In-flight Emergencies Research Articles

Pediatric Emergencies on a US-Based Commercial Airline

The purpose of this investigation was to determine the incidence and character of pediatric emergencies on a US-based commercial airline and to evaluate current in-flight medical kits. In-flight consultations to a major US airline by a member of our staff are recorded in an institutional database. In this observational retrospective review, the database was queried for consultations for all passengers up to 18 years old between January 1, 1995, and December 31, 2002. Consultations were reviewed for type of emergency, use of the medical kit, and unscheduled landings. Two hundred twenty-two pediatric consultations were identified, representing 1 pediatric call per 20,775 flights. The mean age of patients was 6.8 years. Fifty-three emergencies were preflight calls, and 169 were in-flight pediatric consultations. The most common in-flight consultations concerned infectious disease (45 calls, 27%), neurological (25 calls, 15%), and respiratory tract (22 calls, 13%) emergencies. The emergency medical kit was used for 60 emergencies. Nineteen consultations (11%) resulted in flight diversions (1/240,000 flights), most commonly because of in-flight neurological (9) and respiratory tract (5) emergencies. International flights had a higher incidence than domestic flights of consultations and diversions for pediatric emergencies. The most common in-flight pediatric emergencies involved infectious diseases and neurological and respiratory tract problems. Emergency medical kits should be expanded to include pediatric medications.

Potential error in the use of AEDs during an in-flight emergency

Potential error in the use of AEDs during an in-flight emergency

Medical Guidelines for Air Travel Patients to Physicians

With a steady economic growth and the advancement of aircraft design, the demand to travel by air has constantly been on the rise. So much to the fact that there are more than 10 billion people traveling all over the world by aircraft. This demand will continue to rise so long as air travel continues to surpass other methods of transportation in aspects such as speed, comfort, safety, etc. There are about seven million tourists who travel abroad annually in our nation, thus airline travel has become one of the most popular forms of public transport. However, some people travel on flights without considering their state of health and risk suffering from a health ailment while on board. The cabin environment of a modernized aircraft preserves conditions similar to that on the ground, thereby making the travelers feel comfortable. But sometimes people with chronic diseases can make their health condition worse due to long distance flight travel. Traveling overseas among the elder generation has increased, and cases involving patients traveling abroad to receive better medical treatment has increased as well. In advanced countries, the air ambulance system is well prepared, but in Korea we can only transfer patients by commercial airlines based on the destination. This is especially typical in Jeju where there are no alternative ways. Helping an emergency patient inside the cabin is not a simple matter, and therefore it is best to avoid the situation. To be prepared for emergencies, each aircraft has an Emergency Medical Kit, First Aid Kit and Automated External Defibrillator (AED) inside the cabin. Each airline is also developing curriculums for teaching First Aid and training their flight attendants to properly use the Kit, AED and how to give First Aid. If there is a patient with a critical illness, generally the aircraft would land at the closest airport instead of the destination in an attempt to save the precious life. But, it would be more effective to be prepared with a contingency plan beforehand, instead of thereafter. If physicians and patients take more concerns regarding airline travel and kept in close communication with the airlines, some inflight medical emergencies in the cabin can be prevented. A patient who is planning to travel by air would want to receive some aero-medical information from their physicians. It is necessary to understand the cabin environment and to receive information on airline travel myths, the maximum amount of safe time for traveling, and steps to prepare before they leave. In this article, as a physician, I will review the medical guidelines to prevent unexpected accidents or inflight emergencies, and also to have some aviation medicine knowledge to help those on board.

Is There a Doctor on-Board?: Medical Liability during in-Flight Emergencies

Provision of emergency medical care to passengers during flights on commercial aircraft is an issue which concerns many physicians. As world population ages and air travel increases, the number of medical events on board aircrafts is also expected to increase. This paper discusses the liability of the physician-passenger who volunteers and renders care as well as advises the crew, on certain actions. Complex medico-legal issues will be mentioned and there will be a brief discussion on the in-flight environment and unscheduled landings.

