8 Things Doctors and Nurses Need to Do During an In-Flight Medical Emergency

In all the times I’ve traveled, I’ve only ever witnessed one in-flight medical emergency. A middle-aged businessman had temporarily lost consciousness but was okay within a few minutes; altogether, nothing too serious. Still, there was a moment of heightened alertness when we all heard over the airplane’s PA system, “Is there a doctor on board?” I wouldn’t want to get sick on a trip — especially not while 30,000 feet above ground! — but if I were to have an emergency, I would hope that a doctor (or two, or three) would be on board to help me out.

Here are the things doctors, nurses, and other health care professionals need to do in case of a medical emergency on the plane, as compiled from tips by the Aerospace Medical Association (AsMA) and two studies on in-flight medical emergencies published in the New England Journal of Medicine (NEJM).

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Before every flight, keep in mind that you may be asked to provide medical assistance on board.

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In-flight medical emergencies are relatively rare — a 2013 study published in the NEJM estimates that 44,000 such incidents occur worldwide every year, or 1 every 604 flights — but you never know when that one flight will be the flight you’re in. Researchers found that during an in-flight medical emergency, assistance is often rendered by healthcare professionals who happen to be on board as passengers, usually doctors (48.1%) and/or nurses (20.1%).
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If there is an emergency, decide first if you are in a proper condition to respond.

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Physicians who have consumed a significant amount of alcohol, for example, should think twice before responding. According to another study in the NEJM published 2015, “A physician who provides assistance creates a doctor–patient relationship, with its attendant obligations and liability risk.” That means that doctors who respond to emergencies can potentially be sued if things don’t go too well. The rules vary from country to country, but even, for example, the Good Samaritan provision in the United States’ Aviation Medical Assistance Act of 1998 will not protect someone who is “grossly negligent” and exhibits “flagrant disregard for the patient’s health and safety” — such as an intoxicated physician.
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Identify yourself and your level of medical training to the flight crew.

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“Offer proof of credentials if you have them,” says AsMA. “Do not attempt to practice beyond your level of expertise, but remember that whatever your level of expertise is, it is better than any non-health professional and your help may be very valuable.”
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Request that at least one cabin crew member remain available to assist you.

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You may need them to answer your questions, help with procedures, communicate with the pilots, etc.
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Assess the patient.

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First of all, if the patient is conscious, obtain consent to treat. If you do not speak the same language, ask for an interpreter. Take a patient history, get vital signs, and perform a focused physical examination.

Out of 11,920 in-flight medical emergencies reviewed in the 2013 study, the most common problems were:

• Syncope or presyncope (37.4%) – including loss of consciousness, lightheadedness, and “blacking out”
• Respiratory symptoms (12.1%)
• Nausea or vomiting (9.5%)
• Cardiac symptoms (7.7%) – including chest pain and palpitations, but excluding cardiac arrest
• Seizures (5.8%)
• Abdominal pain (4.1%)

Obstetrical/gynecological complaints only made up 0.5% of cases. (See: Airline Policies for Pregnant Passengers)

There were only 38 incidents of cardiac arrest (0.3%) — but 31 of those died (81.6%).

Determine if the patient’s condition is critical; if so, it may be necessary to recommend that the flight be diverted to the nearest airport from which the needed medical facilities can be accessed.
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Communicate and coordinate with ground-based medical resources, if available.

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AsMA advises, “If the situation appears to be serious, inquire if the airline has a contract with a medical ground support company. If so, ask that they be contacted to bring them into the loop as early as possible. Even if you are an emergency qualified physician the support of the ground company may become very helpful – in case of diversion for instance – since they are familiar with the availability of ground based medical facilities.”

Philippine Airlines signed an agreement with MedAire last 2014 for its long-haul international flights but I don’t know if they have a current contract. Another company that provides ground-based medical support is UPMC’s STAT-MD.
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Treat the patient within the scope of your qualifications.

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If necessary, ask the flight attendant to administer oxygen and/or get the emergency medical kit.

Most passenger aircraft are required to have a first aid kit and a universal precaution kit; additionally, an emergency medical kit (EMK) is usually mandatory for planes with a capacity of over 30 passengers. The specific contents of these kits may vary depending on the laws of each country, but first aid kits will typically contain over-the-counter drugs and supplies for dressing wounds, while emergency medical kits will contain emergency medications (atropine, epinephrine, etc.) and equipment such as a stethoscope (hopefully a decent one!), sphygmomanometer, oropharyngeal airways, a bag-valve mask, a system for delivering intravenous fluids, etc. Many planes will also have an automated external defibrillator (AED).

(For a full list, see: Medical Supplies Mandated by the Philippine Civil Aviation Regulations.)
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Don’t forget: document!

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Document your findings and care rendered — preferably on the official form, if the airline has one — and keep your own personal copy.
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Us Cebuanos have a saying: anha pa manguros kung mokilat na (literally, waiting for lightning before making the sign of the Cross — or in other words, not being prepared). That’s something healthcare professionals shouldn’t do. It’s not very likely that you will be called on to assist in a medical emergency on your next flight — but you never know. It’s best to be prepared.

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Sources:

1. Aerospace Medical Association (AsMA): Medical Emergencies: Managing In-flight Medical Events (Guidance material for health professionals). Accessed 26 May 2016.
2. 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. Accessed 26 May 2016.
3. 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. Accessed 26 May 2016.

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8 Things Doctors and Nurses Need to Do During an In-Flight Medical Emergency
© Small-Town Girls, Midnight Trains. All rights reserved. Contents verified as of 26 May 2016.

 

 

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