Aeromedical Forum:

James D Lakin, PhD, MD, FACP

CFI, CFII, MEI

Airline Transport Pilot

FAA Senior Aviation Medical Examiner

We’ve all seen the aviation movies where the B 707 is over the mid-Pacific and a passenger needs an emergency heart transplant. Up pops a recovering alcoholic thoracic surgeon who just happens to be carrying a spare organ. He deftly does the deed with a butter knife and a bottle of brandy for anesthesia. They then fly happily off into the sunset.

Well perhaps I got the plot line a bit twisted but many of us do wonder what we would do if confronted with an in-flight medical emergency. If you’re flying GA in the Midwest the answer is pretty simple: land at the nearest airport and call 911. That’s assuming you as PIC are not the medical emergency in question.

If so let’s hope that somebody’s in right seat that knows how to land the airplane or at least pull the CAPS handle. If you are flying under 14 CFR Part 121, 135 or subpart K part 91 (fractional ownership) things get a little more complicated. Diversion is neither as simple nor as practical as in your Cessna C 172.

Indeed if you are on a trans-oceanic flight, options may be quite limited. Fortunately medical emergencies are infrequent. Commercial airliners serve approximately 2.75 billion passengers worldwide each year. A recently published study reported that about 16 medical emergencies occur per 1 million passengers. This boils down to 1 in-flight emergency per 604 flights. The most common problems were fainting or near-fainting (34 percent), trouble breathing (12 percent) and nausea or vomiting (10 percent). In 7 percent of instances the problem was considered severe enough to warrant diverting the flight.

Roughly one third of sick passengers problems resolved in flight. One third was met by an EMS crew at the aircraft after landing and felt to be OK for release and follow-up by their private physician. The other third were carted off to the emergency room.

Of the 10,914 in-flight emergencies in the New England Journal of Medicine study, 36 deaths occurred, 30 happening in flight.

Bottom-line: medical emergencies in flight are not common but by no means rare. Two-thirds of them can be managed by fairly simple measures. For those of you who are health care providers—physicians, pharmacists, mid-level providers, EMTs, nurses—you might be surprised to find that there is a good deal of help available for you if you volunteer to aid a stricken passenger.

An emergency medical kit is required by the FAA for every commercial flight. It contains medications including IV solutions and heart medications usually sufficient to start treatment for serious problems. If you are interested you can Google the relevant AC for details.

Quite often passengers’ symptoms can be managed with the collaboration of flight attendants. These folks have received first aid training and are well versed in the equipment available on board and in operational procedures for the airline. Speaking of Ops, most airlines do have arrangements with specific health-care delivery groups to provide consistently available medical consultation by radio or satellite phone link.

Indeed some Operations Specifications mandate consultation with the docs on the ground before cracking open the medical kit on-board. Quite frequently the flight crew will initiate contact with the consultant before you ask.

Usually the consultants are part of a group of ER docs experienced in this type of emergency. They know the resources available to you and the limitations of the environment in which you are working. They can be a great help in relieving you from having to “wing it” as you go along.

If you have any concerns about medical liability, there is no legal obligation to intervene. However the 1998 Aviation Medical Assistance Act does include a Good Samaritan clause. I’m no lawyer but it appears to protect passengers in general and health care providers in particular who offer medical assistance from “liability, other than liability for gross negligence or willful misconduct.”

So I guess you’ll be OK as long as you don’t use the butter knife and the brandy!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.