Tuesday, January 22, 2013

What Happens If You Become Seriously Ill During a Flight?

Marc Weber Tobias, Contributor 1/22/2013 @ 1:52PM

I am an investigative attorney and physical security specialist.

If you fly on commercial airlines in the United States and have ever wondered what would happen in the event of a medical emergency, especially if the carrier works in conjunction with physicians on the ground, you should feel more reassured after learning what I found from one airline.

I fly about 150,000 miles a year, primarily on Delta Air Lines, and had a chance to visit with a number of senior crewmembers and pilots, and read the relevant sections about in-flight medical emergencies. I learned about what they do when a passenger becomes ill or suffer a heart attack or other life-threatening event while flying.
I wrote an article last year about an oxygen system failure aboard a Delta flight I was on, and briefly touched upon the role of flight attendants during an emergency. After reading the Delta procedures for crewmembers, there is no question that the primary job of a flight attendant is all about safety and helping passengers in a medical crisis. Their other tasks are secondary.

I shared some of the information I learned from Delta Air Lines with Dr. Tom Stys, Director of the Sanford Cardiovascular Institute in Sioux Falls. What I found was actually quite amazing and encouraging for all passengers that fly this airline. Delta’s procedures are similar to those in effect by all other U.S. carriers.

Delta Air Lines, as well as many other carriers, contract with the University of Pittsburgh Medical Center for their STAT-MD program for immediate medical consultation when they have a problem during a flight. UPMC offers the same kind of service to the airline industry as does another major player, MedAire.

These providers insure that medical events are properly analyzed while they are occurring so that passengers have the best chance of survival, should the emergency be life-threatening.
More passengers are flying, which means more medical emergencies onboard that can result in serious ramifications, including death.

It is estimated the almost six million people travel onboard commercial aircraft every day throughout the world. Passengers are living longer, which equates to having a higher likelihood of recurring medical conditions which can manifest themselves during a journey. Longer flights, larger capacity aircraft and more passengers with underlying health issues all contribute to a growing problem for airline companies.

Unexpected, but planned-for medical emergencies include heart attacks, strokes, choking, diabetic reactions, seizures, and other maladies. Real incidents do happen, and more often than you would think, as reported in the New York Times in May, 2011.

Passengers And Medical Problems
Passengers can be classified in three groups in the context of medical events: those that have unknown conditions; predisposed conditions which are triggered as the result of travel; and known conditions which include those passengers that became ill at their destination and are trying to return home, are securing more appropriate or less expensive treatment, or are literally flying home to die.

There is a technical communications problem when Delta or other carriers communicate with the UPMC STAT-MD or other ground-based doctors during an emergency. There is no direct link between a flight attendant or physician onboard in the cabin and the hospital because evidently it is too complicated to tie the intercom system on the aircraft with the internal company radio system or satellite phone onboard so that instructions do not have to be relayed from the flight crew to the one that is treating the passenger. A spokesman for Delta confirmed this issue but said it has not posed any problems for them.

Security concerns in the U.S. prevent direct communications between a doctor onboard and the airline dispatch facility and medical staff because nobody can enter the flight deck to speak directly to the ground. There is also a new security directive that prevents the Captain from leaving the cockpit to assist a patient or flight attendants because of the potential to create a medical emergency as a diversion for hijackers.

The Doctors On The Ground That Can Help You

I interviewed Dr. Paulo Alves, Medical Director of MedAire, about what they do and his extensive experience in the specialty of aeronautical medicine. His company has been in business for twenty five years and is one of the leading providers of remote medical consultation and care for flights, whether the passengers or crew are on the ground or in the air.

They provide an integrated system with airline crews to make sure that everyone is on the same page as to the latest technology, techniques, medical trends and regulations.
The company oversees training, and equipment provisioning to sixty airlines throughout the world. They have a Global Response and Dispatch center in Phoenix that handled 22,000 cases last year, and assisted with 12,000 medical fit-to-fly assessments of passengers at the boarding gate, and 5,000 cases of airline crew members that had medical issues during layovers.

The company works with airlines to help protect passengers and crew in case of two different scenarios: a medical event, or a potentially life-threatening emergency.
The University of Pittsburgh STAT-MD program is similar to MedAire, but was initially designed to serve Western Pennsylvania to support emergency medical services. UPMC has one of the finest emergency medicine curriculums in the country, so it is natural that airlines also utilize their expertise.

