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What You Should Know About Medical Emergencies in Flight

blogs.nejm.org

The recent death of an American Airlines pilot on a flight from Phoenix to Boston made headlines. Medical emergencies on board commercial flights are rare, but when they occur, treatment can be a real challenge.  A University of Virginia physician who, over the years, has been called to treat three patients on board commercial aircraft thought it might be helpful to write an article on the subject, and the New England Journal of Medicine agreed.  

Dr. William Brady is a professor of emergency medicine at UVA, so he’s well qualified to help if a passenger gets sick or is injured in flight, but he says the job is difficult.  For one thing, planes have minimal equipment, medications and space.

“Some of the smaller commuter aircraft really have very little to know room to even sit, let alone place a patient in a more comfortable position.  It’s quite noise don’t realize it, but when you are trying to listen to a blood pressure or listen to heart or lung sounds with a stethoscope, you hear the aircraft engines.”

He made that discovery while treating a man who appeared to be suffering a stroke. 

“You go and see the patient and introduce yourself and try to determine what the situation is and what resources you might have available.  Then you come up with a plan and share it with the captain.”

In this case, he told the pilot his patient could die without prompt medical care, and without advanced scanning technology, he couldn’t even give the guy an aspirin.

“Certain stroke syndromes benefit t from aspirin and certain stroke syndromes would be significantly harmed by aspirin.”

Fortunately, the crew was able to land quickly and the man survived, but Brady says the public should not expect comprehensive medical services on a plane.

“It is not a flying ambulance; it is not a hospital in the air.”

For that reason, he advises his colleagues to think, in advance, about how they might treat medical problems given minimal support.  One survey suggests that for every 604 flights, there will be one emergency.  Thirty-seven percent of the time it involved a loss of consciousness, 12% of patients suffered shortness of breath or wheezing, 10% complained of nausea or vomiting, 8% had cardiovascular problems and 6% suffered seizures.  The good news was that despite a lack of drugs and medical technology, death in flight was rare, occurring in less than one percent of cases.