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%)

Emergency Medicine Kit

Common Airline Emergency Medical Kit Contents

Medications	Equipment
Epinephrine 1:1000	Stethoscope
Antihistamine, inj	Sphygmomanometer
Dextrose 50%, inj. 50 ml	Airways, oropharyngeal (appropriate range of sizes)
Nitroglycerin tablets or spray	Syringes (appropriate range of sizes)
Major analgesic, inj. or oral	Needles (appropriate range of sizes)
Sedative anticonvulsant, inj.	IV Catheters (appropriate range of sizes)
Antiemetic, inj.	Antiseptic wipes
Bronchodilator inhaler	Disposable gloves
Atropine, inj.	Sharps box
Adrenocortical steroid, inj.	Urinary catheter
Diuretic, inj.	System for delivering intravenous fluid
Medication for postpartum bleeding	Venous tourniquet
Sodium chloride 0.9% (minimum 250 ml)	Sponge gauze
Acetyl Salicylic Acid for oral use	Tape adhesive
Oral beta blocker	Surgical mask
	Flashlight and batteries
	Thermometer (non-mercury)
	Umbilical cord clamp
	Basic Life Support cards
	List of equipment
	Advanced Life Support Guides

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 any focal neurologic deficits
4. If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)
   • 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

Management of Syncope or Presyncope

1. Confirm breathing and pulse
2. Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen
3. Check vital signs
   • Most patients will be hypotensive immediately after the episode
4. If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment.
5. Most patients will recover spontaneously within minutes. Give oral fluids when possible
6. 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

Aftercare

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

United States Liability

"An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."

—Air Carrier Access Act of 1998, Public Law 105–170—April. 24, 1998.pdf

See Also

High Altitude Medicine