In-Flight Medical Emergencies

Written by Clay Smith

Spoon Feed
In-flight medical emergencies (IFMEs) are common, most often presenting with syncope.  As emergency physicians, we can handle most scenarios, but it’s a team effort when it happens in-flight.

Why does this matter?
Knowing how best to help in this complex, resource-limited setting will serve patients well.  As emergency physicians, we are uniquely qualified in such situations.  Make sure you know the rules, what resources are available, and the best way to help.

Is there a doctor in the plane?
IFMEs occur every 1 in 604 flights.  Medical kits vary but should always contain: basic personal protective equipment, AED, basic vital sign assessment tools, hemorrhage control supplies, IV supplies, and common rescue/symptomatic medications. The most common problem in-flight is syncope/near-syncope (30%), followed by gastrointestinal, respiratory, or cardiovascular symptoms.  You are generally protected from legal liability, at least in the U.S.  Ground-based medical control ultimately guides the interventions and the final decision to divert and land early.  Diversion occurs 4-5% of the time and is a complex decision.  Normal SpO2 at 35,000 feet in the cabin is 93-97%.  You are not required to respond in the U.S. and probably should not if you don’t have the requisite skill.  You should also not respond if you’re intoxicated.  Assuming sobriety, we as emergency physicians are well trained to help in this kind of situation.  Even if another person has responded, offer your services and identify yourself as an emergency physician.  A quick, collegial discussion to establish roles is helpful.  Remember, an IFME is a team effort that includes you, the flight crew, pilot, other medical professionals on the plane, and the ground-based medical control.

It’s too bad JAMA locked this article up behind a pay wall.  This is pretty important.  There are some helpful “cheat-sheet” cards for the most common diagnoses in the full text version.  Not to worry, there is a free app (below) that has all this information and more.

Another Spoonful
AirRx is an app to help with IFMEs, should it happen to you.

Source
In-Flight Medical Emergencies: A Review.  JAMA. 2018 Dec 25;320(24):2580-2590. doi: 10.1001/jama.2018.19842.

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