Study: Few Flights Diverted for Medical Crises

Medical emergencies occur on about 1 out of 600 flights, researchers estimate based on a new study. But half of the time there's a doctor aboard to help. And most cases turn out well, the study found. Researchers from the University of Pittsburgh Medical Center did the study. It was based on records of a Pitt service called MD-STAT. The service gets calls from airline crews who need advice during medical emergencies. Researchers reviewed nearly 12,000 cases from a 3-year period. They found that planes needed to be diverted to the closest airport in only 7% of cases. In 26% of cases, people were taken to the hospital after landing in the scheduled city. About 9% of people in the study were admitted. Their symptoms most often were related to the heart, pregnancy or possible stroke. The vast majority of cases were handled on the plane. Doctors aboard volunteered to help nearly half of the time, and nurses or other health workers in 28% of cases. The most common problems were dizziness or fainting, breathing problems, and nausea or vomiting. The Journal of the American Medical Association published the study. The Associated Press wrote about it May 30.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

It's an announcement that no one wants to hear: "Is there a doctor on board this flight?"

Medical emergencies during air travel pose several challenges. These include:

• Cramped quarters
• Limited medicines and equipment
• Engine noise, which can make it hard to take blood pressure or communicate
• Lack of information about the sick passenger

But there's help available, even beyond the health care providers who happen to be on the plane.

• Crew members actually handle many medical problems on their own. They call for help only when they need more medical expertise.
• Most domestic flights carry standard emergency medical kits containing several medicines and basic equipment.
• Flight attendants are required to know CPR.
• Most commercial flights are required to have a defibrillator and a crew trained in its use.
• Flight crews can talk with doctors on the ground. In fact, it's common that airlines work with medical teams who are on call 24 hours a day.

Sometimes the most important medical decision during an in-flight emergency isn't which treatment to provide. The key decision is whether the pilot should divert the flight to the nearest airport where emergency personnel are available.

Most aviation authorities suggest that in-flight emergencies are rare and most aren't serious. But there is much we don't know. Airlines are not required to keep track of medical emergencies on flights. So they could be more common than we think. And maybe they could be handled better.

That's where a new study comes in. Researchers collected data from a communications center that receives medical calls from 5 airlines. From 2008 to 2010, these airlines accounted for about 10% of worldwide passenger flights.

Study results appear in the New England Journal of Medicine. According to this report:

• Medical emergencies occurred on about 1 in 600 flights
• The most common problems were:
  
  • Loss of consciousness or feeling faint
  • Breathing problems
  • Nausea or vomiting
• The crew asked doctors on board to help almost half of the time.
• The most common treatments were rather simple. They included:
  • Oxygen
  • Intravenous fluids
  • Aspirin
• About one-quarter of emergencies led to immediate hospital care after landing.
• About 7% led to flight diversions.
• Deaths occurred in 3 out of 1,000 passengers who had an in-flight medical emergency.

In my view, these findings are reassuring. It seems that in-flight emergencies are rare and most stricken passengers fare well. But because so many people fly, an estimated 44,000 in-flight emergencies occur each year worldwide. So it makes sense to do what you can to avoid them.

What Changes Can I Make Now?

Take measures to reduce the chances you'll have an in-flight medical emergency. And if you do have a problem, planning ahead can increase the chances that you'll come out of it in good shape.

Here are some steps you can take:

• Bring your medicines and medical equipment. Keep those you may need during the flight with you, not in your checked luggage. Examples include asthma inhalers or a blood sugar reader.
• Know your allergies and avoid potentially risky exposures. If you have severe allergies, bring an EpiPen (epinephrine in a spring-loaded syringe).
• Bring an updated list of your medical problems and medicines. Also, try to travel with someone who is familiar with them.
• Consider a travel delay if you are ill. This is especially important if your condition has required emergency care or a hospital admission in the past.
• Ask your doctor whether your medical problems make air travel risky. Many people don't realize that oxygen levels are lower in the aircraft cabin. This may pose a problem for people with lung disease. Changes in cabin pressure or swelling in an arm or leg during flight can make a cast dangerously tight even if it was comfortable on the ground.
• Drink plenty of liquids, and stretch and walk around when you can. These steps can reduce the chances of a blood clot forming in your legs.

If you are a health care professional, offer to help if there's an emergency on your flight. Even if you don't have these skills, listen carefully to the crew's requests. You may have something helpful to offer, such as a blood sugar reader or a medicine someone needs.

What Can I Expect Looking to the Future?

If you fly, chances are excellent that you will land feeling at least as well as when you departed. However, for the few people who become ill during flight, the crew, health care professionals on board and doctors on the ground are usually able to handle matters well.

In the future, I hope we can prevent many in-flight emergencies by predicting better who can safely fly. I agree with the authors of this study, who call for routine tracking of in-flight medical emergencies. This could lead to changes in the contents of the emergency kits, the training of the flight crew or the advice provided by doctors on the ground.