Forth report

Human progress advances in many ways. One method obvious to all is to take something, a bicycle for instance, and make a multitude of small changes to the design over time. Each iteration of the refinement process gives us something newer and nicer to appreciate. That's how you start out with a $50 Schwinn bike and end up with a $10,000 Lotus racing bicycle.Another method is to add another layer of complexity onto the original design, some new technology never expected by the inventors of the product or device, to prevent natural obsolescence. An example here might be the internal combustion engine, invented in the pre-smog 1800's. Many layers of complexity have been applied to this product over the decades. Take fuel management for instance: we have gone from simple mechanical carburetion, to computerized electronic fuel injection, then added forced induction by supercharging / turbocharging. Each layer builds upon (and sometimes replaces) one or more older layers underneath itself.My homemade terminology for adding another layer of complexity or sophistication onto something where it wasn't found before is "strap-on technology". Where does the "strap-on" part come in? It's like in the movie, Six Days, Seven Nights by Touchstone Pictures, 1998 [1]. During an in-flight emergency, Harrison Ford crashes his tourist airplane on the beach of a small Pacific island, incidentally breaking the wheels of his landing gear in the process and stranding himself and Ann Heche there. He later finds two usable pontoons from a derelict 1940-era Japanese seaplane in the jungle. He uses vines and ropes to "strap-on" these pontoons over his broken wheels, thus enabling an essential water takeoff to escape from the tiny beach of that island. Ford "layered" the more advanced technology (pontoons for water takeoffs and landings) over the less advanced wheeled gear, in making his escape. The "strap-on" pontoons advance this movie's plot while, incidentally, illustrating my point about adding new technology to an older product.The remainder of this essay will give additional examples of "strap-on technology", finishing up with cases where the advanced layer which was applied involved the Forth programming language (hence the "strap-on Forth" terminology). As added zest for the reader, I will include some remarks on this subject by my friends at the comp.lang.forth newsgroup, who were invited to contribute examples or commentary of their own.

Clinical aviation medicine: safe travel by air

Commercial air travel has increased dramatically in the last 25 years, which has resulted in an increased number of passengers travelling. In 1995, approximately 1.4 billion passengers flew. There are very few contraindications to flying in commercial jet aircraft and even passengers with medical conditions travel regularly without incident. To avoid in-flight emergencies which potentially have implications for the patient’s medical condition and the operation of the flight it is essential to assess significant medical conditions prior to travel. With appropriate assessment by a physician who has an understanding of the aviation environment and its potential interaction with the patient’s medical condition, the majority of passengers may be carried. If a medial emergency occurs in flight the medical practitioner may have a role to play when asked by the crew, whose training has recently been augmented by many airlines to include the use of self diagnosing defibrillators. This team approach is important and is of benefit to the patient; it may avoid disruption to the flight.

Medical assistance during commercial airline flights: analysis of 11 years experience of the Paris emergency medical service (SAMU) between 1989 and 1999

Emergencies arising during commercial airline flights may have serious consequences. We report the experience of the Paris Emergency Medical Service (SAMU) in providing in-flight assistance to Air France between 1989 and 1999. During this period medical advice was sought 380 times during the carriage of about 350 million passengers. Analysis of the patient files suggests that serious emergencies were rare and that cardiopulmonary resuscitation was required only exceptionally. However the relative frequency of cardiac and neurological emergencies in our analysis supports the necessity of carrying adequate medical equipment and of having direct access to expert medical advice. The results suggest the requirement for a rigorous prospective epidemiological study of in-flight emergencies to evaluate the effectiveness of current practice and possible modifications of equipment and protocols for patient management.

The flight attendant dilemma: an analysis of communication and sensemaking during in-flight emergencies

Building on past research, this article argues that organizational life can be usefully construed as a series of communicative performances that are embedded and enacted in everyday discursive practices. Specifically, this research explores the sensemaking process individuals undertake when faced with the dilemma of knowing when to invent appropriate ways to respond rather than being automatically constrained by past routines. The research presents case study evidence drawn from participant observation and interviews with flight attendants from a major U.S. airline. Shown to be high in emotional and impression management, flight attendants perform a feminized role that privileges accommodation over authority and reassurance over safety that may influence their performances in emergency situations. The work ends with an evaluation of the dominant air travel performance in relation to safety and offers recommendations for facilitating communication and coordination among flight attendants and pilots.

