Inflight emergencies

From Ganfyd

Jump to: navigation, search
Types of inflight medical emergencies

Medical or surgical inflight emergencies have an incidence of 1 per 10 to 40,000 passengers (more accurately 15 per billion revenue passenger kilometres per year) and in order of frequency are[1]:

  1. Syncope (53.5%)
  2. Gastrointestinal disorders (8.9%)
  3. Cardiac conditions (4.9%)
  4. Thrombosis (0.5%)
  5. Appendicitis (0.25%).

Contents

Outcome

  • Death in 0.5%.(one death occurring per 0.3-5 million passengers) with unexpected cardiac death being the most common[2]
  • Aircraft diversion as a result of a medical incident occurs in 2.8% but may be getting more frequent (despite the cost).

Practical issues

LogoKeyPointsBox.png
  • Wait for flight crew to ask you for help, before offering it.
  • Convey your potentially relevant competencies to the flight crew.
  • Work within your professional and situational competence.
  • Assist and advise, the responsibilities remain with the flight crew.
  • Keep a written record.

In 86% of cases with European airlines a physician or medical professional was involved in providing therapy. This works out to about once every 50 hours flying time for a physician.

Before responding, it may be sensible to assess whether you in a fit state to provide a medical opinion - a combination of alcohol and tiredness means it may be sensible to defer to another medical practitioner (if one is onboard).

You may be asked for proof of your medical qualifications! As few of us carry our degree certificates with us, don't be alarmed if you are unceremoniously turned away.

Cabin crew will have been trained in a number of emergency skills, including automated defibrillation where this equipment is on board.

Airlines must have basic first aid equipment, but the medical kits are full of suprises and inconsistencies. Improvisation has been attempted in grave circumstances.[3]

Most scheduled carriers subscribe to the Medlink telemedicine service based in Phoenix, Arizona, with ECG, blood pressure etc. parameters transmitted to Medlink, with Medlink providing advice to the cabin crew.

Your medical opinion can be conveyed to the pilot, but the decision to divert the flight remains the pilots and he or she may chose to prefer the Medlink medical opinion over yours (despite you having seen the patient).

Anecdotal evidence suggests that your thanks may vary from little more than paperwork to complete in your remaining flight, to various gifts/upgrades.

Legal issues

Medical attendance

Most EU nations and Australia require registered physicians to offer help within their scope of practice. In the USA, Canada and the UK there is no legal requirement to do so.

Physicians helping are protected as far as is applicable with good Samaritan acts but may have complex issues should their actions be challenged, although this is very rare.

  • For airlines registered in the USA, the Medical Assistance Act of 1998 helps protects American physicians who provide medical help from possible legal consequences. It reads a medically qualified person such as a doctor, nurse or paramedic is protected from liability arising out of assistance in an in-flight emergency, except for gross negligence or wilful misconduct. Unhappily, most doctors on the planet are not recognised in American law as medically qualified and in American airspace on an American airliner American tort law would apply!
  • The Tokyo Convention of 1963 allows passengers to take actions which are necessary to prevent disruptive passengers from endangering the safety of the flight. Giving increasing reports of non-deliberate behaviour threatening the safety of the aircraft this may be important.
  • "Liability Form--Medical Assistance" or "Doctor's Waiver" may be available if you ask for them
Flag of the United Kingdom.png
  • Unlike in France[4], Japan, Canada and Germany, no legal requirement to rescue a stranger
  • GMC -in an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide
  • MPS advice

Indemity

  • British Airways indemnifies any health professional even if they respond in a voluntary manner.
  • Qantas and Air New Zealand say they will indemnify doctors who are not covered by personal indemnity policies, but a case is known where this did not occur[5].
  • Most airlines do not.

Equipment

Minimal requirements are problematical for even basic medical care and management. However many major carriers and aircraft registration authorities require more than this.

The US Federal Aviation Administration (FAA) requires every US registered commercial aircraft with more than one flight attendant or 12 seats to carry an automatic external defibrillator. Automatic external defibrillators tend to be carried by most operators of intercontinental flights but this would be rare equipment on internal flights outside North America.

References