In-flight medical emergencies: "Is there a doctor on board?"

Abstract

Almost four billion passengers travel aboard commercial airliners every year. Last year In-flight medical emergencies (IMEs) were relatively common and occurred in a complex environment with limited medical resources. More recent data shows that IMEs occur in one passenger for every 604 flights or 24-130 IMEs for every one million passengers, more often in people over 70 years old. Due to the drop in barometric pressure, there are specific conditions in the aircraft passenger cabin that can affect the occurrence of IMEs. Most importantly it is hypobaric hypoxia, which can lead to the development of hypoxia-related symptoms in chronic patients with respiratory, cardiovascular, and hematological diseases. With reduced barometric pressure gases in body cavities and medical equipment can expand by 30%, this can lead to IMEs in recently operated patients (wound dehiscence, bleeding), middle ear and sinus diseases, subocclusions, and lung problems (pulmonary bulla). Other factors that contribute to the occurrence of IMEs are limited movement (deep vein thrombosis), dry and cold air (dehydration), jet lag, turbulence, and psychological stress. IMEs most commonly involve syncope or near-syncope (32.7%), gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Because of ethical, and in some countries also legal responsibilities, doctor-passengers are a great help in the treatment of IMEs. Emergency landing of the aircraft when an IME occurs happens in an estimated 4.4% of cases. Knowing the influence of the specific ambient conditions in the plane on physiological processes in the body is of great importance for determining the absolute and relative contraindications for flying by plane. Doctor-passengers have an important role in the treatment of IMEs. This work aims to introduce us to the specific ambient conditions in the aircraft cabin and their influence on the physiology of the human body, the most common IMEs that occur under the influence of those conditions, the role of the doctorpassenger as well as the absolute and relative contraindications for flying by plane.