The Clinician’s Guide to In-Flight Emergencies

Treating Common Medical Conditions

Air travel places great stress on the body, caused by a variety of factors—carrying heavy luggage through terminals, rushing to make flights, crossing time zones (which interferes with sleep and medication schedules), potential fear of flying, or the use of alcohol or sedatives on board.⁵ Moreover, while many medical emergencies can be attributed to pre-existing medical conditions or acute illness, the aircraft itself can play a role. For example, the pressurized cabin environment causes a 10% decrease in blood oxygen saturation, which can overtax patients with certain chronic diseases.⁵

The authors provide guidance regarding management of specific medical conditions while in flight (Table 3). They conclude that “physicians should be prepared to render care while traveling; physicians must also be aware of the medically austere environment, its related limitations on prudent practice, and the associated liabilities surrounding the delivery of in-flight care.”⁴

Table 3: Treating Specific Medical Conditions In-Flight

Cardiac arrest

Presentation/Causes:

• Recognition essential

Management Approach:

• Compression-only CPR Defibrillation with use of AED
• Diversion/emergency landing if patient is resuscitated
• Consider discontinuing resuscitation if no return of spontaneous circulation within 20-30 minutes; pronouncement of death

Acute coronary syndromes (ACS):

Presentation/Causes:

• Chest discomfort
• Dyspnea
• Nausea
• Vomiting
• Diaphoresis

Management Approach:

• Look for this constellation of symptoms, especially in middle-aged or older adults
• Review patient’s medical history for ACS
• Use aspirin in patients with chest pain and suspected ACS, except with active, hemorrhage and allergic reaction
• Use nitroglycerin with caution
• Use IV fluid bolus in patients with hypotension
• Use supplemental oxygen in cases of suspected respiratory compromise; request descent to lower altitude to improve oxygenation
• Recommend immediate diversion in cases of suspected MI

Stroke

Presentation/Causes:

• Abrupt onset of neurologic symptoms

Management Approach:

• Evaluate patients for focal neurologic deficits
• Consider supplemental oxygen to avoid hypoxemia
• Avoid aspirin because intracranial hemorrhage can mimic stroke
• Measure blood sugar levels if possible to rule out hypoglycemia
• Recommend expedited landing