The common medical events during a flight include dizziness, fainting, diarrhoea, nausea and vomiting, shortness of breath, chest pain, palpitations and headaches. Heart attacks, other cardiovascular problems, seizures, and strokes constitute the most frequent in-flight medical emergencies often requiring diversion of an aircraft.
An estimated 44,000 in-flight medical emergencies occur worldwide each year, according to a study published on May 30, 2013 in the New England Journal of Medicine. Around one in-flight medical emergency occurs in every 604 flights. Data from the Lufthansa registry published in 2012 shows that one medical incident will occur for every 10,000 to 40,000 passengers on board a commercial aircraft. (Dtsch Arztebl Int. 2012 Sep;109(37):591-601).
More than 900-1,000 people die each year in-flight. This number does not include deaths of medical patients being transported from one destination to another. These are unexpected deaths in people who are otherwise healthy or are known-disease patients but fairly well controlled on medicines. Cardiac arrest is the leading cause of in-flight death. When cardiac arrest occurs, any delay in starting resuscitation and in using a defibrillator to deliver a shock when needed, will reduce the person’s chance of survival.
The pilot of the aircraft has the overall responsibility of the safety of passengers, while the flight crew has to manage any in-flight medical emergency. Hence, all flight crew should be trained to recognise common medical emergencies and be certified in first-aid for medical emergencies. They should also be trained in chest compression (CPR), which can be life saving, if the cardiac arrest is due to ventricular tachycardia or ventricular fibrillation and, also in the use of an automated external defibrillator (AED). They should undergo a refresher course periodically, every year or two.
All airlines by law are required to have automatic electric defibrillators (AEDs) on board, which have reduced the death rates due to cardiac arrest by up to 40% (British Airways). They are required to carry a first aid kit, which can be administered only by a doctor.
In addition to other required medications and equipment, the emergency medical kit should also contain tablets like nitrates, aspirin and clopidogrel. If a heart attack is suspected, then chewing 300 mg of aspirin and 300 mg (four tablets) clopidogrel taken orally with water, can reduce the chances of death by almost 40%.
Though the crew is trained in first-aid, it always seeks the help of healthcare providers on board the aircraft. “Is there a doctor on board?” is an announcement familiar to us all.
In every flight, a medical doctor should preferably be on board, however, this may be rather difficult to implement practically. The odds of a doctor being on board are around 50%. So, the airlines could float a scheme whereby subsidised or free tickets could be offered to the first medical doctor boarding a particular flight. Or, all exit seats, which are being sold at a higher cost due to more leg space could instead be reserved for a healthcare provider, not necessarily a doctor, who is trained in first-aid training course, including CPR and is well-versed with an AED.
I had first raised these issues in 2005 when my father-in-law, GL Sanghi - a noted lawyer of the Supreme Court of India passed away in flight, when he was traveling from San Francisco to Frankfurt. He was 73 years old at that time. He was not a known case of diabetes, high blood pressure or heart disease. He was a controlled asthmatic. He took a Lufthansa flight from San Francisco to Frankfurt on 5th January (Thursday) at 2:15 pm. Three hours after the flight took off, he had a large bout of vomiting and within minutes developed cardiac arrest from which he could not be revived. Fortunately, there was a US-based cardiologist on board, who attended to him.”
Very recently, Dr RN Tandon, the Hony Secy of the Indian Medical Association (IMA) revived a fellow passenger who had collapsed in-flight from Delhi to Mumbai. As the only doctor on board, he was called by crew to help another passenger who was pulseless with no respiration. He immediately performed CPR and could successfully revive the person. This incident re-opens the debate about the in-flight health-related issues and the safety of passengers and should a seat be reserved for a doctor (or a healthcare provider) in every flight.
While a doctor being on board a flight does not automatically ensure survival, it does give the person a fighting chance.
(The writer is a former president of the Indian Medical Association and the President, Heart Care Foundation of India.)