Transcript

Lee Tetreault:

Hello and welcome to Frequently Asked Questions from the session 'Is there a Doctor on Board? Medical Emergencies on Commercial Flights.' We are joined today by Dr. Theodore Macnow. Doctor, before we begin, can you provide a few key pointers for our audience from today's session? 

Dr. Macnow:  

Well, thank you for having me. I'd like to remind all the listeners that there's actually a good chance that you'll be asked to serve in an in-flight medical emergency. Fifty percent of surveyed physicians have responded to a medical emergency on an airplane before. No matter our discipline or our anxiety levels, doctors and other health care professionals have a lot to offer in these situations, and research confirms that our volunteer assistance improves patient conditions. Helping mid-air passengers fulfills one of the purest expressions of our Hippocratic Oath, and you should feel comfortable that no physician has ever been sued for rendering care aboard an aircraft.

The equipment available on board an airplane is variable, but it can be extensive. Every flight has an emergency medical kit that contains most life-saving drugs, though it's variable, and has some limitations. I'd note that there's a lot of limitations in this kit for pediatric patients and also, it may not have naloxone. However, a lot of us are now carrying it around these days or other passengers may have it. If there's a drug or equipment you want that is not available in the kit, please ask other passengers. Airplanes all contain oxygen and have AEDs on board, and other passengers and the flight crew also have skills that can be helpful in these situations. The entire flight crew is trained in first aid and AED usage.

When faced with a medical emergency, consider early whether diverting the plane or flying at a lower altitude may improve the patient's oxygenation and help the patient's condition. Ultimately, you may be asked your opinion on the patient's medical condition, but the pilot will be the one making the decision about diversion because sometimes landing early actually would put you farther away from a hospital that could handle the patient's medical situation.

The most common mid-air emergency is vasovagal syncope, which represents 90% of the medical problems in otherwise healthy passengers. Cardiac events represent 10% to 15% of medical emergencies, but are the leading cause of death and are responsible for a third of the aircraft diversions. If you're faced with a medical emergency, remember you're not alone up there. A lot of airlines partner with ground-based physician support companies who are emergency doctors with specific training in air transport medicine. Also remember that other passengers and the flight crew have skills and drugs that can be helpful.

Lee Tetreault:

What should I carry onto an airplane to be prepared? 

Dr. Macnow:  

Fortunately, in Massachusetts, we have a wallet medical license that I always carry on board. You can't tell from the radio, but I look young, and I think that having identification that properly identifies me as a doctor puts everyone at ease. I also always carry my code cards. I'm very familiar with PAL, so I carry ALS and BLS code cards so I can remember these algorithms and dosages in a pinch. I also carry my stethoscope, more to ward off evil spirits, but also because the stethoscope on the plane often isn't that good, and it can be very difficult to hear up on an airplane.

Lee Tetreault:

Can I be sued for trying to help in a mid-air emergency? 

Dr. Macnow:  

The short answer is no. All health care professionals, including NPs, PAs are protected against malpractice by the Aviation Assistance Act of 1998. This act specifies that, if a volunteer healthcare professional is acting in good faith, for no monetary compensation from the passenger and act to the best of their ability within their training, they're protected. No physician in the US has ever been sued successfully for rendering care aboard an aircraft.

Lee Tetreault:

Can nurse practitioners or physician assistants volunteer themselves? 

Dr. Macnow:  

They sure can. The FAA regulations for the emergency medical kit specify that it can only be opened by a trained medical professional, and it's generally interpreted that this includes NPs and PAs. Remember also that a lot of airlines partner with ground-based physician support companies, so often, there is some degree of medical control from the ground. I've heard a lot of stories of NPs and PAs offering assistance in these situations.

Lee Tetreault:

What are some contraindications for flying? 

Dr. Macnow:  

The list is long and it's patient-specific. The Aerospace Medical Association has made some recommendations about who shouldn't fly. It includes people with unstable angina, those who have had a recent myocardial infarction or CVA, those with contagious diseases or those who have had a recent pneumothorax. Interestingly, people who have been scuba diving, need to have a 24-hour interval at sea level so that they don't suffer decompression sickness when they go up in mid-air. For pediatrics, I generally don't recommend flying in the first two months of life due to the risk of contracting an illness. However, the Aerospace Medical Association only recommends not flying for the first week of life. I think it's a personal decision as far as how important that trip is when flying with the baby.

Lee Tetreault:

How can I prepare my patients to fly safely? 

Dr. Macnow:  

Everyone should carry necessary equipment and medications on board. Even diabetes meds, like insulin syringes, and the lancets to use in a glucometer are allowed to be carried on board provided that there's correct pharmacy labeling and a doctor's note. I advise everyone to hydrate well for the flight and to also walk around periodically to avoid vasovagal syncope and help prevent a DVT. Generally, patients with baseline oxygen levels of less than 70 millimeters of mercury or those who can't walk up a flight of stairs will generally require oxygen to fly safely. This needs to be arranged way ahead of time with the airline and sometimes it's an extra cost.

Lee Tetreault:

Do you say that you're a doctor, when you book the ticket? 

Dr. Macnow:  

I don't think it matters what you say on the ticket when you're paged publicly overhead, but I generally do say I'm a doctor when I register for the ticket, I would readily volunteer myself, no matter what. And I have heard of doctors getting upgrades, interestingly, when they present themselves pre-flight as volunteers.

Lee Tetreault:

And lastly, Doctor, why is Narcan not part of the emergency medical kit?

Dr. Macnow:  

That's a great question. The opioid epidemic is a scourge and there have been many incidents of overdoses aboard aircrafts. I hope that the FAA will mandate it soon. It did take eight years to have protective gloves in the emergency medical kit, so hopefully it won't take that long for us to get Narcan. Fortunately, a lot of physicians are carrying it with them these days, as recommended by the Surgeon General. If you think Narcan may be helpful in a situation, ask, 'cause there's a good chance someone on the plane has it.

Lee Tetreault:

This is great information, Doctor. Thank you so much for your time today.

 

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