In-flight medical emergencies: an overview

doi:10.1136/bmj.321.7272.1338

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Tony Goodwin, senior partner (amsgatwick@compuserve.com)

Airport Medical Services, Forte Posthouse Hotel, Horley, Surrey RH6 0BA

Accepted 22 February 2000

This article was commissioned to go with the preceding article on in-flight medical emergencies. It provides an indication of the range of medical conditions health professionals may be asked to deal with on board an aircraft

In-flight medical emergencies are attracting increasing interest from the media, travelling public, aviation industry, and medical profession. I discuss the reasons for this and the magnitude of the problem estimated from available data. Methods for preventing these emergencies and the facilities for dealing with them are listed and future requirements are considered.

Summary points

In-flight emergencies will increase as more elderly passengers fly greater distances

Data on emergencies and deaths worldwide are scarce, but should improve now that there is an agreement to monitor and report in-flight incidents

Removal of legal liability concerns should encourage doctors who are on board to come forward

Methods

I searched recent literature for published articles and also drew information from conference presentations.1^–3 Statistics were made available by Virgin Atlantic Airways.

The problems

Older, less healthy, passengers often wish to fly considerable distances, and they expect that the airlines will look after them should problems arise. Similarly, people with known illnesses or disability expect no discrimination and that special facilities should be provided to make their journeys possible.

Air travel can precipitate or contribute to medical problems in a number of ways, even in previously healthy travellers. The stress of getting to and through a modern airport may be considerable. Uncertainty due to delay compounds any anxiety and may mean that too long is spent drinking at the bar. Three quarters of medical emergencies occur while travellers are still on the ground.4

Once in the air the drop in pressure (the cabin is kept at the equivalent of 6000-8000 feet (1950-2400 m) altitude) causes 30% gas expansion, and less oxygen …