Medical control of commercial airline in-flight emergencies

Medical control of commercial airline in-flight emergencies

The Development of Specifications for an Automated Monitoring System Interface Associated With..

Because of the complexity and interconnectedness of aircraft subsystems, considerable interpretation is required to determine the implications of conventional system warnings and to decide on the appropriate course of action to ameliorate a fault condition. This article focuses on the case of mechanical fault conditions in rotorcraft. Until recently, only a few simple sensors (e.g., oil pressure and temperature, oil debris sensor) were provided to signal mechanical faults. However, a variety of new sensors and analyzers have become available recently, under the general rubric of health and usage monitoring systems, which purport to provide more sensitive identifications of faults along with the promise of future extensions to fault diagnosis and prognosis as well. A motion-based simulator was used to gather performance data associated with air crew responses to a variety of mechanical faults using current cockpit instrumentation. Participants were then interviewed regarding their information requirements for using new diagnostic systems to mitigate in-flight mechanical system emergencies. Results gave initial support for a taxonomy of air crew cognitive activities. This classification scheme is being used in ongoing work to design and evaluate information aids for rotorcraft air crews.

Emergencies in the air: Problems, management, and prevention

Medical emergencies may arise on board commercial airlines. Although infrequent, such events annually affect a substantial number of air travelers. Physicians should be aware of the options available to them should they find themselves in an emergency situation on an aircraft. This article examines the incidence of in-flight emergencies, surveys the onboard medical kit, and explores various in-flight medical problems and treatments. It concludes with a discussion of various methods of prevention.

MEDICAL EMERGENCIES IN COMMERCIAL AIR TRAVEL

There are physiologic and logistic concerns involved in caring for patients with inflight emergencies. This article presents the physiologic changes that occur at altitude, the types of medical problems that can be encountered, and management strategies. An overview is also presented of the medical training of flight attendants and the medical equipment that is available on commercial aircraft.

First aid in the air.

First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in-flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical emergencies. Cramped conditions, difficulties of access to the victim, lack of privacy, cultural and language differences and noise and vibration all compound to increase the difficulties of the normal first aid drills which are required in the management of in-cabin emergencies. Doctors who fly as passengers are liable to be called upon to render first aid in the air. We provide an analysis of the types of medical emergencies encountered during commercial air travel. We have reviewed all consecutive in-flight medical incident reports for QANTAS international flights for 1993. All incidents requiring the attention of a doctor were included. A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angina and cardiac emergencies (23%), gastrointestinal conditions (13%), respiratory tract infections and asthma (9%) and anxiety and panic reactions warranting medical intervention (5%). Syncope, the management of gastrointestinal symptoms and problems of angina comprise over half (58%) of the presenting symptoms which confront a fellow traveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcohol abuse and mild hypoxia are discussed in the context of precipitating factors which may trigger an in-flight emergency. Psychological problems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors and nurses to be trained in first aid, as a distinct profession in its own right and a series of drills and skills which are distinctive from those of surgery-based health care. The 5% annual increase in air-passenger traffic, predicted for the next two decades, highlights the importance of special training for "first aid in the air'.

The effect of an in-flight, emergency training program on crew confidence

Despite some progress, the air medical transport profession continues to experience widely publicized accidents that result in injuries and death to crew members and patients. An air medical crew member's experience, training and confidence may affect his or her ability to deal effectively with an in-flight emergency, and may also affect his or her behavior before and after the emergency. A hospital-based, rural rotor- and fixed-wing program flying approximately 890 flights per year. Seventy-seven percent of these flights are interfacility. A pretraining survey evaluated the experiences of air medical crew members and pilots. A 20-question assessment tool based on a 5-point Likert scale evaluated how confident the individuals were in their ability to react to in-flight emergencies. An extensive in-flight emergency training program was then conducted. Personnel were asked to complete the same questionnaire one month and six months after the training. On the pretraining questionnaire, flight crew members with neither prior training nor actual experience in in-flight emergencies showed the lowest level of confidence. Those with prior training, actual in-flight emergency experience or both, responded with higher levels of confidence. The mean confidence scores of the study participants increased from 82 pretraining to 89 at one month post-training and remained at the increased level six months after training. A training program focusing on in-flight, aircraft-related emergencies can increase the crew's confidence during such situations. This increase in confidence is most noticeable in those without previous training or experience and is maintained for at least six months. Several other benefits occur from the training program.

