Is there a doctor on board? What to do in case of an in-flight emergency

March 1, 2012

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Key Points

Any physician who agrees to assist with a medical request on an airplane has a difficult task. He or she must try to provide care with an incomplete history because this patient will not be known to the clinician and may not even be able to relate a history. The responder will also have to make medical decisions with an incomplete examination, because the patient will not be undressed and often is in a sitting position.

Furthermore, the equipment available on the airplane is likely to be minimal compared with what the clinician is accustomed to having available in a medical office or emergency department. The emergency must often be managed in the cramped quarters of a narrow aisle in an overcrowded airplane. Add the inevitable engine noise, and the situation is even more difficult. Finally, the responder sometimes lacks the knowledge and confidence to handle many emergencies (eg, when an ob/gyn must assist with an elderly passenger).

How often do medical emergencies occur on an airplane?

Which emergencies are likely to occur?

Most medical events onboard a commercial flight are not serious. About 65% are related to preexisting problems, 28% to new medical conditions, and 7% to traumatic injury, such as a burn from a hot drink or an injury from falling luggage.7 Fainting, dizziness, and hyperventilation are the most common events. Cardiac, neurologic, and respiratory problems are the most common serious events and account for most flight diversions.3,7-10 Chest pain, asthma, and gastrointestinal (GI) complaints also are common.1

Deep vein thrombosis with resulting pulmonary embolism is a concern for passengers on long flights, although the incidence of this is unknown.11 Thrombo-embolism is more likely on flights 8 hours or longer, and it occurs more in passengers who have nonaisle seats where they are less likely to move around the cabin.12,13 However, thromboembolism does not seem to be more likely in the economy seats that may have less leg room than business class.14

Cabin pressure may contribute to some medical emergencies on airplanes.1 Cabin pressure on commercial aircraft is adjusted to that found at 5,000 to 8,000 feet above sea level. For most people, this is not a problem, but for those with cardiopulmonary disease, this can increase the risk of hypoxia. As a result of the atmospheric pressure in the cabin, arterial oxygen partial pressure (PaO2) decreases from 95 mmHg to 60 mmHg in a normal person.1,15 A 3% to 4% reduction in oxyhemoglobin saturation may be found, which would be trivial in a healthy person but could lead to significant hypoxia in someone with underlying cardiopulmonary disease or compromise. Newer A380 airbuses have a standard cabin altitude of 6,000 feet, improving oxygen levels compared with other aircraft.11