In-Flight Medical Emergencies Are Common, Best Handled by a Team

Comments: This review article describes the incidence and typical causes of medical emergencies in-flight. It covers laws surrounding medical volunteers and presents an algorithm describing a general approach to inflight medical emergencies. There are helpful specific recommendations for the most common types of emergencies encountered during flight. —Cristina Cabrera-Muffly, MD
I pray for no in-flight emergencies in general, but definitely not complex medical ones. As we gain and practice our specialized skill set, others fall by the wayside. It was nice to see a framework for emergencies presented in a quick and easy to follow manner (I’m saving figures 1 and 2 to my phone!). The article also presents a quick primer on how to handle in-flight emergencies (or even scary situations at a neighborhood BBQ, etc., while waiting for EMS to arrive). —Jennifer A. Villwock, MD

How common are in-flight medical emergencies (IMEs), and what are the best responses to them by traveling medical personnel?

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

Background: Cruising at 35,000 feet with limited medical equipment, often hours away from the closest medical facility, creates an unfamiliar care challenge for many healthcare professionals. The key to success is for everyone involved to contribute their expertise as part of a collaborative team, with the sole goal of ensuring the best interest of the patient and all passengers on board.

Study design: A literature search conducted in MEDLINE using PubMed for 317 English-only articles published between January 1, 1990, and June 2, 2018.

Setting: MEDLINE database.

Synopsis: The aggregate frequency of medical conditions among 49,100 IMEs showed that syncope or near-syncope was the most common; other common condition categories included gastrointestinal, respiratory, and cardiovascular symptoms. In-flight cardiac arrest was rare. Altitude changes commonly trigger discomfort, especially among those with existing upper respiratory tract inflammation or infection, including sinusitis or otitis media. Passengers with hypoxia or respiratory insufficiency at baseline may benefit from supplemental oxygen at cruising altitude. Cabin air, drawn from an outside dry environment at altitude and pressurized and dehumidified, may contribute to dehydration among passengers. Recycled air may also expose passengers to potential allergens.

On a flight crew’s request for assistance, medical professionals should identify themselves and report their training and current clinical practice. Next, the assessment should determine the type and duration of symptoms, presence of high-risk symptoms (e.g., chest pain, shortness of breath, focal weakness), vital signs, mental status, and pertinent physical findings. Communication clarity is often a challenge, including device issues and relaying of information. If multiple potential volunteers exist, a collegial conversation about capabilities is optimal.

Citation: Martin-Gill C, Doyle TJ, Yealy DM, et al. In-flight medical emergencies: a review. JAMA. 2018;320:2580–2590.