Physician passengers handle half of in-flight emergencies



In nearly half of all in-flight medical emergencies, an on-board physician volunteer is the first medical responder, based on a retrospective analysis of nearly 12,000 medical emergency calls over a 3-year period from five domestic and international airlines to a physician-directed medical communications center.

Few in-flight emergencies resulted in diversion of the aircraft or death. Most events were related to syncope (37%), respiratory symptoms (12%), or gastrointestinal distress (9.5%).

The 11,920 in-flight emergencies occurred among an estimated 744 million airline passengers, representing approximately 10% of the global passenger flight volume from Jan, 1, 2008, through Oct. 31, 2010, for an estimated 44,000 such emergencies worldwide each year, according to Dr. Drew C. Peterson of the department of emergency medicine at the University of Pittsburgh, and his colleagues.

An AED was applied in 24 cases of cardiac arrest; with shock delivery in 5 cases. Post flight follow-up was available for 91.6% of patients. The mean age of the 36 passengers who died (30 died in-flight) was 59 years (N. Engl. J. Med. 2013;368:2075-83).

For 31% of patients, the medical situation resolved sufficiently before landing and EMS personnel were not requested. Of the remaining patients, 37% were transported to a hospital emergency department. Of these, 54% were discharged; 32% were admitted or left against medical advice; 13% were lost to follow-up; and 0.6% died.

On-board assistance was provided by physicians (48%), nurses (20%), emergency medical service providers (4.4%), or other health care professionals (3.7%). Aircraft diversions occurred in 7.3% of cases, and the factors most strongly associated with diversion were AED use (applied to 1.3% of patients) and on-board assistance by an EMS provider as the highest level of provider. Hospital admission was associated with possible stroke (odds ratio, 3.36; confidence interval, 1.88-6.03), respiratory symptoms (OR, 2.12; CI, 1.48-3.06), and cardiac symptoms (OR, 1.95; CI, 1.37-2.77).

The 1998 Aviation Safety Medical Assistance Act includes a Good Samaritan provision, protecting passengers from liability other than liability for gross negligence or willful misconduct, therefore: "Although there is no legal obligation to intervene, we believe that physicians and other health care providers have a moral and professional obligation to act as Good Samaritans," the authors stated.

"The emergency medical kit available on every commercial airline regulated by the Federal Aviation Administration is usually sufficient to initiate treatment of serious problems," according to Dr. Peterson and his colleagues. "Symptoms can often be managed in collaboration with the flight attendants, who are well versed in the equipment the airplanes carry and in operational procedures."

The authors recommended that health care providers identify themselves during in-flight medical emergencies and specify their level of expertise to the flight crew; assess the patient by identifying the chief problem and duration as well as associated and high-risk symptoms (such as chest pain, shortness of breath, nausea or vomiting, or unilateral weakness or numbness); assess vital signs; ask for the emergency medical kit, administer oxygen as needed, and initiate consultation with a ground-based consultant if the flight crew has not already done so.

"On the basis of our findings, we believe that airline passengers who are health care professionals should be aware of their potential role as volunteer responders to in-flight medical emergencies. We also advocate for systematic tracking of all in-flight medical emergencies, including outcomes, to better guide interventions in this sequestered population," the researchers concluded.

The authors reported no potential conflicts of interest relevant to the article.

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