Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls

Points and Pearls Excerpt

• Aircraft cabins are typically pressurized to the equivalent of about 8000 ft, resulting in a 4- to 10-point drop in O₂ saturation in healthy adults. Passengers may experience myalgias, fatigue, and generalized discomfort on long-haul flights.
• Only 50% of the cabin air is recirculated. When recirculated, it is subjected to HEPA filtration, which is adequate to prevent infection by airborne pathogens but not the infectious respiratory viruses, which are spread by droplets.
• On long flights, dehydration is likely due to inadequate water intake and the increased use of diuretics such as caffeine and alcohol.
• There is approximately 1 in-flight emergency per 11,000 passengers, or 1 in 604 flights. Syncope and cardiac events are most common, followed by gastrointestinal, respiratory, and neurologic events.

Most Important References

• Peterson DC, Martin-Gill C, Guyette FX, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013;368(22):2075-2083. (Retrospective review; 11,920 in-flight medical emergencies)
• Cottrell JJ. Altitude exposures during aircraft flight. Flying higher. Chest. 1988;93(1):81-8415. (Prospective evaluation; 204 commercial flights)
• Federal Aviation Administration. Advisory circular: emergency medical equipment. 1/12/2006. Accessed August 10, 2019. (Federal government regulation)
• Page RL, Joglar JA, Kowal RC, et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med. 2000;343(17):1210-1216. (Retrospective review; 200 in-flight medical emergencies) 
• Stewart PH, Agin WS, Douglas SP. What does the law say to Good Samaritans?: a review of Good Samaritan statutes in 50 states and on US airlines. Chest. 2013;143(6):1774-1783 (Literature review) 
• Aviation Medical Assistance Act of 1998, Pub. L. 105-170, Apr. 24, 1998, 112 stat. 47, Sec. 5. Washington DC: National Archives and Records Administration; 1998. Accessed August 10, 2019. (US Government report)