How do you manage medical emergencies on a plane?

Managing Medical Emergencies on a Plane

In-flight medical emergencies should be managed by identifying yourself as a healthcare professional, using available medical resources on board, and following a structured approach to stabilize the passenger until landing.

Initial Response to an In-Flight Medical Emergency

• When a medical emergency occurs, flight attendants will make an announcement requesting medical personnel to identify themselves 1
• As a healthcare professional, you should:
  • Identify yourself and your qualifications to the cabin crew
  • Request the emergency medical kit and automated external defibrillator (AED) which are available on all commercial aircraft 1
  • Establish a clear communication channel with the flight crew

Available Resources on Aircraft

• Every commercial aircraft is equipped with:
  • First aid kit
  • Emergency medical kit (containing medications and equipment)
  • Automated external defibrillator (AED) 1
• Flight crews are trained in cardiopulmonary resuscitation
• Ground-based medical consultation services are available via radio to provide guidance 1

Common In-Flight Medical Emergencies

The most common in-flight medical emergencies include:

1. Syncope (35%)
2. Cardiac emergencies (23%)
3. Gastrointestinal conditions (13%)
4. Respiratory issues (9%)
5. Anxiety and panic attacks (5%) 2

Management Approach

For Syncope (Most Common)

• Position patient flat with legs elevated if space allows
• Check vital signs
• Ensure adequate hydration
• Monitor for signs of improvement

For Respiratory Distress

• Administer supplemental oxygen if available
• Position patient upright to maximize respiratory effort
• For asthma or COPD exacerbations, use bronchodilators from the emergency kit
• For hyperventilation or panic attacks, use breathing retraining techniques (slow, controlled breathing) 3

For Cardiac Emergencies

• Position patient for comfort
• Administer aspirin if available and no contraindications
• Use AED if cardiac arrest occurs
• Nitroglycerin may be available in the emergency kit for chest pain

For Anxiety/Panic Attacks

• Move patient to a quiet area if possible
• Use calm, reassuring communication
• Guide through slow breathing techniques
• Benzodiazepines may be available in the emergency kit for severe cases 4

Decision to Divert

• After assessment, communicate findings to the flight crew and ground-based physician
• The goal is to stabilize the passenger for arrival at the scheduled destination
• The decision to divert the aircraft rests solely with the captain, though medical input is considered 1

Legal Considerations

• The 1998 Aviation Medical Assistance Act provides liability protection for healthcare professionals acting as good Samaritans on US flights 1
• Document your assessment and interventions if possible

Special Considerations for High-Risk Passengers

For Passengers with Respiratory Disease

• Those with respiratory conditions should be assessed before travel for fitness to fly
• Cabin pressure corresponds to 2400m altitude, which can worsen hypoxemia 5
• Supplemental oxygen may be required during flight for those with baseline hypoxemia

For Passengers at Risk of DVT

• For flights >4 hours, encourage:
  • Frequent ambulation
  • Calf muscle exercises
  • Maintaining adequate hydration
  • For high-risk individuals, compression stockings (15-30 mmHg) are recommended 6

Preventive Measures for Future Flights

For passengers with cognitive impairment or other medical conditions:

• Inform cabin crew about medical conditions before boarding
• Ensure adequate hydration but avoid excessive alcohol and caffeine
• Take small, frequent meals rather than large ones
• Consider requesting aisle seating for easier movement 5

By following this structured approach and utilizing available resources, healthcare professionals can confidently manage in-flight medical emergencies and improve outcomes for affected passengers.