Carrie Fisher’s untimely death after an in-flight medical emergency (a cardiovascular event) has put focus on what happens when there is a medical emergency during a flight.  Understanding how in-flight medical emergencies work can help people be better prepared and have a better understanding of what an in-flight emergency is, who responds, and what help is available mid-flight.

In-flight medical emergencies on commercial flights occurs on about 50 flights A DAY, or over 17,000 times a year in the United States alone. Among the most common in-flight medical emergencies are cardiac problems, loss of consciousness, seizures, respiratory problems such as asthma, and musculoskeletal problems, such as strains, sprains, and fractures.

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In-flight medical emergencies occur spontaneously, such as minor sprains and unanticipated major health events.  Some in-flight medical emergencies are also related to pressure changes (which can decrease the amount of oxygen available to breathe), lack of movement, and physiological responses to high altitudes.



Having personally responded to many medical emergencies in-flight emergencies, I have seen a wide range of responders, events, and difficult decision making that happens when you are miles above the earth.  Responders to in-flight medical emergencies can be physicians, nurse practitioners, nurses, or paramedics.  Contrary to popular belief, the responders often get no compensation from the airline.  And not once in 15 years of responding too medical emergencies mid-flight have I received a “thank you” from any airline management.  The flight attendants are always grateful, but the lack of remuneration and gratitude causes many medical providers from volunteering to NOT  assist others. 

Once, on a trans-Atlantic United flight– an elderly passenger suffered a seizure on board.  “If there is a doctor on board, please report to the flight attendants” is the ominous call for help.  The respondents included me and a physician who has not practiced medicine for 20 odd years.  Taking a simple blood pressure is impossible on a flight.  The medical equipment is shoddy, at best, and creativity is needed even with simple evaluations. 

Physical space to treat a passenger is a problem, of course. Inserting an IV and starting an infusion, especially in economy seating, is a back-breaking affair, especially with turbulence.  When a passenger has to lie down – the aisles are crowded with all of the displaced passengers.  Forget privacy and HIPAA – at 36,000 feet there is no possibility of these things.  The medical decision making that is needed during serious medical events includes a ground-based medical team who are experts in in-flight emergencies.  The medical responders on board, together with the Captain and ground-based medical team, need to decide: Divert or stay on course?  Diversions are expensive for the airline, but can be life-saving for high-risk events. 

In Carrie Fischer’s case, a decision was made not to divert the flight.  In the case of my seizure patient – the seizure occurred mid-Atlantic which was 2-3 hours away from any possible diversion point.  That is a bad place to be, but the pressure of making the decision is significant. 

Another unresponsive passenger on a trans-continental flight last month, resulted in responses from a retired physician (who declared that it was a diabetic coma and then returned to his seat), a paramedic, and me.  After 30 minutes of difficulties in evaluating her, having no idea what she had or took, we were unsure what to do.  And no, it was not a diabetic coma.  Turns out, this passenger has taken a new medication, at a dose 8 times the normal strength, before boarding the airplane.  Pretty scary that this happened, but we were able to revive her and everything was fine.

Conditions to treat people on an airplane are difficult at best – lack of human and medical resources, lack of space, and noise contribute to difficulties even performing basic medical evaluations.  After a few recent in-flight emergencies, I started bringing my own stethoscope on board, as a few stethoscopes literally fell apart in my hands on board.

There are some things you can do to reduce your risk of having an in-flight emergency, and to reduce your risk of complications or delayed care if you experience a medical emergency in-flight.

1.     Keep a list of medications you are taking clearly available.

2.     DO NOT use a medication for the first time right before or during the flight.

3.     Wear a medical bracelet for any medical condition such as allergies/diabetes/epilepsy/medicines used/etc.

4.     Keep hydrated.  The day before flying, drink plenty of fluids (and less caffeine) to prepare your body for flying.  The cups available on flights are usually 4-6 ounces, so when offered a drink – request 2.  Avoid alcohol and caffeinated beverages when on board, as they will contribute to dehydration.

5.     If you have any special medical needs, discuss with your physician or health care provider.  If you need oxygen or other medical equipment while flying, these must be arranged ahead of time with the airline, and may include additional fees.

6.     Stay seated during turbulence to avoid injuries!

7.     Some people with complex health problems may require medical accompaniment.  

8.     If you have food allergies, bring 2 Epipens on board.

Some airlines allow people with food allergies to announce their food allergies to the flight and to pre-board to clean their immediate seat area including tray table.  Some airlines are less accommodating, unfortunately.

Additionally, walking and stretching on board is important to prevent blood clots.  This is especially true for longer flights. The Center for Disease Control has determined that people at risk for blood clots include:

·           Older age (over age 40)

·           People who are overweight

·           People who had surgery in the previous 3 months.

·           Women using oral contraception pills or hormone replacement therapy

·           Anyone with a family or personal history of blood clots

·           People with recent cancer treatment (or a cancer diagnosis)

·           People with limited mobility

·           People with varicose veins.

If you have any of these risk factors, discuss your flight plans with your physician.  In some cases, anti-clotting medication (an injection) may be prescribed to prevent a blood clot. 

 

Safe Travels and May the Force be with you!

 


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