Recognition and Management of Medical Emergencies in Flight - An Overview

Introduction:

In-flight medical emergencies occur during air travel, and usually, medical professionals are volunteered during such situations. Air travels altitude ranges from 29,000 feet to 39,000 feet. According to the FAA (federal aviation administration), the cabin pressure should be maintained below 8,000 feet. Individuals can move up to a height of 7,800 feet without any problem. But, some can have difficulties when the altitude changes, and patients with lung disorders can undergo symptomatic hypoxia (less oxygen in the blood). Therefore passengers should undergo pre-flight medical screening to avoid adverse events, and in case of relative hypoxia, the passengers should carry supplemental oxygen or should avoid traveling.

What Emergency Kits Should Be Available on the Flight?

According to FAA, the flight should contain:

• An automatic external defibrillator (AED) is a device that can detect abnormal heart rates and can deliver electrical shocks. It is helpful during sudden cardiac arrest.

• The flight attendants should be certified for CPR (cardiopulmonary resuscitation) and AED every two years.

• First aid kit.

• Enhanced emergency medical kit should contain the following:

  1. Stethoscope.

  2. Sphygmomanometer (a device to measure blood pressure).

  3. Syringes.

  4. Intravenous catheters of different sizes.

  5. Bag valve masks (a hand-held ventilating bag).

  6. Medications such as bronchodilators (drugs that help make breathing easier), analgesics (pain killers), anticonvulsants, antiemetics, and antihistamines (treat allergies). It should be restocked after every use.

  7. Needles.

  8. Gloves.

  9. Antiseptic wipes.

  10. Surgical mask.

  11. Sharps disposal box.

  12. Urinary catheter.

  13. Non-mercury thermometer.

  14. Flashlight.

• Medications should include:

  1. Epinephrine 1:1,000.

  2. Dextrose 50 %, injection of 50 ml.

  3. Nitroglycerin tablets.

  4. Adrenocorticoid steroid injection.

  5. Atropine injection.

  6. Normal saline.

How Are In-Flight Medical Events Recognized and Managed?

The aviation medical assistance act for the guidance and protection of volunteered doctors and other medical professionals was passed in 1998, which states that volunteers should be medically qualified, and no compensation should be given. The physician is not responsible for any damages that occur during proving an emergency treatment unless they are guilty of willful misconduct or negligence. The volunteered physician should write down the assessments and interventions made during the emergency treatment; after landing, the documents can be transferred to any hospital for further treatment.

The most common medical events are:

• Syncope: A condition where there is loss of consciousness for a small period of time which can occur due to stress, dehydration, anxiety, fear, or pain. This occurs due to reduced blood pressure. In such cases, the vital signs should be assessed, the cardiovascular system should be evaluated, and the underlying cause should be suspected, such as arrhythmia (irregular heartbeat), hypotension (decreased blood pressure), or a stroke (a brain attack that occurs due to decreased blood supply).

• Altered Mental Status: This can include amnesia, confusion, or poor regulation of emotions. It can occur due to injuries or illness of the brain. In such case, any identification of any toxins should be made, oxygen should be administered, and through the intravenous route, Dextrose 50 percent, and normal saline should be administered.

• Seizure: It is the uncontrolled electrical activity of the brain that causes abnormal movements, behaviors, and moods. In such cases, space should be cleared around the passenger, and an anticonvulsant such as Benzodiazepine should be given. Pot care should be provided.

• Chest Pain: Symptoms of chest pain include tightness or pressure in the chest and pain that spreads to the neck, jaw, and back. In such cases, vital signs should be assessed, the cardiovascular and respiratory systems should be evaluated, and oxygen should be administered. Apart from these, Nitroglycerine and Aspirin should be given. Further evaluations should be made for arrhythmia and myocardial infarction (heart attack caused due to decreased blood flow).

• Asthma Exacerbation: It is an asthma attack that occurs due to infected and swollen airways. The person can present with difficulty in breathing, coughing, and wheezing. In such cases, an inhalational bronchodilator, along with oxygen, should be given. In case of moderate symptoms, steroids should be given intravenously, and intramuscular epinephrine 0.3 to 0.5 ml of 1:1000 solution is given.

• Suspected Pneumothorax: A condition in which the air is present between the chest wall and lungs. The patient presents with severe stabbing pain in the chest region, bluish skin, difficulty breathing, shortness of breath, dry cough, and fatigue. In such cases, a needle thoracostomy is done in which a needle is inserted in the pleural space.

• Suspected Congestive Heart Failure: This condition occurs when the heart does not pump blood and leads to shortness of breath, wheezing, swelling of legs, irregular heartbeat, swelling around the belly area, decreased alertness, and chest pain. In such cases, oxygen should be administered, vital signs should be assessed, and intravenous access should be established through which a diuretic should be administered. Oral Nitroglycerin should be given.

• Allergic Reaction: The symptoms of allergic reaction are hives, rashes, runny nose, watery eyes, itchy nose, vomiting, and stomach cramps. In mild cases, intravenous corticosteroids and antihistamines should be administered. In case of severe allergic reactions called anaphylaxis, a condition that has a sudden onset and can involve many organs. This reaction causes the release of several chemicals, which can cause shock, decreased blood pressure, and breathing difficulty by narrowing the airways. In such cases, Epinephrine 0.3 to 0.5 ml of 1:1000 solution via intramuscular should be given.

• Nausea and Vomiting: In these cases, an antiemetic should be given. Intravenous access should be established, and normal saline should be established.

• Diarrhea: In these cases, intravenous access should be established, and normal saline should be established.

• Pregnancy Complications: Complications can include such as a clot in the leg, high blood pressure, increased sugar levels, stress, or anxiety. In such cases, the vital signs should be assessed. Intravenous access should be established. Further evaluation should be made for vaginal bleeding or abdominal pain.

Conclusion:

Aircraft is a different environment, and the emergency department should focus on the evaluation, diagnosis, and management of emergency events. Therefore before getting into an aircraft, the individuals should undergo screening for any life-threatening disorders and should undergo pre-hospital emergency medical services. Patients with severe cardiovascular or pulmonary disease should avoid traveling through flight.