Medical Matters: Is there a doctor on board this flight?

Happily, it has been a few years since I was called to an inflight medical emergency. The young woman’s shortness of breath turned out to be an anxiety attack; that and the fact that it was a short-haul flight of an hour’s duration meant it was a relatively low-key event.

Long-haul is a different prospect; as you read this, I will just have flown to western Canada and even at this remove I feel a little on edge at the prospect of hearing the announcement: “Is there a doctor on this flight?”

It’s not so much a concern about my ability to deal with a common medical emergency such as heart attack or a seizure that bothers me; it’s having to do so in the unfamiliar and cramped environment of a metal tube hurtling through the air.

Perhaps surprisingly, neither medical schools nor training programmes teach physicians how to handle an emergency confidently while aboard a commercial flight.

Brian Secemsky, an internal medicine trainee in the US, highlighted this issue on his blog recently. He is especially concerned about doctors’ lack of knowledge about what lifesaving medications are available on a commercial aircraft. That, and unfamiliarity with on-board medical equipment, bother him.

“Clinical physicians completing their residencies [postgraduate training] should be formally trained in commercial airline emergency medicine. This should involve real-time emergency simulations and repeated certification of the handling of basic medical equipment,” he says.

So what are the most common medical emergencies encountered in flight? One of the main medical consulting services used by US airlines to help crew handle inflight emergencies is MedAire’s MedLink. In 2014 it responded to 36,512 inflight cases and an additional 30,640 cases to determine whether a passenger was fit to fly.

Most common

Last year, the service received these types of inflight calls: neurological problems were the most common, prompting 32 per cent of requests for advice; some 25 per cent were classified as gastrointestinal; respiratory problems led to 8 per cent of calls; cardiac issues were a surprisingly low 6 per cent; and emergencies caused by allergies made for 4 per cent of calls from aircraft in flight.

Christian Martin-Gill, an emergency physician at UPMC Communication Centre in Pittsburgh, another inflight consulting service, and his colleagues published a study in 2013, "Outcomes of Medical Emergencies on Commercial Airline Flights". The New England Journal of Medicine analysis reviewed 11,920 calls made by five domestic and international airlines to the centre between January 1st, 2008, and October 31st, 2010. Based on that data, the authors estimated an inflight medical emergency occurs somewhere in the world once in every 604 flights, or nearly 50 every day.

Of the cases reviewed the most common symptoms included fainting or light-headedness (37 per cent), respiratory issues (12 per cent), and nausea or vomiting (9.5 per cent).

A statistic that caught my eye was the finding that in three out of four of the calls handled by the Pittsburgh centre, a health professional was on board the aircraft. And 50 per cent of the time that health professional was a doctor. Just over 7 per cent of flights had to divert and land prematurely because of the medical emergency.

I reckon that one of the most stressful aspects of an inflight medical emergency for a health professional is being asked by the flight crew whether they need to divert the plane or whether it is safe to continue to the original destination. Not alone are you responsible for the life of the sick passenger, but your decision will cost the airline a lot of money and possibly strand hundreds of your fellow passengers in some out-of-the-way corner of the world. So while it might make for an entertaining read, with a bit of luck I won’t be regaling you with tales of medical derring-do at 35,000ft in a future column.

mhouston@irishtimes.com muirishouston.com