#19 How to respond to in-flight emergencies

November 21, 2016 | By Matthew Watto, MD

Does the thought of responding to an in-flight emergency ruin your air travel? Then tune in because on this episode, Angelica Zen, MD, Chief Resident of Internal Medicine at UCLA, recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane.  

Clinical Pearls:

1. Stay Calm!  If you freak out, so will everyone else.
2. Think outside the box and be prepared to improvise from available resources. (e.g. ask another passenger for a glucometer)
3. Standard medical kit contains – manual BP cuff, stethoscope (cheap), gloves, oropharyngeal airways, CPR masks, bag-valve masks, IV set, 500 ml saline, needles, syringes, analgesic tabs, antihistamine (tabs or injection), aspirin, atropine, inhaler (bronchodilator), Dextrose 50%, Epi (1:1000 and 1:10000), IV lidocaine, nitroglycerin tabs, supplemental oxygen.
4. Don’t forget to utilize the ground medical team!
5. Legal repercussions very unlikely unless there is “gross neglect” or “intentional harm”. DON’T treat patients if YOU’VE BEEN DRINKING!
6. Common emergencies in order of decreasing frequency – syncope and presyncope, dyspnea, acute coronary syndrome, altered mental status, psychiatric emergencies, stroke, cardiac arrest

Goal: Listeners will understand their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane.

Learning objectives:
By the end of this podcast listeners will:

1. Be familiar with the contents of the standard medical kit
2. Think outside the box to identify, improvise and utilize available resources for patient care
3. Recognize the medical legal consequences of providing emergency medical care on a plane
4. Confidently evaluate and manage common in-flight emergencies using the available resources

Disclosures:
Dr. Zen reports no relevant financial disclosures.

Time Stamps
00:26 Intro

02:06 Start of Interview

03:02 Rapid Fire Questions

07:08 Dr. Zen tells her story

17:27 Monitoring your patient in-flight

18:05 Contents of the standard in-flight medical kit

20:10 What Dr. Zen would have done differently

21:05 How to use available resources in-flight

22:20 Medical legal implications

26:07 How to respond to common in-flight emergencies and how to respond

27:35 Syncope and presyncope

29:52 Hypoxia altitude simulation test (HAST)

31:15 Altered mental status

31:52 Anaphylaxis

33:19 Stroke and acute coronary syndrome

34:51 Dr. Zen’s take home points

36:40 Outro

Links from the show:

1. Baby delivered in-flight by Angelica Zen, MD http://newsroom.ucla.edu/stories/
2. Pharmacy article detailing supplies in standard medical kit on plane http://www.ashp.org/menu/News/PharmacyNews/NewsArticle
3. Great review article on In-Flight Emergencies. Nable JV, Tupe CL, Gehle BD, Brady WJ.  In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45. doi: 10.1056/NEJMra1409213.
4. Article on the hypoxia (or high) altitude simulation test (HAST) https://www.ncbi.nlm.nih.gov/pubmed/18398121
5. Interesting article: Passenger safely defibrillated 21 times during International Flight. Harve H1, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med. 2009 Apr;80(4):405-8.
6. How Doctors Think by Jerome Groupman: Amazon.com link
7. NEJM Physicians First Watch http://www.jwatch.org/medical-news
8. AirRx app for In-Flight Emergencies available on iTunes