In-Flight Emergencies
In-Flight Emergencies
Feb. 1, 2023
If you haven’t heard it yet, the chances are you will eventually: Is there a doctor on board? Emergency physicians, step right up – Amy Ho, MD, MPH, visits with EMRA*Cast host Dustin Slagle, MD, about the finer points of managing an in-flight emergency.
Host
Dustin Slagle, MD
NYU Pulmonary & Critical Care Medicine
dustyslags on Instagram
EMRA*Cast Episodes
Is there a doctor onboard? In-flight emergencies are not rare, supplies and resources are limited, and it is always good to be prepared. Dr. Amy Ho joins EMRA*Cast host Dr. Dustin Slagle to discuss what to expect and how to help.
Take-Home Points
Common Complaints1
|
Chief Complaint |
Percent Incidence |
|
Syncope/Pre-syncope |
37.4 |
|
Respiratory |
12.1 |
|
Nausea and Vomiting |
9.5 |
|
Cardiac Symptoms |
7.7 |
|
Seizure |
5.8 |
|
Agitation/Psychiatric |
2.4 |
|
Allergic reaction |
2.2 |
|
Stroke |
2.0 |
|
OB emergencies |
0.5 |
|
Cardiac Arrest |
0.3 |
Quick Stats2
- Passenger physician responding to request for in-flight help: 48.1%
- How often are flights diverted? 7.3% total; 9.4% if doctor responded
- 8% of in-flight emergencies resulted in the patient transported to a hospital via EMS and of those, 8.6% were admitted, and 0.3% died
- A medical emergency happens in 1/603 flights
- Chief complaints associated with the highest rates of hospital admission after flight landing: cardiac arrest, stroke-like symptoms (23.5%), obstetrical emergencies (23.4%), and cardiac symptoms (21.0%)
- Out of 36 deaths in one data set of in-flight emergencies, 30 occurred in the air
Pro Tips3
- Apple watches can be used for basic pulse/rhythm analysis.
- Ask to have a flight attendant overhead request for other meds/glucometer/additional assistance.
- While medical personnel can recommend, the captain ultimately makes the call for diversion.
- Ground medical assistance available and should always be used/contacted.
- FiO2 remains the same but is similar to having ~17% at 5k ft and ~15% at 8K ft due to decreased partial pressure of O2 which can pose an issue for those with chronic lung disease.4
The FAA requires an AED for flights with 30+ passengers and a medical kit with the contents a listed below3 (some airlines carry an expanded kit beyond these mandated contents):
|
CONTENTS |
QUANTITY |
|
Sphygmomanometer |
1 |
|
Stethoscope |
1 |
|
Airways, oropharyngeal (3 sizes): 1 pediatric, 1 small adult, 1 large adult or equivalent |
3 |
|
Self-inflating manual resuscitation device with 3 masks (1 pediatric, 1 small adult, 1 large adult or equivalent) |
1:3 masks |
|
CPR mask (3 sizes): 1 pediatric, 1 small adult, 1 large adult or equivalent |
3 |
|
IV admin set: tubing with 2 Y-connectors |
1 |
|
Alcohol sponges |
2 |
|
Adhesive tape, 1-inch standard roll adhesive |
1 |
|
Tape scissors |
1 pair |
|
Tourniquet |
1 |
|
Saline solution, 500 cc |
1 |
|
Protective nonpermeable gloves or equivalent |
1 pair |
|
Needles • 2 18-ga • 2 20-ga • 2 22-ga • Or sizes necessary to administer required meds |
6 |
|
Syringes • 1 5cc • 2 10cc • Or sizes necessary to administer required meds |
4 |
|
Analgesic (non-narcotic tablets, 325 mg) |
4 |
|
Antihistamine tables (25 mg) |
4 |
|
Antihistamine injectable (50 mg, single-dose ampule or equivalent) |
2 |
|
Atropine (0.5 mg, 5 cc, single-dose ampule or equivalent) |
2 |
|
Aspirin (325 mg tablets) |
4 |
|
Bronchodilator, inhaled (metered dose inhaler or equivalent) |
1 |
|
Dextrose (50%/50cc injectable, single-dose ampule or equivalent) |
1 |
|
Epinephrine 1:1000 (1cc injectable, single-dose ampule or equivalent) |
2 |
|
Epinephrine 1:10,000 (2cc injectable, single-dose ampule or equivalent) |
2 |
|
Lidocaine (5cc, 20 mg/mL injectable, single-dose ampule or equivalent) |
2 |
|
Nitroglycerine (0.4 mg tablets) |
10 |
|
Basic instructions for use of the drugs in the kit |
1 |
The pertinent law protecting good-faith effort to provide medical assistance during an in-flight emergency by a good samaritan:5
- HR 2843, Aviation Medical Assistance Act of 1998
- Liability of Individuals: 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.
ASMA Resources
The Aerospace Medical Association offers a host of additional resources and information for physicians, medical students, pilots, and the public, including:
- Medical Considerations for Airline Travel
- Managing In-Flight Medical Events
- In-Flight Emergencies Slide Presentation
Sources
- Nable JV, Tupe CL, Gehle BD, Brady WJ. In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45.
- Peterson DC, Martin-Gill C, Guyette FX, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013 May 30;368(22):2075-83.
- Görgens S, Ho A. (2022, December 9). How to prepare for in-flight emergencies. ACEP Now. Dec. 9, 2022. Retrieved January 28, 2023.
- Arshad F, Lenz T. EMRA EMS Essentials. (R. L. Rogers, Ed.). EMRA.
- Aviation Medical Assistance Act of 1998. HR 2843. 105th Congress. 1998.
