Commercial in-flight medical emergencies - Revision history

ClaireLewis at 17:23, 28 September 2019

2019-09-28T17:23:55Z

← Older revision		Revision as of 17:23, 28 September 2019
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	===Epidemiology<ref name="peterson"/>===		===Epidemiology<ref name="peterson"/>===
	*Syncope or presyncope (37.4%)		*[[Syncope]] or presyncope (37.4%)
	*Respiratory symptoms (12.1%)		*[[SOB\|Respiratory symptoms]] (12.1%)
	*Nausea or vomiting (9.5%)		*[[nausea/vomiting\|Nausea or vomiting]] (9.5%)
	*Cardiac symptoms (7.7%)		*[[chest pain\|Cardiac symptoms]] (7.7%)
	*Seizures (5.8%)		*[[Seizures]] (5.8%)
	*Abdominal pain (4.1%)		*[[Abdominal pain]] (4.1%)
	*Infectious disease (2.8%)		*[[infection\|Infectious disease]] (2.8%)
	*Agitation or psychiatric symptoms (2.4%)		*[[Agitation]] or psychiatric symptoms (2.4%)
	*Allergic reaction (2.2%)		*[[Allergic reaction]] (2.2%)
	*Possible stroke (2.0%)		*Possible [[stroke]] (2.0%)
	*Trauma, not otherwise specified (1.8%)		*[[Trauma]], not otherwise specified (1.8%)
	*Diabetic complication (1.6%)		*[[DM\|Diabetic complication]] (1.6%)
	*Headache (1.0%)		*[[Headache]] (1.0%)
	*Arm or leg pain or injury (1.0%)		*Arm or leg pain or injury (1.0%)
	*Obstetrical or gynecologic symptoms(0.5%)		*Obstetrical or gynecologic symptoms(0.5%)
	*Ear pain (0.4%)		*[[earache\|Ear pain]] (0.4%)
	*Cardiac arrest (0.3%)		*[[Cardiac arrest]] (0.3%)
	*Laceration (0.3%)		*[[Laceration]] (0.3%)

	==Emergency Medical Kit==		==Emergency Medical Kit==
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	*Goal is to keep patient stable until the flight lands<ref name="Gendreau" />		*Goal is to keep patient stable until the flight lands<ref name="Gendreau" />
	*Management should be based on your assessment and evidence-based best practices, but within the confines of the resources available on board		*Management should be based on your assessment and evidence-based best practices, but within the confines of the resources available on board
	**e.g. angina/chest pain may be given aspirin (± NTG), hypoglycemic episodes may be given PO or IV dextrose, vasovagal syncope may be given PO fluids or placed in leg-elevated position, etc.		**e.g. angina/chest pain may be given [[aspirin]] (± [[nitroglycerin\|NTG]]), hypoglycemic episodes may be given PO or IV [[dextrose]], vasovagal syncope may be given PO fluids or placed in leg-elevated position, etc.
	*Be aware of available options		*Be aware of available options
	**Emergency medical kit, oxygen, and AED		**Emergency medical kit, oxygen, and AED

Mholtz at 22:38, 31 December 2016

2016-12-31T22:38:26Z

← Older revision		Revision as of 22:38, 31 December 2016
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	==Background==		==Background==
	*Incidence of in-flight emergencies: 1 per 604 flights<ref name="peterson">Peterson DC, et al. "Outcomes of Medical Emergencies on Commercial Airline Flights" N Engl J Med 2013;368:2075-83. DOI: 10.1056/NEJMoa1212052</ref> (0.3% of cases died)		*Incidence of in-flight emergencies: 1 per 604 flights<ref name="peterson">Peterson DC, et al. "Outcomes of Medical Emergencies on Commercial Airline Flights" N Engl J Med 2013;368:2075-83. DOI: 10.1056/NEJMoa1212052</ref> (0.3% of cases died)
	**For ~~references~~, there are ~29,000 commercial flights per day in the US alone<ref>NOAA. Air Traffic. http://sos.noaa.gov/Datasets/dataset.php?id=44 Accessed 03/08/2016</ref>		**For reference, there are ~29,000 commercial flights per day in the US alone<ref>NOAA. Air Traffic. http://sos.noaa.gov/Datasets/dataset.php?id=44 Accessed 03/08/2016</ref>
	*As the population ages and people travel longer distances, this number is likely to increase<ref>Goodwin T. In-flight medical emergencies: an overview. BMJ : British Medical Journal. 2000;321(7272):1338-1341.</ref>		*As the population ages and people travel longer distances, this number is likely to increase<ref>Goodwin T. In-flight medical emergencies: an overview. BMJ : British Medical Journal. 2000;321(7272):1338-1341.</ref>

