1. Retrospective study of medical emergency
calls from a major Asian international airline
Dr Stan Baltsezak, Royal United Hospital, Department of Emergency Medicine, Bath, UK
11th Conference of the International Society of Travel Medicine, Budapest, Hungary, May 24 - 28, 2009
Almost 2 billion people travel by air
each year, and it is likely that every
doctor will have several patients
who fly. Therefore, medical
professionals should be well
equipped with the knowledge of
altitude physiology, fitness to fly, and
potential in-flight medical problems.
There is also a high likelihood of a
medical professional being onboard
the aircraft at the time of emergency.
Therefore, a health-care professional
should be familiar with in-flight
medical events and how to deal with
them.
Few studies, so far, looked at what
medical problems make aircraft crew
call for medical support and use
ground-based medical assistance.
Restricted aircraft environment creates
a challenge to deliver appropriate
medical help
Introduction
Aim
Method
Results Conclusion
References
The aim of the study was to analyse
all medical distress calls from the
airline to the alarm centre.
I present a 12-month retrospective
study of medical distress calls from
a major Asian international airline for
which International SOS provided
in-flight telemedical assistance.
All the calls from the airplane to our
centre were analysed
from January 1, 2006, to January 1,
2007. The number of recommended
diversions, availability of a medical
professional, the range of medical
problems, and used medications
were considered.
1. Six most common causes of
emergency calls were GI
complaints, vasovagal syncope,
chest pain/palpitations,
neurological, respiratory and
musculoskeletal problems.
2. Most of the in-flight problems
were successfully treated
symptomatically with initial
recommendation to lie the patient
down and administer oxygen.
3. Each airline should establish
what medical events are occurring
onboard the unique air carrier and
base the content of the medical kit
on the type of in-flight incidents
4. Pre-flight check-in screening by
airlines and encouraging of future
air travellers with health concerns
to seek medical help before flying
is advised.
Overall, there were 191 in-flight air-
to-ground consultations. Twenty-
three (12.04%) calls were made for
paediatric problems, with the
youngest patient being 9 months old.
More than 50% of the calls were for
gastrointestinal (GI) complaints,
vasovagal syncope, and chest pain/
palpitations symptoms.
A recommendation to divert the
aircraft was made in the following six
(3.1%) cases:
- Chest pain (acute coronary
syndrome, left ventricular failure (2
cases))
- Exacerbation of asthma (not
improving on available therapy)
- Status epilepticus (seizure, reduced
GCS)
- Stroke (reduced GCS)
- Vaginal haemorrhage
(hypovolaemia)
Medical Problems No of
calls
%
Gastrointestinal: diarrhoea
and vomiting, abdominal
68 35.6
Vasovagal syncope 28 14.6
Chest pain/palpitations 18 9.4
Musculoskeletal pain or 16 8.37
Shortness of breath 13 6.8
Fits/Cerebro-vascular 9 4.71
Allergic reaction 7 3.66
Psychiatric (anxiety/
depression)
6 3.14
Dermatological (rash/
swelling/infection)
5 2.61
Fever 5 2.61
Vaginal haemorrhage 3 1.57
Ureteric colic/urinary tract
infection
3 1.57
Epistaxis, barotrauma 3 1.57
Ophtalmological
(conjunctivitis)
2 1.04
Forgotten medication 2 1.04
Side effect from medication 1 0.52
Cardiac arrest 1 0.52
Hypoglycaemia 1 0.52
Table 2. The most often (on two or more
occasion) used medications
Table 1. Categorization of all medical
distress calls.
Chart 1. Availability of the health-care
professional on the aircraft
Symptoms Drugs
Gastrointestinal Metoclopromide
Buscopan
Famotidine
Imodium
Stemetil
Respiratory Salbutamol
Oxygen
Cardiac Aspirin
Glyceryl-trinitrate
Neurological or
pain syndrome
Paracetamol
Diclofenac
Pentazocine
Diazepam
Allergic Adrenaline
Hydrocortisone
Piriton
1. International Air Transport Association
Medical manual, 1st Ed . International Air
Transport Association, 2004 .
2. Aerospace Medical Association Medical
Guidelines Task Force . Medical Guidelines for
Airline Travel ,2nd ed. Aviat Space Environ
Med 2003 ; 74:A1-19.
3. Gendreau M , DeJohn C . Responding to
medical events during commercial airline
flights . N Engl J Med 2002 ; 346 : 1067 – 1073 .
4. Qureshi A , Porter K. Emergencies in the air.
Emerg Med J 2005 ; 22 : 658 – 659 .
5. Dowdall N. “ Is there a doctor on the
aircraft? ” Top 10 inflight medical
emergencies. BMJ 2000 ; 321 : 1336 – 1337 .
6. Donaldson E , Pearn J. First aid in the air .
Aust N Z J Surg 1996 ; 66 : 431 – 434 .
7. Speizer C , Rennie C , Breton H. Prevalence
of inflight emergencies on commercial
airlines. Ann Emerg Med 1989 ; 18 : 26 – 29 .
1%3%
14%
46%
35%
No med. professional
Doctor
Nurse
Paramedic
Pharmacist
Med. Student
Dentist
