Top 10 in-flight medical emergencies

1. Top 10 in-flight medical emergencies

2. Important • Do no harm • 70% incidents managed by crew • Practice within limits of training and knowledge

3. Chest Pain • Careful history • Differential same as on ground • Antacid may help exclude indigestion • MI suspected • Aspirin, opioid, oxygen • Cardiac monitor may be available with link to ground based advisory service

4. Collapse • Usually due to simple faint • Remain calm • Check pulse BP • Epilepsy no increased risk when flying • Crew are trained to manage fits • Aircarft carry parentral diazepam

5. Life threatening collapse • Crew trained in basic CPR • Many carry defibrillators • Crew will be trained in use • Doctor’s role IV access & giving drugs

6. Asthma • Commonest life threatening condition on aircraft • Induced by realisation tha tinhalers are in baggage hold • Oxygen available and usually injectable bronchodilator and adrenaline • May carry inhalers but not nebulisers

7. Head injuries • Items falling from overhead luggage compartment • Little a Dr can do except perahps advice re need to divert

8. Mental health problems • Anxiety • Phobias • Major psychiatric illness • Conformation of diagnosis and reassurance • Diazepam/lorazepam might be available be cautious as may have drunl xs alcohol or taken other illicit drugs

9. Abdominal problems • D & V common • Doctors role is providing diagnosis • Advsing on need to divert

10. Diabetes • Hypoglycaemic episodes frequent • Glucose injections usually available

11. Allergic reactions • Anaphylaxis occurs rarely • Adrenailine and antihistamine sometimed injectable steroid carried • Passengers with known allergies may have own epipen

12. Obs and Gynae • Several babies born on board every year • Drs have very little roll to play except provide reassurance and uterine contractant such as ergometrine

13. Miscarriage • Occur occasionally • Examination facilities limited • Monitor general condition is only real possibilty

14. Diverting Aircraft • Cardiac problems 28% • Neurological problems 20% • Food poisoning 20%

15. Liability • In UK no legal duty for Dr to offer assistant in an emergency • GMC considers that such a duty exists • Law varies from country to country • Several airline have indemnity to cover Drs that come forward • MDU covers its members

16. Liability • US Aviation medical assistance act 1998 • Protects Drs that act in good Samaritan situations • Gives legal protection for airlines

17. Medlink • Direct communication between flight crew and MedAire • Instant expert advice • List of Airports suitable for diversion • Once MedAire contacted Dr is relieved of liability • Captain makes decision to divert • MedAire has insurance cover