As I get warmed up to this whole attempting-to-post-regularly thing, I’m going to share some articles that I came across during medical school that I found interesting or amusing, along with the more serious stuff that utilizes a little bit more critical thinking– first up is this review article on outcomes of medical emergencies on commercial airline flights, from some emergency physicians at U. Pittsburgh and ECU. The authors reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center over an approximately a two year period and reported the epidemiology of in-flight emergencies, along with some outcomes and some commentary.
The most common chief complaints were syncopal events and GI distress, which is not surprising. There were, scattered amongst the less serious complaints, 38 cardiac arrests and 36 deaths reported, alongside some OB/GYN emergencies (most of which were less than 24 weeks and labeled as possible abortions/vaginal bleeding, with 18% involving labor beyond 24 weeks). Physicians provided the majority of assistance, with nurses and EMTs stepping up to the plate as well. The article also describes the FAA laws on medical control, liability issues pertaining to providing care on-board a flight (the 1998 Aviation Medical Assistance Act includes a Good Sa- maritan provision protecting passengers who offer medical assistance from liability, other than liability for gross negligence or willful misconduct), and offers some approaches to common problems. Also, interestingly, a supplementary appendix contains a list of items found in the “Enhanced Emergency Kit” carried by many airlines, which has a lot more than one might expect to find on an airplane. I am planning on working on an educational project for medical students on EM clerkships involving this list– could be fun.
What this study doesn’t address is something I read somewhere a long time ago about a resuscitation that took place on a plane following an arrest. Two physicians on-board initiated CPR and performed chest compressions for 40 minutes or so and applied an AED, which did not find a shockable rhythm. When they told the flight attendants that they were going to pronounce the patient and terminate resuscitative efforts, they were told that the flight attendants were required by policy to continue CPR until they had arrived back at an airport– I can’t remember the exact details, but I believe they decided that they would keep working on the patient, if only to spare the flight attendants the experience. The anecdote, apocryphal as it may be, raises an interesting question though– who can terminate resuscitative efforts on-board an airplane? The captain? On-line medical control? Any random on-board physician or nurse? I’m not really sure what I would do in such a position, but hopefully (and the data seems to suggest that) it will never come up,