Commercial aviation in‐flight emergencies and the physician

Abstract

Commercial aviation in-flight emergencies are relatively common, so it is likely that a doctor travelling frequently by air will receive a call for help at some stage in their career. These events are stressful, even for experienced physicians. The present paper reviews what is known about the incidence and types of in-flight emergencies that are likely to be encountered, the international regulations governing medical kits and drugs, and the liability, fitness and indemnity issues facing 'Good Samaritan' medical volunteers. The medical and aviation literature was searched, and information was collated from airlines and other sources regarding medical equipment available on board commercial aircraft. Figures for the incidence of significant in-flight emergencies are approximately 1 per 10-40 000 passengers, with one death occurring per 3-5 million passengers. Medically related diversion of an aircraft following an in-flight emergency may occur in up to 7-13% of cases, but passenger prescreening, online medical advice and on-board medical assistance from volunteers reduce this rate. Medical volunteers may find assisting with an in-flight emergency stressful, but should acknowledge that they play a vital role in successful outcomes. The medico-legal liability risk is extremely small, and various laws and industry indemnity practices offer additional protection to the volunteer. In addition, cabin crew receive training in a number of emergency skills, including automated defibrillation, and are one of several sources of help available to the medical volunteer, who is not expected to work alone.

“If There is a Doctor Aboard this Flight…”: Issues and Advice for the Passenger-Psychiatrist

“…The Aviation Medical Assistance Act was passed in the USA in 1988 consequential to the reluctance of doctors to offer assistance for fear of litigation. 4 This Act has a Good Samaritan provision which protects an American physicianpassenger unless they are guilty of gross negligence or willful misconduct (on US registered aircraft only). 1 This provision does not apply if spontaneous medical assistance is given.…”

In-Flight Medical Emergencies

“…One medical incident is estimated to occur for every 10 000 to 40 000 passengers on intercontinental flights (5). Assuming the lower figure and assuming that there are 400 passengers on board each flight, one can calculate that with 95% probability one medical incident will be experienced within 24 intercontinental flights.…”

Cabin Cruising Altitudes for Regular Transport Aircraft

“…They discuss cabin environment as a consideration in responding to in-fl ight medical emergencies, and correlate cabin altitude pressure with the effects of hypoxia and gas expansion. Quoting Schesser, they state " At cruising altitude, the cabin pressure is set to 5,000 to 8,000 feet above mean sea level, rendering all passengers a degree of hypoxia, which can have serious effects on an already sick person " ( 6 ). This in-fl ight emergency pattern was confi rmed by Gendreau and DeJohn, who also found that in many passengers with cardiopulmonary disease oxygen saturation may fall dramatically at ordinary cabin pressures, resulting in hypobaric hypoxia ( 19 ).…”