'Is there a doctor on board?' A guide to managing in-flight medical emergencies

A new article in CMAJ (Canadian Medical Association Journal) practical tips for physicians on airplanes who may step in to help in a medical emergency.

"Hearing the call go out for a doctor onboard at 36,000 feet can be anxiety-provoking for any physician," says Dr. Alun Ackery, an emergency physician at St. Michael's Hospital and the University of Toronto. "If the health professional offers their expertise, they may have to manage an unfamiliar clinical scenario, in a foreign and limited environment without knowledge of the available resources. This article provides practical tips to inform physicians about what to expect if they are in this situation."

The article reviews the policies and procedures of Canada's two major airlines, Air Canada and WestJet Airlines Ltd. and literally unpacks the medical equipment found onboard these carriers in a video to help health care professionals understand what they might encounter during an in-flight medical emergency and what resources are available to help with treatment.

An estimated 2.75 billion passengers worldwide fly each year on commercial airlines, with 133.4 million fliers in Canada in 2015, a 27 per cent increase over 2009. The increased number of passengers is one reason for an increase in in-flight medical emergencies. Another reason is longer flights, which subject people to stressors, such as lower oxygen humidity levels, for a longer period of time.

There are no standardised methods for identifying in-flight emergencies making it difficult to find reliable incidence rates. Estimates range from one medical emergency per every 604 flights (16 events per one million passengers) to one per 7,700 passengers.

The top five causes of medical emergencies are lightheadedness/loss of consciousness (37.4 per cent), respiratory symptoms (12.1 percent), nausea or vomiting (9.5 per cent), cardiac symptoms (7.7 per cent) and seizures (5.8 per cent).

Physicians are the primary responders in 40 per cent to 50 per cent of in-flight emergencies, nurses and paramedics in 5 per cent to 25 per cent and flight attendants alone in almost half (45 per cent) of incidents.

The authors suggest that in complex medical situations, a team-based approach, assigning clear roles and responsibilities to use the skills of other health care professionals, is valuable.

Flight attendants should be involved as key resources who know the aircraft, emergency procedures and can liaise with the cockpit and ground communications staff for telemedicine support and potential emergency landings.

"The incidence of in-flight medical emergencies continues to rise and it is likely that many physicians will hear a call to attend to a fellow passenger. Knowing what to expect may help physicians be better prepared the next time that fateful call goes out at 36 000 feet," says Dr. Ackery.

Researchers from St. Michael's Hospital, the University of Toronto, Air Canada, WestJet Airlines Ltd. and ORNGE Air Ambulance collaborated on the article.

Is there a doctor on board?: Practical recommendations for management of in-flight medical emergencies has been published today 26 February 2018.