On this episode, host Jason Woods speaks with Dr. TJ Doyle, medical director of the communicaton center at the University of Pittsburgh Medical Center (UPMC) and medical director for STAT-MD, a ground based consulting group for airlines. The discussions encompasses that frequency and types of in-flight medical emergencies (IME), what is in the medical kit on airplanes, what resources are available in-flight, and the legal ramifications for medical vounteers.

The highlights:

• Worldwide ~ 2.75 billion persons fly annually.
• IME occur in roughly 1 per 604 US flights, or 24-130 IME per 1 million passengers.
  1. 69% had EMS requested, 25% transported to hospital, 8.6% admitted, 0.3% died.
  2. Aircrafts divert in about 4$ of IME
• Airplane cabins are pressurized to between 5000 and 8000 ft altitude
• Minimum equipment in the US (see graphic)

• AED
  • Hemorrhage control
  • IV line
  • Gloves
  • Medications to treat “basic conditions”
    1. Pain
    2. Allergic reactions
    3. Bronchoconstriction
    4. Hypoglycemia
    5. Dehydration
    6. “Some” cardiac conditions
  • Equipment for initial assessment
• Most common IME
  • Syncope or near 32.7%
  • GI 14.8%
  • Resp 10.1%
  • CV 7.0 %
• Medical volunteer role
  • Individual airline policies may have different guidance
  • Not generally required to carry proof of medical license
  • Primary role is to gather info, provide assessment, and communicate with ground support. May need to admin medicines or perform procedures but direction of care is by ground medical.
• Legal and ethical issues
  • US Aviation Medical Assistance Act
    1. Protects passengers who provide medical assistance from liability except in cases of negligence or willful misconduct.
    2. Medical volunteers who seek compensation for this service may jeopardize their protections under this law, though now lawsuit of such has been filed
  • Duty to respond
    1. In US, Canada, England, Singapore, no legal duty
    2. In Australia, many European countries, physicians are required to render assistance.
  • Other countries may have different protections or no protections at all

Guests

Thomas J. Doyle, Clinical Assistant Professor of Emergency Medicine, University of Pittsburgh Medical Center; Associate Medical Director, STAT MedEvac; Medical Director, Command Center, STAT-MD.

References

1. Christian Martin-Gill, MD, MPH; Thomas J. Doyle, MD, MPH; Donald M. Yealy, MD. In-Flight Medical Emergencies: A Review. JAMA. 2018;320(24):2580-2590. doi:10.1001/jama.2018.19842
2. Peterson DC, Martin-Gill C, Guyette FX, et all. Outcomes of Medical Emergencies on Commercial Airline Flights. NEJM. 2013:368(22):2075-2083. doi:10.1056/NEJMoa1212052

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