Publication Date: September 2019 (Volume 21, Number 9)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 09/01/2022.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Ethics credit, subject to your state and institutional approval.
When medical emergencies arise in flight, commercial airline flight crews may ask for help from onboard medical professionals. Qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal reprisal. An understanding of the typically available resources, the hierarchy of authority, and medicolegal precedents can help providers feel confident in responding to these situations. This review addresses the pathophysiology related to air travel and common causes of in-flight medical emergencies and discusses the medications and equipment commonly stocked by commercial airlines. In addition, the complexity of flight diversion and the medicolegal concerns surrounding volunteering to provide medical care are addressed.
Excerpt From This Issue
You are flying from London Heathrow Airport to New York JFK on British Airways when a flight attendant makes a request over the intercom for medical personnel to respond to an ill passenger. Among the responders is a Basic Life Support-trained EMT, a nurse intensivist, a psychiatrist, and yourself, an emergency medicine physician. The flight attendant informs you that a 53-year-old female passenger in the economy section has become “unresponsive.” Her husband says that she has a history of diabetes, hypertension, and coronary artery disease; has 2 stents; and is currently taking insulin, aspirin, clopidogrel, and metoprolol. On physical exam, she is initially diaphoretic, pale, and lethargic, but quickly regains consciousness and is able to provide some history, and she reports feeling lightheaded prior to losing consciousness. She reports ongoing general weakness and presyncope. She is bradycardic at 35 beats/min but she is alert, with no increased work of breathing. Her neurological exam is nonfocal, and she has a soft abdomen and thready peripheral pulses. You wonder what resources you have available to narrow your differential diagnosis and begin treatment...
You are onboard a flight from Los Angeles to Atlanta. Three hours into the flight, you hear a call on the intercom asking for any available medical providers. You identify yourself as an emergency physician and are asked by the flight attendant for proof of your medical training. You have your hospital ID badge in your carry-on bag, and after showing this to the crew, you are taken to the back of the plane. On assessment, you find a 25-year-old woman lying across 3 seats. She is awake and complaining of abdominal pain. The patient is alert, has diffuse abdominal tenderness with guarding, and states that her last menstrual period was 2 months ago. She is normotensive on exam, but has subjective orthostasis. You are concerned for a ruptured ectopic pregnancy and wonder whether diverting the plane is an option...