In-flight medical emergencies and their outcome in a commercial airliner

Abstract

Introduction: Super-connected modern era facilitated an unprecedented no. of air passages all around the world, simply because the number of people has doubled over the past 50 years culminating to around 4 billion air trips annually. An ever-increasing number of elderly passengers traveling with antecedent medical morbidities resulted in an upsurge in the In-flight Medical Emergencies (IME). Objective: Considering the trend, it was decided to ascertain the type of IMEs based on various organ systems and their outcome aside causes of flight diversion due to IME and types of in-flight medical assistance rendered by onboard physicians and paramedics. Material and Method: Crew safety report from March 1, 2015, to March 31, 2019, in a commercial airline of a Middle-Eastern country was analyzed for IMEs along with allied issues. Results: There were 614 IMEs during the period of study resulting in 01 IME for every 336 flights. About 81% of IMEs occurred during the main cruising phase of the flight. Nine onboard deaths were recorded during the study tenure. Causes of death were two each for Myocardial Infarction (MI) and malignancy, one due to cardiac failure with arrest and uncertain in four cases. The most common IME was syncope (35.5%) followed by trauma (26.8%) and respiratory difficulty (17.3%). Gastrointestinal symptoms accounted for 10% of cases. Diversion of aircraft was carried out on 16 IME incidents. The main causes of diversion were MI, epilepsy, stroke, and Bell’s palsy. Onboard assistance from physicians and nurses was sought in 62 % and 27% of incidents, respectively. Oxygen and onboard medications were used in 74% and 32% of cases correspondingly. Conclusion: There is no comprehensive globally accepted reporting and management of IMEs. Every airline has its own protocols for the same. Onboard healthcare professionals play a key role in the outcome of IMEs.