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Abstract

Introduction: Nearly 2.9 billion passengers are transported every year in commercial airline flights, many of whom are children. When a serious medical emergency arises during flight, care is provided by crew members and passenger volunteers with a medical background, frequently in consultation with a specialized remote medical control center. Although in-flight medical emergencies and fatalities are well characterized for adults, data on pediatric subjects are lacking. Methods: We reviewed the records of all in-flight emergencies from January 2010 to June 2013 involving children (ages 0 to 18 years) treated in consultation with the world’s busiest global response center providing remote medical support to commercial airlines. This center is staffed by physicians trained in airline protocols, procedures and in-flight resources. De-identified data were abstracted by one of the authors and analyzed with descriptive statistics. Results: During the study period there were a total of 81,104 in-flight medical emergencies, including 7,573 (9.3%) involving children. There were 10 pediatric deaths (0.13% of all pediatric in-flight emergencies), or 0.025 deaths/million passengers transported. Of these, 5 were males. The overall median age was 3.5 months (range 1 month to 15 years) with 90% younger than 2 years, the age until which children are allowed to travel seated with an adult. Highest health care rank of in-flight responder was physician in 6 cases, crew in 2, nurse in 1 and EMT in 1. An AED was employed in 40% of the cases. Five patients had no previous medical history, with one arresting after developing respiratory distress and 4 found asystolic (including 3 lap infants). Five patients had pre-flight medical conditions, including 2 traveling for medical care (a 6 month-old with unspecified medical issues accompanied by a doctor and a 1 month old with cardiomegaly), a 2 month-old with truncus arteriosus, a 4 month-old with lethargy and a 12 month-old with fever, diarrhea and vomiting. An unscheduled landing (diversion) occurred in 50% of the flights in which a passenger death occurred. Conclusions: Pediatric in-flight medical emergencies rarely result in death, but death is most common in infants and those with a pre-existing medical condition. The high share of fatalities involving children under the age of 2 years (lap infants) is intriguing and warrants further study, particularly as co-sleeping has been implicated in sudden infant death syndrome.