated with simple first aid measures. CCMs acting according to a simplified algorithm were very efficient in providing first aid. A standardized symptom-based IME form will assist in creating a reliable registry for further studies.Paxinos O, Savourdos P, Alexelis V, Anastasopoulos A, Karantoni E, Grigoropoulos P, Konstantinou X. In-flight medical events and cabin crew first aid response. Aerosp Med Hum Perform. 2021; 92(1):3238.

Commercial Air Travel for Passengers With Cardiovascular Disease: Stressors of Flight and Aeromedical Impact

The exponential growth of commercial flights has resulted in a sharp rise of air travellers over the last 2 decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that had set back the aviation industry for the next 1 to 2 years, air travel is expected to rebound fully by 2023-2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an overview of the stressors of commercial passenger flights with an impact on cardiovascular health for the general cardiologist and family practitioner, when assessing the suitability of such patients for flying fitness.

Are pulmonologists well aware of planning safe air travel for patients with COPD? The SAFCOP study

Background

Patients with respiratory diseases are more prone to health risks of air travel.

Purpose

The aim of this study was to investigate the current knowledge and attitudes of Turkish pulmonary physicians for air travel in patients with chronic obstructive pulmonary disease (COPD).

Participants and methods

A questionnaire was developed and administered either by congress mobile phone application or by e-mail. A total of 242 physicians participated in the study (75 by mobile phone application and 167 through the e-mail).

Results

Among participants, only 30.6% reported that they usually inform COPD patients about possible risks of air travel in their routine practice. A preflight assessment was performed by 61.2% of them and a fit to fly report was prepared by 34.3%. The most common methods/tests used for preflight assessment were reported as oxygen saturation with pulse oximetry, arterial blood gas analysis, and pulmonary function tests (51.2%, 50.8%, and 49.6%, respectively). When the participants were asked to plan safe air travel in two clinical case scenarios, only 16.2% were able to answer both cases correctly.

Conclusion

This study shows that a standard approach for preflight assessment in patients with COPD is lacking and an active initiative is needed to increase awareness and education for fit to fly concept for COPD among pulmonologists.

In-Flight Medical Emergencies: A Review

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 volunteers should identify their background and skills, perform an assessment, and report findings to ground-based medical support personnel through the flight crew. Ground-based recommendations ultimately guide interventions on board.

CONCLUSIONS AND RELEVANCE

In-flight medical emergencies most commonly involve near-syncope and gastrointestinal, respiratory, and cardiovascular symptoms. Health care professionals can assist during these emergencies as part of a collaborative team involving the flight crew and ground-based physicians.

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)

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.

A Systematic Review of Pediatric and Adult In-Flight Medical Emergencies

In-flight medical emergencies (IMEs) are acute onboard events of illnesses or injuries with potential immediate risk to a passenger's short- or long-term health, or life. IMEs are significant events that are related to public safety concerns. With the increasing amount of annual air travel every year, it is expected that the number of encountered IMEs will continue to grow. Thus, it will be critical to develop and implement appropriate measures to manage IMEs with the best possible outcome. Despite the fact that most IMEs are self-limited with no serious adverse events, serious IME can lead to death, disability, or other unfavorable health outcomes, particularly as a result of suboptimal medical care. In this article, we systematically reviewed the published up-to-date evidence on the subject of in-flight emergencies with a specific focus on pediatric population.

Should I stay or should I go? COPD and air travel

Chronic obstructive pulmonary disease (COPD) is a challenging respiratory problem throughout the world. Although survival is prolonged with new therapies and better management, the magnitude of the burden resulting from moderate-to-severe disease is increasing. One of the major aims of the disease management is to try to break the vicious cycle of patients being homebound and to promote an active lifestyle. A fundamental component of active daily life is, of course, travelling. Today, the world is getting smaller with the option of travelling by air. Air travel is usually the most preferred choice as it is easy, time saving, and relatively inexpensive. Although it is a safe choice for many passengers, the environment inside the aeroplane may sometimes have adverse effects on health. Hypobaric hypoxaemia due to cabin altitude may cause health risks in COPD patients who have limited cardiopulmonary reserve. Addressing the potential risks of air travel, promoting proactive strategies including pre-flight assessment, and education of COPD patients about the "fitness to fly" concept are essential. Thus, in this narrative review, we evaluated the current evidence for potential risks of air travel in COPD and tried to give a perspective for how to plan safe air travel for COPD patients.

