Medical emergency

Onboard Medical Emergency is an acute health problem that can pose great risk for the occupant’s life. If the emergency is serious enough and can not be treated with on board equipment and medical substances, immediate diversion is required.

The most common medical emergencies are

• Heat attack

• Cardiac arrest

• Epileptic seize

• Severe allergic reaction

• Diabetic episode

• DVT ( deep vein thrombosis)

• Asthma

• Poisoning

• Decompression sickness

• Baby delivery

• Severe injuries/ limb fractures

Contributing factors to the developing of medical emergency during a flight are

• travelling of elderly people ( over 70-75)

• travelling of people with chronic diseases ( heart problems, asthma, epilepsy, blood pressure problems. Time zone changes and altered meal times can result in insulin dependent diabetics becoming hypoglycemic, though diabetic meals can be provided. Passengers on other strict drug regimens, such as epilepsy, may also have problems, especially if they have packed their medication in the hold. )

• travelling of pregnant women ( in the late months of pregnancy)

• alcohol abuse

• long range flights ( DVT can develop due to long time motionless sitting in restricted room )

• unexpected severe turbulence ( falling objects from overhead storage bins can lead to injuries )

• fear of flying

• stress (the stress of getting through a modern airport security checks, stress due to flight delay)

Each aircraft is equipped with first aid kit and medical emergency kit.

The first-aid kit is accessible to the flight attendants and generally includes:

• Bandage

• Adhesive plaster

• Antiseptic swabs

• Thermometer

• Inhalers

• Blood pressure cuffs

• Arm and leg splints

• Iodine

• Light pain killers

• Ammonia spirit

The medical emergency kit is carried on the aircraft sealed and has to be used only by medical professionals as it contains serious drugs. It usually includes:

• Stethoscope

• Syringes

• CPR masks

• Nitroglycerin tablets for chest pain

• Dextrose solution for hypoglycemia

• Adrenalin for asthma or allergic reactions etc.

One more critical medical emergency is crew incapacitation – inability of a member of the crew to fulfill his/her duties due to physiological factors (sickness, injury, fever or intoxication etc. )

Crew incapacitation may occur as a result of:

• the effects of Hypoxia (insufficient oxygen) in case of depressurization

• the consequences of suffocation due to smoke or fumes in case of fire

• food poisoning

• being asleep

• a medical condition such as a heart attack, stroke or seizure or transient mental abnormality

• a malicious or hostile act such as assault by an unruly passenger, terrorist action

Incapacitation generally falls into two groups:

1) Subtle or Incomplete

Skills or judgment may be lost with little or no outward sign.

The person may make illogical actions and decisions, or he/she can manipulate the controls in a hazardous manner.

Subtle incapacitation is most commonly caused by hypoxia, hypoglycemia, extreme fatigue, alcohol, drugs or other toxic substances. Neurological problems, such as stroke or brain concussion, may also be a cause.

2) Obvious or Complete

The first indication of illness may be loss of consciousness, seizures, severe pain or paralysis.

Heart attack or stroke is the most common causes of complete incapacitation. Warning signs include pallor, sweating, nausea, etc.

In case of passenger’s collapse it’s a duty of a flight attendant to assist him with all possible means applying the contest of first medical kit or oxygen mask if necessary. If his condition deteriorates the cabin attendant reports to the captain and makes announcement if there is any doctor among the passengers. Meanwhile the pilots have to evaluate the situation and taking into account the company’s policy make decision as for diverting to the alternative in order to save the passenger’s life.

In case of one flight crew member incapacitation a flight attendant should be invited into the cockpit in order to deal with him or her. While another pilot takes over the control of the aircraft, a steward assists a collapsed one. If the pilot fails to regain consciousness flight attendant has to move the victim's seat to its full aft position, to recline his seat, to remove his legs from the control pedals, fasten his seat belt with the hands tied up in order to restrain him. Some air companies oblige flight attendants to help the pilot-flying ( e.g. reading the check list). So emergency has to be declared and diversion has to be requested.

To the methods of crew incapacitation avoidance we can attribute

• Correct use of the aircraft pressurization system and emergency oxygen supplies to prevent Hypoxia and protect the crew from the effects of Smoke and Fumes.

• Therapeutic Oxygen supplies can also alleviate the condition of a crew member or passenger suffering a medical condition.

• Staggering crew meal times and ensuring that each pilot eats different meals both prior to and during flight, will reduce the chance of both pilots becoming incapacitated due to Food Poisoning.

• Proper sleep before the flight

Medlink

A recent innovation that is used by some airlines is Medlink, a direct communication between the flight crew and an organization where doctors are aware of in-flight medical emergencies and can give an instant help how to deal with this or that case. They also supply the crew with the list of the nearest available airports for diversion where qualificated assistance can be provided. This service when being contacted relieves the responsibility from on board doctor.

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