Top 10 in-flight medical Top 10 in-flight medical emergenciesemergencies

ImportantImportant

Do no harmDo no harm

70% incidents managed by crew70% incidents managed by crew

Practice within limits of training and Practice within limits of training and

knowledgeknowledge

Chest PainChest Pain

Careful historyCareful history Differential same as on groundDifferential same as on ground Antacid may help exclude indigestionAntacid may help exclude indigestion MI suspectedMI suspected

Aspirin, opioid, oxygenAspirin, opioid, oxygen Cardiac monitor may be available with Cardiac monitor may be available with

link to ground based advisory servicelink to ground based advisory service

CollapseCollapse

Usually due to simple faintUsually due to simple faint Remain calmRemain calm

Check pulse BPCheck pulse BP

Epilepsy no increased risk when Epilepsy no increased risk when

flyingflying Crew are trained to manage fitsCrew are trained to manage fits

Aircarft carry parentral diazepamAircarft carry parentral diazepam

Life threatening collapseLife threatening collapse

Crew trained in basic CPRCrew trained in basic CPR

Many carry defibrillators Many carry defibrillators

Crew will be trained in useCrew will be trained in use

Doctor’s role IV access & giving drugsDoctor’s role IV access & giving drugs

AsthmaAsthma

Commonest life threatening Commonest life threatening condition on aircraftcondition on aircraft

Induced by realisation tha tinhalers Induced by realisation tha tinhalers are in baggage holdare in baggage hold

Oxygen available and usually Oxygen available and usually injectable bronchodilator and injectable bronchodilator and adrenalineadrenaline

May carry inhalers but not nebulisersMay carry inhalers but not nebulisers

Head injuriesHead injuries

Items falling from overhead luggage Items falling from overhead luggage

compartmentcompartment

Little a Dr can do except perahps Little a Dr can do except perahps

advice re need to divertadvice re need to divert

Mental health problemsMental health problems

AnxietyAnxiety PhobiasPhobias Major psychiatric illnessMajor psychiatric illness Conformation of diagnosis and Conformation of diagnosis and

reassurancereassurance Diazepam/lorazepam might be Diazepam/lorazepam might be

available be cautious as may have available be cautious as may have drunl xs alcohol or taken other illicit drunl xs alcohol or taken other illicit drugs drugs

Abdominal problemsAbdominal problems

D & V common D & V common

Doctors role is providing diagnosisDoctors role is providing diagnosis

Advsing on need to divertAdvsing on need to divert

DiabetesDiabetes

Hypoglycaemic episodes frequentHypoglycaemic episodes frequent

Glucose injections usually availableGlucose injections usually available

Allergic reactionsAllergic reactions

Anaphylaxis occurs rarelyAnaphylaxis occurs rarely

Adrenailine and antihistamine Adrenailine and antihistamine

sometimed injectable steroid carriedsometimed injectable steroid carried

Passengers with known allergies may Passengers with known allergies may

have own epipenhave own epipen

Obs and GynaeObs and Gynae

Several babies born on board every Several babies born on board every

yearyear

Drs have very little roll to play except Drs have very little roll to play except

provide reassurance and uterine provide reassurance and uterine

contractant such as ergometrinecontractant such as ergometrine

MiscarriageMiscarriage

Occur occasionallyOccur occasionally

Examination facilities limitedExamination facilities limited

Monitor general condition is only real Monitor general condition is only real

possibiltypossibilty

Diverting AircraftDiverting Aircraft

Cardiac problemsCardiac problems 28%28%

Neurological problemsNeurological problems 20%20%

Food poisoningFood poisoning 20%20%

LiabilityLiability

In UK no legal duty for Dr to offer In UK no legal duty for Dr to offer assistant in an emergencyassistant in an emergency

GMC considers that such a duty GMC considers that such a duty existsexists

Law varies from country to countryLaw varies from country to country Several airline have indemnity to Several airline have indemnity to

cover Drs that come forwardcover Drs that come forward MDU covers its membersMDU covers its members

LiabilityLiability

US Aviation medical assistance act US Aviation medical assistance act

19981998

Protects Drs that act in good Protects Drs that act in good

Samaritan situationsSamaritan situations

Gives legal protection for airlinesGives legal protection for airlines

MedlinkMedlink

Direct communication between flight Direct communication between flight crew and MedAirecrew and MedAire

Instant expert adviceInstant expert advice List of Airports suitable for diversionList of Airports suitable for diversion Once MedAire contacted Dr is Once MedAire contacted Dr is

relieved of liabilityrelieved of liability Captain makes decision to divertCaptain makes decision to divert MedAire has insurance coverMedAire has insurance cover