Review of Issues and Challenges of Practicing Emergency Medicine Above 30,000-Feet Altitude: 2 Anonymized Cases

We present 2 anonymized cases to identify issues and challenges associated with long-haul in-flight medical emergencies. The first case involved a middle-aged man with a history of carditis on a systemic steroid who developed vomiting and rigor. Four physicians, including a pediatric intensivist, responded to the emergency call. In the second case, a pediatric trainee who was the only onboard medical personnel was summoned for help when a middle-aged man developed acute shortness of breath while traveling on a commercial flight. The cases illustrate the challenges and issues on the critical decisions of diagnosis, resuscitation, and whether the flight had to be returned or diverted. An extensive literature search is made to summarize the evidence available for these decisions and challenges. Epidemiology and outcomes associated with these medical emergencies are reviewed. In-flight medical emergencies are not rare. Physicians of all disciplines should be prepared to deal with these emergencies and make sensible decisions when equipment and resources are likely to be limited.

Fitness to fly in the paediatric population, how to assess and advice

The number of children on commercial aircrafts is rising steeply and poses a need for their treating physicians to be aware of the physiologic effects and risks of air travel. The most important risk factors while flying are a decrease in partial oxygen pressure, expansion of trapped air volume, low cabin humidity, immobility, recirculation of air and limited options for medical emergencies. Because on-board medical emergencies mostly concern exacerbations of chronic disease, the medical history, stability of current disease and previous flight experience should be assessed before flight. If necessary, hypoxia altitude simulation testing can be performed to simulate the effects of in-flight hypoxia. Although the literature on paediatric safety of air travel is sparse, recommendations for many different situations can be given.

CONCLUSION

We present an overview of the most up to date recommendations to ensure the safety of children during flight. What is Known: • Around 65% of on-board medical emergencies are complications of underlying disease. • In children, the three most common emergencies during flight concern respiratory, neurological and infectious disease. What is New: • Although studies are scarce, some advices to ensure safe air travel can be given for most underlying medical conditions in children, based on physiology, studies in adults and expert opinions. • In former preterm infants without chronic lung disease, hypoxia altitude simulation testing to rule out in-flight desaturation is not recommended.

In-flight angina pectoris; an unusual presentation

BACKGROUND

An unusual case of typical angina which occurred on a long haul flight is presented. This case is notable as this was the index presentation, with no previous symptoms prior to this. Physiological changes at altitude can be marked, and include hypoxia, tachycardia and an increase in cardiac output. These changes were enough to expose underlying angina in our patient.

CASE PRESENTATION

A 68 year old man presented with typical cardiac chest pain on a long haul flight. His symptoms first started 10-15 min after take-off and resolved on landing. This was his index presentation, and there were no similar symptoms in the past. Background history included hypercholesterolaemia and benign prostatic hypertrophy only. He led a rather sedentary lifestyle. A CT coronary angiogram showed significant disease in the proximal left anterior descending artery and proximal right coronary artery. He went on to have a coronary angiogram with invasive physiological measurements, which determined both lesions were physiologically significant. Both arteries were treated with drug eluting stents. Since treatment, he once again embarked on a long haul flight, and was completely asymptomatic.

CONCLUSION

The presentation of symptoms in this individual was rather unusual, but clearly caused by significant coronary artery disease. Potentially his sedentary lifestyle was not enough in day-to-day activities to promote anginal symptoms. When his cardiovascular system was physiologically stressed during flight, brought about by hypoxia, raised sympathetic tone and increased cardiac output, symptoms emerged. In turn, when landing, with atmospheric conditions normalised, physiological stress was removed, and symptoms resolved. Clinically therefore, one should not exclude symptoms that occur with differing physiological states, such as stress and altitude, as they are also potential triggers for myocardial ischaemia, despite absence of day-to-day symptoms.

International Flight Considerations

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.

Comparison of inflight first aid performed by cabin crew members and medical volunteers

BACKGROUND

Since the number of air travellers, including the elderly and passengers with an underlying disease, is increasing every year, the number of inflight emergency patients is expected to increase as well. We attempted to identify the incidence and types of reported inflight medical incidents and analyse the first aid performed by cabin crew members or medical volunteers in flights by an Asian airline. We also investigated the cases of inflight deaths and aircraft diversions.

METHODS

We reviewed the cabin reports and medical records submitted by cabin crew members and inflight medical volunteers from 2009 to 2013.

