Commercial in-flight medical emergencies

Background

• 1 per 604 flights
  • 0.3% of cases died

Epidemiology

• syncope or presyncope (37.4%)
• respiratory symptoms (12.1%)
• nausea or vomiting (9.5%)
• Cardiac symptoms (7.7%)
• Seizures (5.8%)
• Abdominal pain (4.1%)
• Infectious disease (2.8%)
• Agitation or psychiatric symptoms (2.4%)
• Allergic reaction (2.2%)
• Possible stroke (2.0%)
• Trauma, not otherwise specified (1.8%)
• Diabetic complication (1.6%)
• Headache (1.0%)
• Arm or leg pain or injury (1.0%)
• Obstetrical or gynecologic symptoms(0.5%)

Ear pain (0.4%)

• Cardiac arrest (0.3%)
• Laceration (0.3%)

Management

General Approach

• Identify yourself and level of medical training
• Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed

Patient assessment

1. Identify chief complaint and HPI
2. Obtain vital signs (pulse and blood pressure)
3. If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse
   • Assess mental status and if there are focal neurologic deficits
4. f the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)
   1. For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities
      • The airline may require contact with a ground-based consultant before use

• Initiate consultation with the ground-based consultant if not already initiated by the flight crew
• Consider discussing administration of medications or intravenous fluids with ground-based consultant
• Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation
• Document the clinical presentation and care rendered and give documentation to medical personnel on arrival at the destination with transfer of care

Management of Syncope or Presyncope

• Confirm breathing and pulse
• Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen
• Check vital signs
  • Most patients will be hypotensive immediately after the episode
• If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment
  • A device may also be available in enhanced EMKs
• Most patients will recover spontaneously within minutes. Give oral fluids when possible
• Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication

Management of Chest Pain or Palpitations

• Check vital signs
• Provide oxygen
• If chest pain may be cardiac in origin, administe aspirin
• If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes
  • Check blood pressure after each dose
• If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads
• If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions

See Also

High Altitude Medicine