In-Flight Medicine Examined for Emergency Risks

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dv2074059An airplane is what’s known academically as a “medically austere environment.” During a flight, medical supplies are limited or nonexistent and a doctor may not always be available. A recent review published in the New England Journal of Medicine examines the types of medical situations that can occur in-flight and highlights the challenges doctors face when trying to respond.

Cardiac arrest is the most deadly threat but only makes up 0.3% of in-flight medical emergencies. In addition to CPR, which both doctors and some airline staff are trained in, every plane is supposed to have a defibrillator available. While capable of shocking an errant heart out of an abnormal rhythm, defibrillators are not always successful.

In addition to the defibrillator, in-flight emergency kits have several other supplies available for various medical emergencies. Aspirin and nitroglycerine are available in case of a heart attack, angina, or similar cardiology event (eight percent of emergencies); oxygen is on-hand for anyone who is having a stroke, which makes up two percent of emergencies; and in the case of breathing difficulties (12% of emergencies), an albuterol inhaler is in the kit.

However, one thing not all airplanes have in the kit is a blood glucose meter, since it is not required. If someone is suspected of having low blood sugar (1.6%), a meter must be borrowed from another passenger. The altered mental status that low blood sugar can cause is also possible from seizures (5.8%), which may be exacerbated by the lower air pressure in airplane cabins. The low pressure, dry air, and possible fatigue also boost the risk of a fainting spell, which accounts for 37% of all in-flight medical emergencies.

A tricky situation to encounter in-flight is a passenger who is experiencing a psychiatric emergency, which is what happens in 3.5% of cases. Flying has numerous stressors that can trigger an incident and medical kits do not contain sedatives. In extreme cases, restraints sometimes have to be improvised if the situation cannot be de-escalated.

Even if there is a doctor on board, whether or not to make an emergency landing is completely up to the pilot. As a 2006 survey noted, only three percent of in-air medical incidents examined resulted in an emergency landing.

Interestingly, although there is only a one in 600 chance of any given flight experiencing a medical emergency in the air, a doctor is present on the flight in about 45% of these cases.

Sources for Today’s Article:
Campion, E.W., et al., “In-Flight Medical Emergencies during Commercial Travel,” New England Journal of Medicine 2015: 939–45.
“Few flights diverted for medical emergencies,” CBC News web site, last updated May 30, 2013; http://www.cbc.ca/news/health/few-flights-diverted-for-medical-emergencies-1.1301321, last accessed September 4, 2015.

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