![]() 12 For the same reasons that establishing the true incidence of in-flight emergencies is challenging, so too is determining the causes of these events. 11 The UK government analyzed data from the Aerospace Medical Association, British Air Transportation Association and a ground-based consultant company to report an incidence of 1 event per 14 000 passengers but notes substantial difficulties in establishing the true incidence, given the lack of consistency between data sets. 1 In contrast, a European study of medical records from a single airline over a two-year period reported 1312 events among 10.1 million passengers, or the equivalent of roughly 1:7700 passengers. 8 – 10 One recent study of data from a ground-based medical consultation company that serviced five different North American airlines estimated an incidence of 1 medical emergency per 604 flights (or 16 events per 1 million passengers). The true incidence of in-flight medical emergencies is difficult to determine, as there is no consensus on what defines an in-flight “emergency,” no agreed-upon classification system, no mandate for airlines to collect or report these events and, therefore, no reliable database of information. 3 – 5 These stressors may have greater effect on the increasing proportion of older passengers and those flying with pre-existing medical conditions. 3 Another important cause is longer flight durations, which subjects passengers to longer exposure to physiologic stressors, including relative hypoxia and lower relative humidity. 2 This rise in passenger traffic is just one of the reasons why the incidence of in-flight medical emergencies is increasing. 1 In Canada, there were 133.4 million airline passengers in 2015, a 27.3% increase from 2009. A recent study estimated that about 2.75 billion passengers worldwide fly on commercial airlines each year. The global airline industry continues to grow. What is the incidence of in-flight medical emergencies and their most common causes? We draw on examples and resources from Canada’s two largest air carriers, Air Canada and WestJet. Our search for evidence used in this review is summarized in Box 1. We review these issues to offer resources for Canadian health care practitioners who must manage in-flight medical emergencies. Furthermore, they may be unfamiliar with the airline’s policies and procedures and their legal and ethical duties to respond. They may be unaware of the medical equipment on board and the environmental challenges of treating patients on an aircraft. Although flight crews receive some training in the treatment of in-flight medical emergencies, health care professionals receive little to none. Passengers who are health care professionals, along with members of the flight crew, are often important resources for in-flight front-line care. If health professionals offer their expertise, they may have to manage an unfamiliar clinical scenario, in a foreign and limited environment, without knowledge of the available resources. Hearing the call go out for a doctor at 36 000 feet can be anxiety-provoking for any physician. Open, two-way communication with the flight attendants, cockpit and ground-based consultants should be maintained to ensure the pilots can make the safest decisions for all of the passengers. Flight attendants should provide the medical kit and contact ground-based telemedicine support early. The working environment should be optimized by creating space, turning on the cabin lights and recruiting additional help. Most of the medications in the medical kit can be administered via the intramuscular route the administration of intravenous epinephrine should not be used for any indication other than cardiac arrest, unless the medical professional is comfortable doing so or it is done under the advice of the ground-based consultant. The cabin environment will affect patients’ vital signs as well as how to measure them reliably - e.g., normal oxygen saturation at 6000–8000 ft (1829–2438 m) is about 90% and aircraft noise may limit the usefulness of a stethoscope. Medical professionals who voluntarily provide emergency medical assistance on a commercial aircraft are protected from liability.
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