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	===United States===		===United States===
	*The Aviation Medical Assistance Act (AMAA) of 1998 provides liability coverage for "medically qualified individuals" who provide medical care aboard an aircraft and imposes a standard of "gross negligence or willful misconduct"		*The Aviation Medical Assistance Act (AMAA) of 1998 provides liability coverage for "medically qualified individuals" who provide medical care aboard an aircraft and imposes a standard of "gross negligence or willful misconduct"
	**Covers a wide range of medically trained passengers, including physicians, nurses, PAs, EMTs, etc.		**Covers a wide range of medically trained passengers, including physicians, nurses, PAs, paramedics, EMTs, etc.
	**Provider is not prohibited from accepting compensation in order to receive liability protection under the AMAA<ref name="Nable"/>		**Provider is not prohibited from accepting compensation in order to receive liability protection under the AMAA<ref name="Nable"/>
	<center>________</center>		<center>________</center>
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	==See Also==		==See Also==
	*[[High ~~Altitude Medicine~~]]		*[[High altitude medicine]]

	==References==		==References==
	<references/>		<references/>

			[[Category:EMS]]
	[[Category:Environmental]]		[[Category:Environmental]]

Ostermayer: Text replacement - "Category:Environ" to "Category:Environmental"

2016-03-22T14:47:28Z

Text replacement - "Category:Environ" to "Category:Environmental"

← Older revision		Revision as of 14:47, 22 March 2016
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	<references/>		<references/>

	[[Category:~~Environ~~]]		[[Category:Environmental]]

Mholtz at 22:38, 11 March 2016

2016-03-11T22:38:19Z

← Older revision		Revision as of 22:38, 11 March 2016
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	==Management==		==Management==
	===General Approach===		===General Approach===
			*Flight crew is responsible for responding to medical emergencies in flight - your role is to offer assistance, not to take control<ref name="Gendreau">Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med. 2002 Apr 4;346(14):1067-73.</ref>
	*Identify yourself and level of medical training to the crew		*Identify yourself and level of medical training to the crew
	*Ask a flight attendant to obtain the emergency medical kit (EMK)		*Ask a flight attendant to obtain the emergency medical kit (EMK)

	===Patient ~~assessment~~===		===Patient Assessment===
	*Identify chief complaint and HPI		*Identify chief complaint and perform HPI and appropriate focused physical exam
	*Obtain vital signs ~~(pulse and blood pressure)~~		*Obtain vital signs - emergency medical kit will have sphygomomanometer
	**~~If you are unable to assess blood pressure~~ by ~~means of~~ auscultation~~, assess it by palpating the radial pulse~~		**Measuring BP by palpation may be easier than auscultation in flight
	*Assess mental status and perform a focused physical exam based on chief complaint		*If the patient is unresponsive or in cardiac arrest, obtain and apply an automated external defibrillator (AED)
	*If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)
	**For patients with a pulse but a suspected cardiac problem, consider applying AED pads to use as a cardiac monitor and rhythm strip (if AED has display screen)

