Medical Matters: Inflight emergencies are part and parcel of air travel for doctors

When we’re planning for the holidays, the chance of being at the centre of an inflight emergency is not a concern that preoccupies most travellers.

That is unless you are a medic or a nurse, for whom the request “is there a doctor or a nurse on the plane?” is not an infrequent occurrence.

Just how common and for what specific reasons they occur is the subject of an interesting study recently published in the New England Journal of Medicine.

Sifting through the records of nearly 12,000 inflight emergency calls made to a dedicated University of Pittsburgh medical communications centre from five commercial airlines in the US, researchers found that one medical emergency occurred for every 604 flights.

The communications centre received calls about 11,920 inflight medical emergencies among an estimated 744 million airline passengers during the period from January 2008 to the end of October 2010.

This works out as a rate of 16 medical emergencies per 1 million passengers. The youngest passenger needing assistance was 14 days old; the eldest an impressive 100 years old.

Common symptoms
What symptoms were the most common midair medical problems? Feeling dizzy or fainting accounted for almost four in 10 cases.

Respiratory symptoms and nausea and vomiting each accounted for about 10 per cent, while cardiac symptoms were the next most likely to occur while flying. And a measure of how serious the underlying problems were is the finding that in just over 7 per cent of cases, the plane had to divert from its planned destination.

For most of the passengers treated inflight, the eventual outcome was a good one. Some 25 per cent were transported to hospital after landing, with about 9 per cent requiring admission; just 0.3 per cent died either onboard the aircraft or during transport to a hospital.

Hospital admission
The most common causes for hospital admission were stroke or cardiac symptoms, with a quarter of passengers needing further attention because of obstetric or gynaecological symptoms.

Interestingly, of these cases, most occurred in pregnant women less than 24 weeks gestation, suggesting the nightmare scenario of dealing with a woman in unexpected labour at 37,000 feet is less likely than doctor-passengers worry about.

And as far as inflight treatment was concerned, half of those who became ill needed oxygen, while 5 per cent required intravenous fluids with another 5 per cent requiring the administration of aspirin (most likely given to people who doctors thought might be having a heart attack or stroke).

While most medical emergencies occur due to pre-existing medical conditions or an acute illness, the aircraft itself can contribute to health problems.

A pressurised cabin is the equivalent of being 6,000 to 8,000 feet above sea level, causing a 10 per cent drop in blood oxygen saturation in the average traveller. For some, that may mean a need to book onboard oxygen.

As a general rule of thumb if you can walk 50 yards at a normal pace or climb one flight of stairs without chest pain or significant shortness of breath, you are probably okay to fly without supplemental oxygen.

Most airlines’ emergency medical kits include a portable heart defibrillator. The rate of survival after cardiac arrest on a commercial airliner ranges from 14 to 55 per cent.

This study found that in 42 per cent of cases of cardiac arrest, the flight was not diverted. They included arrests that occurred at a time when immediate diversion was not feasible (for example, while the airplane was crossing the ocean), and arrests that occurred when the airplane was close to the intended destination and diversion would not have been beneficial to the patient.

From the ill passenger’s perspective, there is an element of luck involved.

If you suffer a cardiac arrest, you probably don’t want the only doctor on the plane to be a psychiatrist. And if a pathologist arrives to help, well then it probably isn’t your day.

mhouston@irishtimes.com
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