Travelers play valuable role assisting crew in common medical emergencies on flights

(Press-News.org) PITTSBURGH, May 30, 2013– Medical emergencies during commercial airline travel can be a frightening experience, but most situations are well-treated by other passengers and flight attendants, in collaboration with consulting physicians on the ground. A University of Pittsburgh study published today in the New England Journal of Medicine found that doctors, nurses and other medical professionals on the aircraft helped to treat sick fellow passengers in three-fourths of the emergencies studied.

Led by Christian Martin-Gill, M.D., M.P.H., assistant professor of emergency medicine, the study examined records of in-flight medical calls from five domestic and international airlines to UPMC's STAT-MD Communications Center, a 24-hour, physician-directed medical command center, from Jan. 1, 2008, through Oct. 31, 2010. Although not required to by the Federal Aviation Administration (FAA), many airlines use a medical communications facility to consult with physicians on the ground. STAT-MD handled 11,920 in-flight medical calls during the study period. The most common in-flight problems reported were syncope (fainting) or near-syncope, respiratory symptoms, nausea or vomiting, and cardiac symptoms.

Physician passengers provided medical assistance in nearly half of those calls, according to the researchers. Other medical professionals, such as nurses and emergency medical technicians, provided help in another 28 percent of the calls. Flights were diverted to alternate destinations because of medical concerns in only 7.3 percent of the incidents.

Most of the passengers who were treated in-flight had favorable outcomes. According to data for nearly 11,000 of those patients, 25.8 percent were transported to a hospital by emergency medical services; 8.6 percent were admitted, and 0.3 percent died, either on board the aircraft or upon transport to the hospital. The most common causes for admission to a hospital were stroke, respiratory and cardiac symptoms.

The study found that most calls could be managed by the flight attendants, who are trained in emergency protocols and have access to an FAA-required emergency medical kit, along with medical volunteers in the majority of cases. In these cases, ground-based physician consultants provided additional guidance, including use of specific medications in the kit, and assisting the pilot and crew in making decisions regarding need for diversion of the aircraft.

"We wanted to provide a description of the type of emergencies commonly treated on an aircraft, identify the outcomes of these patients and provide an understanding of the treatment capabilities available on the aircraft in the medical kit and through experts on the ground," said Dr. Martin-Gill.

The researchers suggest physicians and others obtain a basic knowledge and awareness of the resources available to them in this unfamiliar and cramped setting to be effective volunteers during an in-flight emergency.

"Commercial air travel is generally safe, and in-flight deaths are rare," said Dr. Martin-Gill. "We hope to look more closely at the most common conditions and which ones require follow-up care so we can better tailor treatment recommendations for passengers."

### Co-authors of the paper include Drew Peterson, M.D., Francis Guyette, M.D., M.P.H, Adam Tobias, M.D., M.P.H., Catherine McCarthy, B.S., Scott Harrington, M.D., Theodore Delbridge, M.D., M.P.H., and Donald Yealy, M.D., through the Department of Emergency Medicine, University of Pittsburgh School of Medicine.

The work was funded by the National Institutes of Health grants UL1 RR024153 and UL1 TR000005.

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

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