	===Management ~~of Syncope or Presyncope~~===		===Management Options===
	*~~Confirm breathing and pulse~~		*Goal is to keep patient stable until the flight lands<ref name="Gendreau" />
	*Move the patient to ~~an aisle or galley, place the~~ patient ~~in a supine position with legs raised, and provide oxygen~~		*Management should be based on your assessment and evidence-based best practices, but within the confines of the resources available on board
	*Check vital signs		**e.g. angina/chest pain may be given aspirin (± NTG), hypoglycemic episodes may be given PO or IV dextrose, vasovagal syncope may be given PO fluids or placed in leg-elevated position, etc.
	**Most patients will be hypotensive immediately after the ~~episode~~		*Be aware of available options
	*~~If the patient has diabetes, a glucometer from the patient or a fellow passenger may~~ be ~~used for glucose~~ assessment.		**Emergency medical kit, oxygen, and AED
	*Most patients will recover spontaneously within ~~minutes. Give oral fluids when possible~~		**May ask crew to lower altitude of plane (increases cabin pressure)<ref name="Gendreau" />
	*Consider intravenous fluids only if the ~~patient is persistently hypotensive and cannot take oral fluids or has another indication.~~		**May request to speak with ground-based physician consult service
			**May request diversion of flight to closer airport (ultimate decision rests with captain)
	~~===Management~~ of ~~Chest Pain or Palpitations===~~
	*~~Check vital signs~~
	*~~Provide oxygen~~
	*If chest pain may be ~~cardiac~~ in ~~origin~~, ~~administe aspirin~~
	*~~If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes~~
	**~~Check blood pressure after each dose~~
	*~~If the AED has monitoring capabilities, consider its use~~ to ~~evaluate the cardiac rhythm and evidence~~ of ~~ST-segment changes in the limb leads~~
	*~~If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions~~

	~~===Aftercare===~~
	*~~Initiate consultation~~ with ~~the~~ ground-based ~~consultant if not already initiated by the flight crew~~
	*~~Consider discussing administration of medications or intravenous fluids with ground-based consultant~~
	*~~Aircraft~~ diversion~~, ground-based medical assistance, or both should be coordinated with ground-based consultation~~
	*Document the clinical presentation and care rendered and give documentation to ~~medical personnel on arrival at the destination~~ with ~~transfer of care~~

	==Medicolegal Issues==		==Medicolegal Issues==

Mholtz at 08:12, 9 March 2016

2016-03-09T08:12:45Z

← Older revision		Revision as of 08:12, 9 March 2016
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	==Background==		==Background==
	*1 per 604 flights<ref name="peterson">Peterson DC, et al. "Outcomes of Medical Emergencies on Commercial Airline Flights" N Engl J Med 2013;368:2075-83. DOI: 10.1056/NEJMoa1212052</ref>		*Incidence of in-flight emergencies: 1 per 604 flights<ref name="peterson">Peterson DC, et al. "Outcomes of Medical Emergencies on Commercial Airline Flights" N Engl J Med 2013;368:2075-83. DOI: 10.1056/NEJMoa1212052</ref> (0.3% of cases died)
	**0.3% of cases died		**For references, there are ~29,000 commercial flights per day in the US alone<ref>NOAA. Air Traffic. http://sos.noaa.gov/Datasets/dataset.php?id=44 Accessed 03/08/2016</ref>
			*As the population ages and people travel longer distances, this number is likely to increase<ref>Goodwin T. In-flight medical emergencies: an overview. BMJ : British Medical Journal. 2000;321(7272):1338-1341.</ref>

	===Epidemiology<ref name="peterson"></~~ref~~>===		===Epidemiology<ref name="peterson"/>===
	*~~syncope~~ or presyncope (37.4%)		*Syncope or presyncope (37.4%)
	*~~respiratory~~ symptoms (12.1%)		*Respiratory symptoms (12.1%)
	*~~nausea~~ or vomiting (9.5%)		*Nausea or vomiting (9.5%)
	*Cardiac symptoms (7.7%)		*Cardiac symptoms (7.7%)
	*Seizures (5.8%)		*Seizures (5.8%)
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	*Arm or leg pain or injury (1.0%)		*Arm or leg pain or injury (1.0%)
	*Obstetrical or gynecologic symptoms(0.5%)		*Obstetrical or gynecologic symptoms(0.5%)
	Ear pain (0.4%)		*Ear pain (0.4%)
	*Cardiac arrest (0.3%)		*Cardiac arrest (0.3%)
	*Laceration (0.3%)		*Laceration (0.3%)

