in-flight medical emergencies there are only two emotions in
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American Osteopathic College of Occupational and Preventive Medicine2013 Mid Year Educational Conference, Phoenix, Arizona
February 14-17, 2013
In-flight Medical Emergencies
Patricia C. Hunt, DO, MHA, CHCQM,FAOBIM, FAOCOPM
"There are only two emotions ina plane: boredom and terror."~ Orson Welles
A two-pronged approach
• How can I ADDRESSin-flight medicalemergencies?
– What resources areavailable?
– What are the liabilities?
– What constitutes thebest evidence-basedapproach within theseconstraints?
• How can I PREVENT anin-flight medicalemergency?
– Who should not fly?
– How do I assess?
How often DO in-flight medicalemergencies occur?
• According to FAA,domestic travel: 1passenger in 39,600.
• 47% of ill passengerswere sent to an ER.
• 10% of those wereadmitted to thehospital.
• Between 1968 and1988 Air Francereported 1,800 pilotswere incapacitated inflight.
Physiology and Flight
• Jet lag
• Pre-existing diseases– Hypoxia: Pao2=55 mmHg
– Cabin Air Quality is Dry: <10% humidity
– Barometric pressure changes,approximates 8,000 ft.
• Medical equipment
– Pneumatic splints
– Tracheostomy cuffs
– Surgical wounds/drains
• Psychological stress
• Decompression sickness
– “No fly” time.
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American Osteopathic College of Occupational and Preventive Medicine2013 Mid Year Educational Conference, Phoenix, Arizona
February 14-17, 2013
Etiology of in-flight events---Domestic Travel
Most COMMON
• Syncope
• Near syncope
• Hyperventilation
• Vasovagal episodes
LEAST COMMON
• Children– 27% infectious disease
– 15% neurologic
Most SERIOUS
• Neurologic
• Cardiac
• Respiratory
On-Board EmergencyMedical Kithttp://www.jems.com/photos/training/care-air
• Stethoscope
• Sphygmomanometer
• Bag-mask resuscitator
• Oral airways (three sizes required)
• Nitroglycerin (at least 10 tablets); aspirin (atleast four tablets);
• Albuterol : one metered-dose inhaler
• Dextrose 50% (at least 25 grams);
• Injectable 1:1000 epinephrine (2 mg);
• Oral antihistamines (at least four tablets);
• IV antihistamines (at least two amps)
• IV 1:10,000 epinephrine (at least 2 mg),
• Atropine (at least 1 mg total)
• Lidocaine (at least 200mg total)
• 500 ml normal saline,
• An IV drip set, various needles and syringes
One Medic’s Observations
• Auscultation in an aircraft using astethoscope can be difficult dueto ambient engine noise. Palpatesystolic blood pressure.
• Aviation portable oxygen bottles(POBs) generally have only one oftwo fixed settings: "low flow" (2lpm) and "high flow" (4 lpm) forfirst aid purposes anddecompression emergencies,which is far lower than what isnormally used in EMS settings.
• Oxygen tubing for the bag-valvemask resuscitations aren'trequired to be compatible withthese on-board oxygen bottles.
• The AEDs on board aren'trequired to have ECG screenthough ACLS medications areprovided;
• Glucometers aren't mandated inEMKs, despite the requirement tohave dextrose 50%, make itdifficult to identify hypoglycemicemergencies.
Source:http://www.jems.com/article/patient-care/handling-flight-medical-emerge
A General Approach
• NO federal regulationsor guidelines
• Each airline has policies
• Flight crew isresponsible to respondto acute illness
• Health careprofessional’s role is TOASSIST, not take control
• Act to stabilize: use O2,medications/suppliesavailable, lower altitudeof aircraft (to increasecabin pressure)
• Consult with ground-based support
• May suggest flightdiversion
Overview: Worth Reiterating---
• Act within your scope
• Obtain consent, assume implied consentwhere appropriate
• Request the enhanced EMK
• Request and establish communication withground support
• Remember, you can request diversion
• Never officially pronounce
Liability• Good Samaritan Laws (USA)
• Specific by state
• Act in “good faith”
• No acts of “gross negligence or wanton conduct”– Wanton = lewd, gratuitously cruel, immoral
• Aviation Medical Assistance Act:• Federal Law: as of 5/24/06, no individual rendering aid
in the case of an in-flight medical emergency will beliable unless there is “gross negligence or willfulmisconduct.”
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American Osteopathic College of Occupational and Preventive Medicine2013 Mid Year Educational Conference, Phoenix, Arizona
February 14-17, 2013
Liability cont’d
• Receive no monetary compensation
– Travel vouchers, a glass of wine, or a seat upgradeis not considered compensation.
• Must provide care similar to the care of otherswith similar training under similarcircumstances.
Case Discussionsas our time permits
'Boozed-up' plane passenger duct-tapedto his seat to stop rampage: sourcesBy PHILIP MESSING, JOSH MARGOLINand PEDRO OLIVEIRA JR.Last Updated: 9:41 AM, January 5, 2013Posted: 1:41 AM, January 5, 2013
Resources
• www.thelancet.com
– February 19,2009: Medical Issues Associated withCommercial Flight
• www.jems.com
– http://www.jems.com/article/patient-care/handling-flight-medical-emerge
• www.asma.org
– http://www.asma.org/publications/medical-publications-for-airline-travel
Resources cont’d
• http://www.cfp.ca/
– Use the Advanced Search: 2009 vol 55 pg 992
• www.medscape.com
– http://emedicine.medscape.com/article/810246-overview
• www.nejm.com
– http://www.nejm.org/doi/full/10.1056/NEJMra012774 (with subscription)
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American Osteopathic College of Occupational and Preventive Medicine2013 Mid Year Educational Conference, Phoenix, Arizona
February 14-17, 2013