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Rhythm Disorders Review 1 Credit CME

In-Flight Medical EmergenciesA Review

Educational Objective
To review the pathophysiology of in-flight medical emergencies.

JN Learning lets you earn AMA PRA Category 1 CME Credit™ from a source you trust, JAMA Network. Find relevant articles, audio, video, and interactives, track your progress, and print certificates—all while deepening your knowledge of the topic at hand. Learn more


Importance  In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment.

Observations  In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical volunteers should identify their background and skills, perform an assessment, and report findings to ground-based medical support personnel through the flight crew. Ground-based recommendations ultimately guide interventions on board.

Conclusions and Relevance  In-flight medical emergencies most commonly involve near-syncope and gastrointestinal, respiratory, and cardiovascular symptoms. Health care professionals can assist during these emergencies as part of a collaborative team involving the flight crew and ground-based physicians.

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Article Information

Corresponding Author: Christian Martin-Gill, MD, MPH, Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes Ave, Iroquois Building, Ste 400A, Pittsburgh, PA 15261 (martingillc2@upmc.edu).

Accepted for Publication: November 20, 2018.

Author Contributions: Dr Martin-Gill had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: All authors.

Supervision: Martin-Gill, Yealy.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Martin-Gill, Doyle, and Yealy reported that they oversee the University of Pittsburgh Medical Center Medical Communications Center, which provides ground-based medical support for commercial airlines. Dr Yealy reported receipt of grants from the National Heart, Lung, and Blood Institute and royalties from McGraw-Hill, Lippincott Williams & Wilkins, and Oxford Press.

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