	==Emergency ~~Medicine~~ Kit==		==Emergency Medical Kit==
			*The FAA requires all aircraft with >30 passengers to carry an Emergency Medical Kit and an AED<ref name="Bukowski">Bukowski JH, Richards JR. Commercial Airline In-Flight Emergency: Medical Student Response and Review of Medicolegal Issues. J Emerg Med. 2016 Jan;50(1):74-8.</ref>
			**This requirement is the "minimum acceptable", but some airlines carry more extensive kits

	{{EMK}}		{{EMK}}

	==Management==		==Management==
	===General Approach===		===General Approach===
	*Identify yourself and level of medical training		*Identify yourself and level of medical training to the crew
	*Ask a flight attendant to obtain the emergency medical kit (EMK) ~~and administer oxygen as needed~~		*Ask a flight attendant to obtain the emergency medical kit (EMK)
	====Patient assessment====
	#Identify chief complaint and HPI		===Patient assessment===
	#Obtain vital signs (pulse and blood pressure)		*Identify chief complaint and HPI
	#If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse		*Obtain vital signs (pulse and blood pressure)
	#*Assess mental status and ~~any focal neurologic deficits~~		**If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse
	#If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)		*Assess mental status and perform a focused physical exam based on chief complaint
	#*For patients with a pulse but a suspected cardiac problem, consider ~~using an~~ AED if it has ~~monitoring capabilities~~		*If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED)
	~~#*The airline may require contact with a ground-based consultant before use~~		**For patients with a pulse but a suspected cardiac problem, consider applying AED pads to use as a cardiac monitor and rhythm strip (if AED has display screen)

	===Management of Syncope or Presyncope===		===Management of Syncope or Presyncope===
	#Confirm breathing and pulse		*Confirm breathing and pulse
	#Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen		*Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen
	#Check vital signs		*Check vital signs
	#*Most patients will be hypotensive immediately after the episode		**Most patients will be hypotensive immediately after the episode
	#If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment.		*If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment.
	#Most patients will recover spontaneously within minutes. Give oral fluids when possible		*Most patients will recover spontaneously within minutes. Give oral fluids when possible
	#Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication.		*Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication.

	===Management of Chest Pain or Palpitations===		===Management of Chest Pain or Palpitations===
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	===Aftercare===		===Aftercare===
	#Initiate consultation with the ground-based consultant if not already initiated by the flight crew		*Initiate consultation with the ground-based consultant if not already initiated by the flight crew
	#Consider discussing administration of medications or intravenous fluids with ground-based consultant		*Consider discussing administration of medications or intravenous fluids with ground-based consultant
	#Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation		*Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation
	#Document the clinical presentation and care rendered and give documentation to medical personnel on arrival at the destination with transfer of care		*Document the clinical presentation and care rendered and give documentation to medical personnel on arrival at the destination with transfer of care

	==~~=United States Liability~~===		==Medicolegal Issues==
	~~{{quote\|text~~="~~An individual shall not be liable~~ for ~~damages in any action brought in~~ a ~~Federal or State court arising out of the acts or omissions of the individual in providing or attempting~~ to ~~provide assistance in the case of~~ an in-flight ~~medical~~ emergency ~~unless~~ the ~~individual~~, ~~while rendering such assistance~~, ~~is guilty~~ of ~~gross negligence or willful misconduct."\|sign=Air Carrier Access Act of 1998\|source=Public Law 105–170—April. 24, 1998[http://www.medaire.com/docs/default~~-~~document-library/aviation-medical-assistance-act~~-of~~-1998-.pdf?sfvrsn~~=~~0 .pdf]}}~~		*Responding to a request for assistance creates a "doctor-patient" relationship<ref name="Nable">Nable JV, Tupe CL, Gehle BD, Brady WJ. In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45.</ref>
			*Duty to respond<ref name="Bukowski"/>
			**There is no legal duty for a physician to respond to an in-flight emergency in the USA, Canada, and the UK (in the absence of a pre-existing doctor-patient relationship)
			**In Australia and many European countries, there is a legal duty to respond
			*Legal jurisdiction is usually determined by the country in which the aircraft is registered, but the location of the incident may apply as well<ref name="Nable"/>

