In-flight medical emergencies

Abstract

Background: One in every 10 000 to 40 000 passengers on commercial aircraft will have a medical incident while on board. Many physicians are unaware of the special features of the cabin atmosphere, the medical equipment available on airplanes, and the resulting opportunities for medical intervention.

Methods: A selective literature search was performed and supplemented with international recommendations and guidelines and with data from the Lufthansa registry.

Results: Data on in-flight medical emergencies have been collected in various ways, with varying results; it is generally agreed, however, that the more common incidents include gastrointestinal conditions (diarrhea, nausea, vomiting), circulatory collapse, hypertension, stroke, and headache (including migraine). Data from the Lufthansa registry for the years 2010 and 2011 reveal the rarity of cardiopulmonary resuscitation (mean: 8 cases per year), death (12 cases per year), childbirth (1 case per year), and psychiatric incidents (81 cases per year). If one assumes that one medical incident arises for every 10 000 passengers, and that there are 400 passengers on board each flight, then one can calculate that the probability of experiencing at least one medical incident reaches 95% after 24 intercontinental flights.

Conclusion: An in-flight medical emergency is an exceptional event for the physician and all other persons involved. Physician passengers can act more effectively if they are aware of the framework conditions, the available medical equipment, and the commonly encountered medical conditions.

Figure 1

Symptom and diagnosis classification for more than 20 000 documented medical events on Lufthansa flights, 2000–2011. The symptoms are classified by suspected diagnosis. Cardiovascular conditions are grouped together with neurological conditions, including stroke, for the purpose of this diagram. Accidents usually involved luggage falling out of the overhead storage rack or burns and scalds from hot drinks. The category “Other” includes conditions of the ear, nose, and throat, colic, suspected infectious conditions, and psychiatric disturbances

Figure 2

Interventions carried out during medical incidents on Lufthansa flights in 2010 and 2011 (based on 2264 filled-out emergency protocols); more than one intervention was possible per incident. (Blood-pressure measurement, administration of drugs, administration of oxygen, blood sugar measurement, monitoring of oxygen saturation with a pulse oximeter, use of an automatic external defibrillator [AED]). Only about 50% of the physicians who helped in medical incidents on board filled out an emergency protocol

Figure 3

Patient-transport compartment (PTC) for intensive care on board Lufthansa commercial long-distance aircraft on intercontinental routes. The configuration on board a Boeing 747–400 is shown. Three rows of seats are removed to make room for the PTC. Backup devices are present for all vital medical equipment (for monitoring, artificial ventilation, infusions, etc.) in case of failure. 13 000 L of oxygen (gas volume) are carried on the flight. The patient is accompanied by one intensive care nurse and one physician

Figure 4

Supplemental oxygen: a 2 L carbon-composite cylinder at a pressure of 300 bar. Oxygen flows of 1.2 to 5.2 L/min can be achieved for 10 to 20 hours with the aid of an electronic valve (actuated by the drop in pressure during inspiration). This system is used by Lufthansa, Swiss, Air France, and other airlines. A pulse oximeter is incorporated in the shockproof hard-shell case