Ashok Devkota, International Organization for Migration
6 June 2012
To the Editor:
Working as a medical escort I frequently encounter medical emergency on flight. In addition to patients I accompany, I often attend other passengers who develop medical conditions inflight. Syncope, gastrointestinal problems and respiratory problems are frequently encountered inflight (1). Many of these problems are treated symptomatically; lying down and oxygen for syncope, antiemetic for vomiting and motion sickness (2). But cardiac, respiratory and neuropsychiatric problems may often necessitate flight diversion (3).
Even for a physician onboard, it is difficult to examine and access patients¿ status in flight. The problems are due to limited cabin space and equipment. In crammed cabin it is difficult to maintain patients¿ privacy while talking to and examining a patient. It is difficult to obtain adequate information on health status and medication usage in absence of medical records. Traditional stethoscope cannot be used to measure blood pressure and auscultate chest and heart due to background noise and vibration. But a physician on flight can measure pulse and systolic blood pressure by palpation, oxygen saturation and blood sugar level if pulse oxymeter and glucometer are available. This may help in treatment of patient but it is not adequate to make a definite diagnosis. So best we can do is identify life threatening conditions, make a presumptive diagnosis and treat symptomatically. There is great variation in documentation of inflight medical emergency in commercial flights (4) and we have very limited studies which identify causes of problems and prognosis of those passengers after they get to health facility on ground. In this regard, maintaining a uniform central registry of inflight emergencies and recording post flight assessment and diagnosis of patients would be very helpful.
References:
1. Sand M, Bechara FG, Sand D, Mann B. Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases. Crit Care 2009, 13:R3.
2. Baltsezak S. Clinic in the air? A retrospective study of medical emergency calls from a major international airline. J Travel Med. 2008 Nov-Dec;15(6):391-4.
3. Valani R, Cornacchia M, Kube D. Flight diversions due to onboard medical emergencies on an international commercial airline. Aviat Space Environ Med. 2010 Nov;81(11):1037-40.
4. Sand M, Morrosch S, Sand D, Altmeyer P and Bechara FG. Medical emergencies on board commercial airlines: is documentation as expected? Critical Care 2012, 16:R42.
Ashok Raj Devkota, MBBS
Medical Escort
International Organization for Migration, Kathmandu
Email: ashokdevkota@hotmail.com
Critical Care
Postflight evaluation of inflight emergency cases
6 June 2012
To the Editor:
Working as a medical escort I frequently encounter medical emergency on flight. In addition to patients I accompany, I often attend other passengers who develop medical conditions inflight. Syncope, gastrointestinal problems and respiratory problems are frequently encountered inflight (1). Many of these problems are treated symptomatically; lying down and oxygen for syncope, antiemetic for vomiting and motion sickness (2). But cardiac, respiratory and neuropsychiatric problems may often necessitate flight diversion (3).
Even for a physician onboard, it is difficult to examine and access patients¿ status in flight. The problems are due to limited cabin space and equipment. In crammed cabin it is difficult to maintain patients¿ privacy while talking to and examining a patient. It is difficult to obtain adequate information on health status and medication usage in absence of medical records. Traditional stethoscope cannot be used to measure blood pressure and auscultate chest and heart due to background noise and vibration. But a physician on flight can measure pulse and systolic blood pressure by palpation, oxygen saturation and blood sugar level if pulse oxymeter and glucometer are available. This may help in treatment of patient but it is not adequate to make a definite diagnosis. So best we can do is identify life threatening conditions, make a presumptive diagnosis and treat symptomatically. There is great variation in documentation of inflight medical emergency in commercial flights (4) and we have very limited studies which identify causes of problems and prognosis of those passengers after they get to health facility on ground. In this regard, maintaining a uniform central registry of inflight emergencies and recording post flight assessment and diagnosis of patients would be very helpful.
References:
1. Sand M, Bechara FG, Sand D, Mann B. Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases. Crit Care 2009, 13:R3.
2. Baltsezak S. Clinic in the air? A retrospective study of medical emergency calls from a major international airline. J Travel Med. 2008 Nov-Dec;15(6):391-4.
3. Valani R, Cornacchia M, Kube D. Flight diversions due to onboard medical emergencies on an international commercial airline. Aviat Space Environ Med. 2010 Nov;81(11):1037-40.
4. Sand M, Morrosch S, Sand D, Altmeyer P and Bechara FG. Medical emergencies on board commercial airlines: is documentation as expected? Critical Care 2012, 16:R42.
Ashok Raj Devkota, MBBS
Medical Escort
International Organization for Migration, Kathmandu
Email: ashokdevkota@hotmail.com
Competing interests
None