	==~~Source~~==		===United States===
	<~~references~~/>		*The Aviation Medical Assistance Act (AMAA) of 1998 provides liability coverage for "medically qualified individuals" who provide medical care aboard an aircraft and imposes a standard of "gross negligence or willful misconduct"
			**Covers a wide range of medically trained passengers, including physicians, nurses, PAs, EMTs, etc.
			**Provider is not prohibited from accepting compensation in order to receive liability protection under the AMAA<ref name="Nable"/>
			<center>________</center>
			{{quote\|text="An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."\|sign=Aviation Medical Assistance Act of 1998\|source=Public Law 105–170—April. 24, 1998[http://www.medaire.com/docs/default-document-library/aviation-medical-assistance-act-of-1998-.pdf?sfvrsn=0 .pdf]}}

	==See Also==		==See Also==
	[[High Altitude Medicine]]		*[[High Altitude Medicine]]

			==References==
			<references/>

	[[Category:Environ]]		[[Category:Environ]]

Rossdonaldson1: Rossdonaldson1 moved page Commercial In-Flight Medical Emergencies to Commercial in-flight medical emergencies

2015-05-13T23:28:12Z

Rossdonaldson1 moved page Commercial In-Flight Medical Emergencies to Commercial in-flight medical emergencies

← Older revision	Revision as of 23:28, 13 May 2015
(No difference)

Ostermayer: numbering

2014-05-02T04:53:38Z

numbering

← Older revision		Revision as of 04:53, 2 May 2014
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	===Management of Syncope or Presyncope===		===Management of Syncope or Presyncope===
	*Confirm breathing and pulse		#Confirm breathing and pulse
	*Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen		#Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen
	*Check vital signs		#Check vital signs
	**Most patients will be hypotensive immediately after the episode		#*Most patients will be hypotensive immediately after the episode
	*If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment~~. Some in flight kits have a glucometer~~.		#If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment.
	*Most patients will recover spontaneously within minutes. Give oral fluids when possible		#Most patients will recover spontaneously within minutes. Give oral fluids when possible
	*Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication		#Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids or has another indication.

	===Management of Chest Pain or Palpitations===		===Management of Chest Pain or Palpitations===

Ostermayer: /* General Approach */

2014-05-02T04:50:39Z

General Approach

← Older revision		Revision as of 04:50, 2 May 2014
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	===General Approach===		===General Approach===
	*Identify yourself and level of medical training		*Identify yourself and level of medical training
	*Ask a flight attendant to obtain the emergency medical kit (~~[[Commercial Airline Emergency Medicine Kit~~ EMK) and administer oxygen as needed		*Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed
	====Patient assessment====		====Patient assessment====
	#Identify chief complaint and HPI		#Identify chief complaint and HPI

Ostermayer: /* United States Liability */

2014-05-02T04:22:25Z

United States Liability

← Older revision		Revision as of 04:22, 2 May 2014
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	===United States Liability===		===United States Liability===
	{{quote\|text=An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.\|sign=Air Carrier Access Act of 1998\|source=Public Law 105–170—April. 24, 1998[http://www.medaire.com/docs/default-document-library/aviation-medical-assistance-act-of-1998-.pdf?sfvrsn=0 .pdf]}}		{{quote\|text="An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."\|sign=Air Carrier Access Act of 1998\|source=Public Law 105–170—April. 24, 1998[http://www.medaire.com/docs/default-document-library/aviation-medical-assistance-act-of-1998-.pdf?sfvrsn=0 .pdf]}}

	==Source==		==Source==

Ostermayer at 04:21, 2 May 2014

2014-05-02T04:21:49Z

@@ Line 38: / Line 38: @@
 #*For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities
 #*The airline may require contact with a ground-based consultant before use
 ===Management of Syncope or Presyncope===
@@ Line 62: / Line 56: @@
 *If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads
 *If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions
 ==Source==