AAPA: Providing Emergency Medicine in the Air

PHILADELPHIA, June 5 -- An average of 15 in-flight medical emergencies happen on domestic flights every day in the United States, according to estimates from the Federal Aviation Administration (FAA).

So said Jeff W. Hinshaw, P.A.-C., of Wake Forest University School of Medicine in Winston-Salem, N.C.

These in-flight emergencies result in about 75 fatalities per year, 80% of which result from cardiac events, Hinshaw told attendees at the American Academy of Physician Assistants meeting here.

The good news for medical providers who might be called on to treat these patients is that every plane is required to carry an emergency medical kit that includes an automated external defibrillator, Hinshaw said.

The on-board emergency medical kit should contain the following FAA-mandated devices and medications:

Medical Devices:

• FDA-approved automated external defibrillator
• Mask for cardiopulmonary resuscitation
• Bag-valve device
• Bronchodilator inhaler
• Intravenous infusion kit
• Syringes and needles
• Oropharyngeal airway devices of varying sizes
• Sphygmomanometer
• Stethoscope
• Gloves

Medications:

• Saline
• Nitroglycerine
• Diphenhydramine
• Dextrose (injectible)
• Epinephrine
• Aspirin
• Lidocaine

Vasovagal and cardiac events are the most common types of in-fight medical emergencies, Hinshaw said. The reason, he explained, is that as airplanes climb to high cruising altitudes, atmospheric pressure and inspired oxygen levels fall, even within the pressurized cabin.

Healthy passengers can handle the resulting mild hypoxia well, but those with underlying cardiovascular or pulmonary disease may do poorly in such an environment, he said.

Health professionals who provide emergency medical assistance do have legal protection, Hinshaw noted. They can't be held liable for any acts or omissions while giving such assistance, unless they are guilty of gross negligence or willful misconduct, he said, quoting the Aviation Medical Assistance Act of 1998.

Doctors help during about 40% of in-flight medical emergencies. Nurses provide the emergency medical assistance 25% of the time, and 22% of the time it's a volunteer with no certification but perhaps some training or experience, such as a firefighter, Hinshaw said.

A certified EMT or paramedic is the medical provider in 6% of in-flight emergencies, and the remaining 7% of the time it is simply recorded as "other" or not reported, he said.

It's important to remember, Hinshaw cautioned, that the flight crew may be better trained in the use of the automated external defibrillators than health professionals. Evidence indicates that in emergencies where these devices are used, the survival rate ranges from 27% to 40%, he added.

Overall, Hinshaw advised, medical personnel should try to assist the captain and flight crew rather than trying to take control.