RESULTS

We found that inflight medical incidents increased annually, with a total of 2818 cases reported. Fifteen cases of inflight deaths and 15 cases of aircraft diversions during this period were also reported. First aid was performed by the cabin crew alone in 52% of the cases and by medical volunteers in 47.8% of the cases. The most commonly reported causes for first aid performed by the cabin crew and medical volunteers were burns and syncope, respectively.

CONCLUSION

: Since burns were one of the common reasons that first aid was provided by the cabin crew, it may be necessary to include first aid treatments for burns in the annual re-qualification training programme. Furthermore, the assessment of unconsciousness and potentially critical respiratory symptoms is very important for cabin crew members because those conditions can lead to inflight deaths and aircraft diversion.

In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

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.

Inflight Emergencies During Eurasian Flights

BACKGROUND

This study evaluated the incidence and status of urgent medical conditions, the attitudes of health professionals who encounter such conditions, the adequacy of medical kits and training of cabin crew in data-received-company aircrafts suggested by Aerospace Medical Association, and the demographic data of patients.

METHODS

Data were collected from medical records of a major flight company from 2011 through 2013. All patients with complete records were included in the study. Numerical variables were defined as median and interquartiles (IQR) for median, while categorical variables were defined as numbers and percentage.

RESULTS

During the study period, 10,100,000 passengers were carried by the company flights, with 1,312 (0.013%) demands for urgent medical support (UMS). The median age of the passengers who requested UMS was 45 years (IQR: 29-62). Females constituted 698 (53.2%) among the patients, and 721 (55%) patients were evaluated by medical professionals found among passengers. The most common nontraumatic complaints resulting in requests for UMS were flight anxiety (311 patients, 23.7%) and dyspnea (145 patients, 11%). The most common traumatic complaint was burns (221 patients, 16.8%) resulting from trauma during flight. A total of 22 (1.67%) emergency landings occurred for which the most frequent reasons were epilepsy (22.7%) and death (18.2%). Deaths during flights were recorded in 13 patients, whose median age was 77 years (IQR: 69-82), which was significantly higher compared to the age of patients requiring UMS (p < 0.0001). A total of 592 (45%) patients did not require any treatment for UMS. Medical kits and training were found to be sufficient according to the symptomatic treatments.

CONCLUSION

Most of the urgent cases encountered during flights can be facilitated with basic medical support. "Traumatic emergency procedures inflight medical care" would be useful for additional training. Medical professionals as passengers are significantly involved in encountered emergency situations. Adding automated external defibrillator and pulse oximetry to recommended kits and training can help facilitate staff decisions such as emergency landings and tele-assistance.

Emergency medical equipment on board German airliners

BACKGROUND

Medical emergencies often occur on commercial airline flights, but valid data on their causes and consequences are rare. Therefore, it is unclear what emergency medical equipment is necessary. Although a minimum standard for medical equipment is defined in regulations, additional material is not standardized and may vary significantly between different airlines.

METHODS

German airlines operating aircrafts with more than 30 seats were selected and interviewed with a 5-page written questionnaire between August 2011 and January 2012. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted another three times by e-mail and/or phone. Descriptive analysis was used for data presentation and interpretation.

RESULT

From a total of 73 German airlines, 58 were excluded from analysis (eg, those not providing passenger transport). Fifteen airlines were contacted and data of 13 airlines were available for analysis (two airlines did not participate). A first aid kit was available on all airlines. Seven airlines reported having a doctor's kit, and another four provided an "emergency medical kit." Four airlines provided an automated external defibrillator (AED)/electrocardiogram (ECG). While six airlines reported providing anesthesia drugs, a laryngoscope, and endotracheal tubes, another four airlines did not provide even a resuscitator bag. One airline did not provide any material for cardiopulmonary resuscitation (CPR).

CONCLUSIONS

Although the minimal material required according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in the provision of additional material. The equipment on most airlines is not sufficient for the treatment of specific emergencies according to published medical guidelines (eg, for CPR or acute myocardial infarction).

In-flight Medical Emergencies

Introduction:

Research and data regarding in-flight medical emergencies during commercial air travel are lacking. Although volunteer medical professionals are often called upon to assist, there are no guidelines or best practices to guide their actions. This paper reviews the literature quantifying and categorizing in-flight medical incidents, discusses the unique challenges posed by the in-flight environment, evaluates the legal aspects of volunteering to provide care, and suggests an approach to managing specific conditions at 30,000 feet.