Telemedicine And The Airline Industry In The U.S.
According to MedAire the U.S. carriers do not have telemedicine capabilities as yet, while five different carriers in Europe do. Even though many aircraft now have WiFi they don’t use it for medical emergencies, but they all have voice links via satellite phones, company frequencies, or Airinc, which is a national aeronautical radio link for air transport.
Technology really has not caught up with the airline industry. While the FDA just approved a cardiac monitor for use with an iPhone last week, such technology is not available on aircraft even thought it could be.

I confirmed with Delta Air Lines that at present they do not have any remote monitoring capabilities onboard any of their aircraft. Delta and other carriers will implement international Internet access, which means that in the future they may offer enhanced services in order to more effectively communicate with medical personnel on the ground.

Delta Air Lines And Your Care Onboard
Delta carries several different medical kits on board, called Enhanced Emergency Medical Kits (EEMK) and Expanded Medical Kit (XMK). As Dr. Stys explained, there is essentially everything onboard that he has in his emergency room for treating heart patients as far as the basics. There are a number of drugs carried for emergency treatment including Atropine, Diphenhydramine, Dextrose, epinephrine and Lidocaine. Aspirin, Acetaminophen, and Nitroglycerine tablets, as well as inhalants and surgical instrument are available.

Medical equipment includes a variety of needles and syringes, trauma shears, tourniquets, gloves, tape, alcohol, normal saline solutions, I.V. sets and I.V. catheters. Airways, masks and resuscitation equipment are standard, as well as one-way CPR valves and oxygen supplies. Blood pressure monitors and stethoscope are also included in the XMK kit, as are the American Heart Association ACLS (Advanced Cardiac Life Support) book, splints and related equipment.

Flight crews even have protective gowns, face shields and gloves, as well as hazard bags, digital thermometers, and digital glucometers.

There are definite procedures for flight crews to follow on all airlines. If you fly on Delta and you suffer a heart attack, stroke, blood-sugar reaction or other illness, the Flight Attendants are trained and re-certified every year to act instantly.

The critical task for airline crews is to stabilize, rather than treat a passenger that is experiencing medical problems.

There are specific procedures that are detailed for flight crews to treat cardiac arrest, stroke, smoke inhalation, chest pain, and angina.

I wanted to know if the medical equipment, training and procedures for Delta crews would meet medical standards that are recognized by Dr. Tom Stys, the Director of the Sanford Cardiovascular Institute in Sioux Falls. After my discussion with the Director of MedAire I felt that a cardiac emergency was probably the most life-threatening and of concern for most passengers. See my interview with Dr. Stys after we reviewed information I had gathered from Delta Air Lines. He was quite surprised at the level of care that could be afforded for passengers and crew as a result of the medicine and equipment that is standard on all Delta aircraft.

The Last Alternative: Diversion Of Aircraft

While most medical problems onboard are not serious or constitute a life-threatening emergency, some are and diversion of aircraft or death can be the result. In 2010, 442 of the 19,000 cases that MedAire handled resulted in aircraft being diverted from their final destination. Ninety four people died onboard of the cases they managed.

A pilot has the ultimate responsibility to make the decision whether to divert the aircraft to the nearest airport to get a passenger or crewmember proper medical treatment. This must be based upon a sound understanding of the actual medical situation that is occurring and several factors go into this decision. These include alternatives to mitigate the risk to the patient, the time required to get to the destination in comparison with the flight time required to land at the nearest suitable airport, and the condition of the patient.

The decision is even more complex because if a diversion is contemplated there has to be an airport within range that has the proper medical facilities to handle the type of emergency.

MedAire and UPMC both have an extensive data base of medical facilities in proximity to every airport so if their team is consulted they can advise the pilot as to their opinion whether the passenger or crewmember can be stabilized until reaching the planned destination or if it is a life-threatening event that requires immediate action.

According to MedAire and UPMC, the airlines are quite responsive to protecting their passengers, even if a diversion is expensive and very inconvenient for all passengers onboard. When I spoke with corporate-level representatives of Delta they confirmed that their primary concern was for passenger safety and health and that cost was not factored into the equation. They indicated that the procedure for determining when to divert for a medical situation is with primary guidance from UPMC.

With enhanced air-to-ground communication capabilities that include the availability of broadband Internet connection and the introduction of specifically designed aviation medical devices, passengers will benefit from upgraded technology and telemedicine in the future.

For the latest in airline industry information, the updated Air Transport Association website is an excellent reference.

No comments: