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Suddenly a passenger
experiencing medical
emergency
Do we have on board
What should we emergency medical kits?
do?
HISTORY
Respiratory Symptom
23%
4% Cardiac Symptom
6%
Seizure
8%
12%
10% Abdominal Pain
Etc
HOW DOES CABIN PRESSURE EFFECTS OUR BODY
• People with cardiac or pulmonary illness may be starting further to the left
on the oxygen dissociation curve before gaining altitude, which increase the
risk for acute exacerbation
• Many patients with supplemental oxygen are advised to increase their oxygen
support during flight
HOW DOES CABIN PRESSURE EFFECTS
OUR BODY
• According to Boyle’s Law, as the pressure drops in the cabin after take off, air
trapped in closed space such as our bodies can increase in volume up to 30%
• Clinically pneumothorax during flight has been reported, also patients with recent
ocular or intracranial surgery may be at risk for in-flight complication
• Because of these changes, patients who have undergone abdominal surgery are
advised to avoid flying at least 2 weeks after the procedure
RESOURCES
Consultation
Services
In-Flight Medical
Resources
Other On-Board
Provider
Flight Diversion
MEDICAL KITS AND DEFIBRILLATOR
• Airlines are required to carry basic first aid supplies such as bandages and splints
• Based on Federation Aviation Administration (FAA), airlines should carry medical kits
consisting of this following item:
• Assessment Supplies (Blood Pressure cuff and Stethoscope)
• Acute Interventional Equipment
• Oropharyngeal airway
• Bag valve and CPR mask
• IV administration set
• Saline Solution
• Needles
• Syringes
MEDICAL KITS AND DEFIBRILLATOR
• The FAA does not require sedative, anti psychotic agents and obstetric
supplies. However, in international carrier, contents of medical kits are highly
variable
CONSULTATION SERVICES
• This centers are staffed with healthcare provider who can provide advice how
to handle medical event in real time
• Ground based call centers can also communicate with prehospital providers
should a flight need to be diverted
OTHER ON-BOARD PROVIDERS
• Some medical events require the involvement of more than one medical provider
• Critically ill patients or those with time sensitive medical emergencies involve
cardiovascular, neurologic, or respiratory system may require the aircraft to
divert.
3. Postflight Issues
• Provider who undertakes care should continue to provide until the patient recovers
or the responsibility has been transferred into another provider
• The provider should document the encounter using airline-specific documentation
and protects the patient’s privacy
SUGGESTED RESPONSE
• Healthcare provider who wish to respond must first determine if they are sufficiently
capable of providing care and state his/her qualifications to passenger and flight
personnel
• Volunteer provider should obtain patient’s consent for evaluation and treatment
• If the patient has a critical medical needs, volunteers can recommend flight diversion,
while medical care provider should perform the treatment.
• After landing, providers should supply prehospital personnel with communication.
However, it is appropriate to accompany the patient to hospital
SPECIFIC CONDITIONS
• The list of possible acute medical issues is extensive. Here are a few of them:
1. Trauma
• Responding physician should assess for potential life-threatening injury, such as
extrimity fracture or blunt head injury
2. Gastrointestinal Issues
• Acute GI issues such as nausea and vomiting are often reported
• Responding physician should consider if the condition is benign such as
gastroenteritis or has more serious condition such as AMI
• Providers can initiate IV fluid therapy for passengers who show signs of hypovolemia
SPECIFIC CONDITIONS
3. Cardiac Arrest
• Provider should immediately begin CPR and use on-board AED to defibrillate a
potentially shockable rhythm
• If the patient is resuscitated, the physician should recommend diversion of the flight
4. Anaphylaxis
• In the event of severe allergic reaction, for an adult patient, a responding physician can
administer diphenhydramine 50 mg and epinephrine 0.3 mg 1:1000 IM from the
medical kit
• for patients with bronchospasm, a metered dose inhaler of albuterol can be given
SPECIFIC CONDITIONS
5. Myocardial Infarction
• When AMI is suspected, it is appropriate to give aspirin as long as the patient does
not allergic to aspirin and does not experiencing acute hemmorhage
• Supplemental oxygen should be provided
• Responding physician should recommend diversion of the aircraft
6. Acute Psychiatric Issues
• 2.4% on board medical events
• Anti psychotic and sedative are not included in medical kit, so the responding
physician need to attempt verbal de-escalation of aggressive behavior
• If the safety of flight is compromised, improvised physical restraint may be needed.
SPECIFIC CONDITIONS