Methods:

We conducted a MEDLINE search using search terms relevant to aviation medical emergencies and flight physiology. The reference lists of selected articles were reviewed to identify additional studies.

Results:

While incidence studies were limited by data availability, syncope, gastrointestinal upset, and respiratory complaints were among the most common medical events reported. Chest pain and cardiovascular events were commonly associated with flight diversion.

Conclusion:

When in-flight medical emergencies occur, volunteer physicians should have knowledge about the most common in-flight medical incidents, know what is available in on-board emergency medical kits, coordinate their therapy with the flight crew and remote resources, and provide care within their scope of practice.

[The elderly travellers]

We attend a considerable increase in the number of old travellers, because of facilitation of transport, and increase of the life expectation without incapacity. This way, practicians will be more and more confronted with old travellers avid councils before their departure. In spite of the risk of intercurrent pathologies, data shows that the age in itself is not a contra-indication of travel: the stage of life considered as a limit becomes a period privileged to discover the world. On a theoretical plan, the ageing characterized by a reduction of the functional reserve of organ, represents more a fragility than a contra-indication. On the other hand, comorbidities and their accumulation make elderly more vulnerable to medical complications potentially serious and in conditions of stress than can gather a travel. We could propose to the vulnerable old patient avid to leave, in coordination with the geriatrician and the travel doctor, a personalized prevention in the form of a consultation "old traveller" where we would adopt a geriatric approach to review the compatibility between the health and the type of travel, in particular at elderly with polypathologies and many treatments.

Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases

Introduction

In-flight medical and surgical emergencies (IMEs) onboard commercial aircrafts occur quite commonly. However, little epidemiological research exists concerning these incidents.

Methods

Thirty-two European airlines were asked to provide anonymous data on medical flight reports of IMEs for the years 2002 to 2007. The total number of incidents was correlated to revenue passenger kilometers (rpk). Additionally, on-board births and deaths, flight diversions, flight routes (continental/intercontinental) and involvement of a physician or medical professional in providing therapy were analysed.

Results

Only four airlines, of which two participated in this study, were able to provide the necessary data. A total of 10,189 cases of IMEs were analysed. Syncope was the most common medical condition reported (5307 cases, 53.5%) followed by gastrointestinal disorders (926 cases, 8.9%) and cardiac conditions (509 cases, 4.9%). The most common surgical conditions were thrombosis (47 cases, 0.5%) and appendicitis (27 cases, 0.25%). In 2.8% of all IMEs, an aircraft diversion was performed. In 86% of cases, a physician or medical professional was involved in providing therapy. A mean (standard deviation) of 14 (+/- 2.3, 10.8 to 16.6 interquartile range) IMEs per billion rpk was calculated.

Conclusions

The study demonstrates that although aviation is regulated by a variety of national and international laws, standardised documentation of IMEs is inadequate and needs further development.

Clinic in the air? A retrospective study of medical emergency calls from a major international airline

BACKGROUND

There is a high likelihood of a medical professional being onboard the aircraft at the time of emergency. Therefore, a health-care professional should be familiar with in-flight medical events and how to deal with them.

METHODS

I present a 12-month retrospective study of medical distress calls from a major Asian international airline for which International SOS provided in-flight telemedical assistance. All the calls from the airplane to our center were analyzed from January 1, 2006, to January 1, 2007. The number of recommended diversions, availability of a medical professional, the range of medical problems, and used medications were considered.

RESULTS

Overall, there were 191 in-flight air-to-ground consultations. Twenty-three (12.04%) calls were made for pediatric problems, with the youngest patient being 9 months old. Gastrointestinal complaints and simple faints comprised 50.2% of all calls. Most of the in-flight problems were successfully treated symptomatically with the initial recommendation to lie the patient down and administer oxygen. Metoclopramide, stemetil, loperamide, and buscopan were the most often administered drugs. A doctor was onboard in 45.5% of all calls. A recommendation to divert the aircraft was made in six (3.1%) cases.

CONCLUSIONS

Although developments in telemedical assistance and the content of a medical kit make the management of potential in-flight medical emergency much easier, they will never turn a commercial aircraft into a flying clinic. Preflight check-in screening by airlines and encouraging future air travelers with health concerns to seek medical help before flying should be recommended.

Cabin fever

Health emergencies on aeroplanes often make the headlines, but how common are they and what would you be expected to do if you were on the flight? Alison Tonks investigates