Airline advisory nursing

The commercial airliner cabin is a specialized environment, usually pressurized to an equivalent of 2,438-meter pressure altitude. Such an altitude can adversely affect people prone to hypoxia. Preflight attention to this and other problems by an advisory nurse (AN) can minimize or prevent in-flight emergencies. The AN can also facilitate travel for passengers with medical needs by being familiar with airline policies and federal regulations. By educating the patient/passenger, health care providers and airline personnel, the safety, comfort and dignity of all concerned can be maximized.

Design of an intelligent information system for inflight emergency assistance From prototype to real time application

Design of an intelligent information system for inflight emergency assistance From prototype to real time application

An intelligent information system for in-flight emergency assistance

The present research has as its goal the development of Artificial Intelligence (AI) tools to help flight crews cope with in-flight malfunctions. The relevant tasks in such situations include diagnosis, prognosis, and recovery plan generation. Investigation of the information requirements of these tasks has shown that the determination of paths figures largely: what components or systems are connected to what others, how they are connected, whether connections satisfying certain criteria exist, and a number of related queries. The formulation of such queries frequently requires capabilities of the second-order predicate calculus. We describe an information system that features second-order logic capabilities, and is oriented toward efficient formulation and execution of such queries.

In-flight Emergencies: Doc Riders in the Sky

To the Editor.— I read with a great deal of interest the March 3 issue ofThe Journal, which included the results of a 1-year survey of in-flight emergency medical situations. 1 This survey included exhaustive data outlining the incidence of emergencies, type of complaint, treatment, and individual responding to the emergency. I found the last figure rather surprising. While only 13% of all in-flight emergencies were treated by a physician, commercial flights usually include two or three physicians among the list of passengers. This figure seems to indicate that during many of these situations physicians were reluctant or otherwise unable to provide assistance. I feel such reluctance can be directly attributed to fear of malpractice liability. In January 1989, I introduced HR 676, The In-Flight Emergency Medical Assistance Act, which would free licensed physicians from constraining malpractice laws when treating this special type of emergency. James H. Sammons, MD,

In-flight Emergencies: Doc Riders in the Sky-Reply

In Reply.— In response to Dr Glass, my editorial suggested that flight attendants (and consequently passengers) might benefit from receiving basic life support training, eg, learning to clear a foreign object from the throat, stop an acute hemorrhage, or perform cardiopulmonary resuscitation. The fact that flight attendants might be trained as emergency medical technicians was meant to be tongue-in-cheek. Dr Glass' proposal to have at least one on-board flight attendant trained as an emergency medical technician might one day prove to be useful, but from the airlines' point of view is currently impractical. Crew schedules being what they are (attendants bid for flights on a month-to-month basis), trying to ensure one emergency medical technician on each flight would prove to be a logistic nightmare (not even considering the havoc created in crew schedules by canceled flights, weather delays, and crew illnesses). Dr Glass has accurately characterized what is probably the

In-flight Emergencies: Doc Riders in the Sky

To the Editor.— The recent article by Cummins and Schubach 1 on medical emergencies among commercial air travelers points out helpfully that a "doctors only" medical kit containing a few essential drugs has been required by the Federal Aviation Administration on US commercial aircraft since August 1,1986. Perhaps it is worth pointing out to physicians traveling on international flights that in-flight emergency drugs are also available from other passengers on the same aircraft. Common drugs such as nitroglycerin, calcium channel blocking agents, tranquilizers, bronchodilators, etc, are so widely used that an announcement on the airplane loudspeaker will usually bring forth most necessary drugs in oral form. Some years ago, I was called to assist a middle-aged Englishman on a British Airways flight from London to New York. The man had a history of coronary disease and had developed unremitting (preinfarction) angina in midflight (beyond the point of no return). His