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MDs Suggest System-wide Changes to Improve Care During In-Flight Medical Emergencies


Flight attendants are well trained to respond to emergency landings and evacuations. Yet, most flight attendants will never experience an emergency landing or evacuation for their entire career. On the other hand, in-flight medical emergencies are a much more common occurrence.Dr. Melissa L.P. Mattison and Dr. Mark Zeidel of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston published an article this month in the online Journal of the American Medical Association suggesting a series of across-the-board improvements to ensure airline passengers receive the best level of care in the unfortunate but inevitable event of an unexpected medical emergency in the air.

The doctors pointed out that in recent years, healthcare has improved by focused increasingly on standardization of processes of care. Interestingly, some major concepts in this movement originated in the airline industry. This standardization has improved aviation safety so much that there were no fatalities on U.S. domestic flights last year.

The kinds of approaches that have increased the level of flight safety have not necessarily helped provide optimal care for passengers who become acutely ill during a flight. Nevertheless, the authors of the AMA article say there is evidence to suggests that significant improvements can potentially be made to improve the quality of patient care provided in these situations.

In European countries, a survey of multi-national airlines looked at 10,000 in-flight medical emergencies over a period of 5 years. Each airline was found to have had its own reporting system and protocol. Further, despite the fact that emergency medical kits are required to contain certain medications and equipment, the makeup of the actual medical kits varies between airlines.

In the U.S., the FAA requires that flight attendants receive training in CPR and in the proper use of automated external defibrillators at least once every two years. However, there is no standardized curriculum or test across the airlines. In addition, some airlines contract with commercial on-ground support companies that can offer real-time medical advice over a radio — some do not.

The Journal of the American Medical Association suggests that to improve the chances of positive outcomes of in-flight medical emergencies, airlines and airline regulators could take steps similar to what they have done to improve overall air safety — by analyzing outcomes and standardizing procedures.

Medical Emergency on Air Transportation

Various flight and medical personnel respond to an ill passenger on an airline flight — Image Source: Flickr.

First, they have suggested a standardized recording system for all in-flight medical emergencies, including mandatory reporting of each incident to the NTSB. This system would also include a debriefing of anyone directly involved with the in-flight medical emergency, preferably immediately following the incident. The JAMA article suggests that collection and analysis of all these records may provide valuable lessons and overall improve the level of care given in in-flight emergencies on domestic airlines.

Secondly, they suggest that medical kits should be standardized across all airlines, with the optimal contents of a kit being determined by expert recommendations and later modified, if necessary, based on the findings of the reporting system. These identical kits, they suggest, should contain identical elements and be placed in identical locations on every single flight. While they say the current required emergency kit is a start, the kits vary in appearance and organization because each airline has a different kit. Because of this, practitioners responding to medical emergencies in the air are likely to be unfamiliar with individual airline kits and waste valuable moments identifying and searching for the correct medications and supplies.

Third, they suggest that emergency medical training of flight attendants should be both enhanced and standardized. The obligations of attendants to the ill passenger should be clear, and standards should state explicitly that a single flight attendant be assigned to in-flight emergencies, staying nearby until the patient is safe. When accompanied by health care professionals, the flight attendant(s) should ensure rapid access to the medical kit materials. In the absence of health care professionals the flight attendants should be trained in first aid – with standard training and expectations being defined by expert panels. Again, these standards should be modified and refined continuously by review of reported in-flight medical emergencies.

Lastly, they say that access to ground-to-air medical support should be standardized across all airlines. If the support of ground-based medical advice providers is proven to be effective, it should be made available to all passengers regardless of what airline they’re flying with. Further, these ground-support contractors should be standardized somewhat, with the effective elements of their services being defined. Flight crews should then receive identical training in how to interact effectively with entities providing over-the-radio medical support during emergencies.

A major benefit of standard medical kits and standardized training of flight personnel is that it would become possible to provide all physicians and nurses with a fundamental level of training in responding to in-flight medical emergencies. In theory, similar standards of reporting and care for acutely ill passengers could be adopted internationally.

Because of the lack of a reporting system, there is not much information on the outcomes of medical emergencies during air travel. Therefore, it is inherently impossible to know whether the four changes above would improve the outcomes of these emergencies. The authors of the AMA article are merely drawing upon experience in systematic quality improvement in the healthcare field, as well as the success of the airline industry in improving overall flight safety through similar steps in other areas. They say that the new measures would not add significant expense, and could potentially further improve outcomes for passengers who become ill during their flight.

Are there any doctors on board? Let us know what you think about these proposed system-wide changes in the comments area below.


JAMA. 2011 May 3. [Epub ahead of print]
Navigating the Challenges of In-flight Emergencies.
Mattison ML, Zeidel M.

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