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On a flight from Delhi to Munich, LH 763, on 1 June 2023, a 60 year-old gentleman from Amritsar suffered from a minute-long seizure two hours after the flight took off. As soon as his wife informed the crew, they asked,
I identified myself as a doctor registered with the Medical Council of India to the air crew and to the patient’s wife, noted the medical history of the patient, ruled out any cardiac event, tested blood sugar, blood pressure, and pulse rate.
The patient was conscious but dull and drowsy. He even vomited once. His sensorium had returned to normal. I gave him a tablet with a glass of juice. The patient remained well. There was no further seizure and no flight diversion was needed.
An inflight medical emergency is defined as a medical occurrence requiring the assistance of the cabin crew. It may or may not involve the use of medical equipment, drugs, assistance from a medical professional travelling as a passenger on the flight.
It can be something as simple as a headache or a vasovagal episode, or something major such as a myocardial infarction or impending childbirth.
But serious IFMIs are rare, as are flight diversions caused due to them.
However, when these diversions do happen, they can cost anywhere between Rs 3 Lakh- Rs 7.38 crore or USD 3,000 – 9,00,000. The pilot is advised by the ground team and the doctors on board if a diversion is needed.
Did You Know?
The cabin air in flights is relatively dry which increases the risk of bronchial spasm.
Although the main problems relate to the physiological effects of hypoxia and expansion of trapped gases, it is important to remember that the complex airport environment can be stressful and challenging to the passenger.
Some common conditions seen during IFMIs are:
Loss of consciousness
Diarrhoea and vomiting
Bronchospasm
Asthma exacerbations
Tension pneumothorax
Congestive heart failure/pulmonary edema
Angina pectoris
Cardiac arrest
Seizures
Strokes
Hypoglycemia/Hyperglycemia
Severe pain
Emergency delivery
Air sickness
Anaphylaxis
Sinus/ Middle ear disease
Head injuries, burns and scalds
In case of a cardiac arrest, the protocol includes early transfer to an intensive care facility for continuing monitoring and treatment, which is not always possible in the flight environment.
In case of prolonged immobilisation too, we see deep vein thrombosis, which can lead to economy class stroke syndrome, which is seen in some 20 percent cases of stroke on board.
When the flight is at a higher altitude, relative hypoxia and saturation normally drop by 10 percent.
While it is usually well tolerated in normal individuals, problems can arise in those with respiratory or cardiac impairment.
Pneumothorax or ENT problems can be faced if there is a ‘trapped gas’ in the cabin.
Did You Know ?
Avoid excess alcohol and caffeine containing drinks.
Remain mobile and exercise your legs.
Postpone your air travels if you have had any recent illness.
For Passengers Who Might Be Pregnant:
Air travel before 36 weeks of pregnancy is safe only for people who are not dealing with any pregnancy problems.
Keep your seat belt buckled up.
Drink plenty of fluids.
Avoid gassy food and drinks before you fly.
Move your legs, walk up and down the aisle every hour.
Come forward to help.
Stay calm.
Seek help if needed via telemedicine.
Treat the passenger while they are seated.
Create space.
Turn on cabin lights.
Ask for additional help.
Ask the cabin crew to contact ground based telemedicine early in case of emergency.
Open a two-way communication with the pilot to make the safest decision.
Unfamiliar clinical scenario
Foreign and limited environment
No idea of available resources
No assistance often
Airline policies
Legal/ethical issues
Did You Know?
Although the crew are trained to handle common medical emergencies, in serious cases they may request assistance from a medical professional travelling as a passenger. Such assisting professionals are referred to as Good Samaritans.
An aircraft in flight is subject to the laws of the state in which it is registered, although when not moving under its own power (ie stationary at the airport), it is subject to the local law.
In the UK, the major medical defence insurance companies provide indemnity for their members acting as Good Samaritans. Some airlines provide full indemnity for medical professionals assisting in response to a request from the crew.
(Dr Deepak Gupta is a Neurosurgery professor. He can be reached at drdeepakgupta@gmail.com. Or you can connect with him on Twitter @drdeepakguptans. This is an opinion piece, and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
(At The Quint, we question everything. Play an active role in shaping our journalism by becoming a member today.)
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