Is there a doctor on board?

You’ve reached cruising altitude, when suddenly, a flight attendant asks if there’s a doctor on board. It’s happening more and more. An article just published in the Canadian Medical Association Journal has the rundown on what and who is available in the cabin.

study by a company that provides medical advice to five North American airlines puts the incidence at one medical emergency for every 604 scheduled flights. That works out to 16 emergencies for every million passengers. Another study that looked at records from a single airline over a two-year period found 1,312 incidents among 10.1 million passengers for a much higher incidence of one per 7,700.

The most common by far is fainting or near-fainting at 37 per cent. Next is wheezing or shortness of breath at 12.1 per cent, followed by nausea or vomiting at 9.5 per cent, chest pain or palpitations at 7.7 per cent, and seizures at 5.8 per cent. There are stories of attending births and treating punctured lungs, but these are exceptions.

The ranking of most common emergencies during commercial flights tracks with my limited experience. I’ve answered the call for a doctor on three occasions. One was for a guy who was having an anxiety attack. I calmed him down and taught him breathing exercises. The second was for a man who had a witnessed seizure lasting around a minute. He had a MedicAlert bracelet that confirmed that he had epilepsy. When he regained consciousness, he said that he’d been up most of the night prior to the flight, which increases the risk of a seizure.

The third time, I saw someone who had fainted. By the time I reached her seat, she was starting to awaken. Her pulse was very slow, and she was pale and sweaty. Those signs told me she had vasovagal syncope, a kind of fainting spell often triggered by pain or a wave of nausea, and in places where the air is stuffy such as a subway car that is stuck. It looks scary to bystanders, but it is not life threatening. She did not have any of the typical symptoms of a heart attack such as chest pain. I stayed with her for the remainder of the flight.  She was met by paramedics on the jetway, and got checked out at a local ER.

There are several reasons why these episodes are on the rise. The biggest is that more people than ever are flying. In 2015, there were just over 133 million air passengers in Canada, an increase of 27 per cent in just six years. Assuming the rate of emergencies stays constant, an increase in the number of passengers means an increase in emergencies. In addition, there are more older passengers. Often, they have pre-existing medical conditions that can get aggravated during a flight. Although aircraft cabins are pressurized, the air pressure at cruising altitude is lower than at sea level. That means less oxygen in the blood stream. This is well tolerated by healthy passengers, but less so in those with heart and lung diseases. Cabins have less humidity, which makes passengers prone to dehydration. That makes people on blood pressure pills more prone to low blood pressure and fainting.

Transport Canada requires that any aircraft with 100 seats or more carry a medical kit in addition to the standard first aid kit. The Air Canada and Westjet medical kits carry atropine, which can raise the heart rate, and furosemide, a diuretic used to treat heart failure. Diazepam can stop a seizure and relieve anxiety. Haloperidol can sedate a violent patient. Epinephrine and methylprednisolone are both used to treat anaplylaxis as well as asthma. The kits carry a stethoscope and blood pressure cuff, pulse oxymeter to measure oxygen levels, oxygen tanks and an external defibrillator. Physicians respond to nearly half of in-flight emergencies, followed by nurses and paramedics. Many in-flight emergencies are managed by flight attendants alone. They have first aid training, know CPR, and can operate the defibrillator. Both Air Canada and Westjet hire ground-based agencies that provide medical advice.

The big question is whether to divert the flight to the nearest airport, which happens in 7.3 per cent of in-flight emergencies. The pilot makes that decision, not the doctor.

Passengers need to prepare themselves better for in-flight emergencies. The most predictable ones happen to people with pre-existing medical conditions. Anyone with heart disease, a history of deep venous thrombosis or pulmonary embolism, chronic lung disease, seizures, and recent stroke may want to check with their doctor before flying. Take all of your essential medicines with you in the cabin.

Travelers who need oxygen must arrange their own supplies on the ground, at departure, on arrival, and during layovers.  Passengers who need oxygen during the flight can bring their own approved Personal Oxygen Concentrator (POC) on board along with enough battery power for 1.5 times your total travel time.  Or, they can rent the supplemental oxygen system provided by the airline. You need to give the airline 48 hours’ notice, and you need to obtain medical approval to travel.

It’s reassuring to know that commercial airlines are putting more and more thought into meeting in-flight emergencies.
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