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Is there a doctor in the … airplane?

July 6, 2013
By C. Paul Martin, M.D. , Marshall Independent

"One of the last places anyone wants to have a heart attack - or deliver a baby - is on board an aircraft."

Air travel is a commonplace activity. It is known that nearly 3 billion passengers use commercial airlines to travel for business and/or pleasure each year. About 44,000 in-flight medical emergency situations occur during these flights, thus averaging 50 incidents per day.

A recent New England Journal of Medicine article found that, on average, one in 604 flights will have an occurrence which may require medical attention.

Presently in the U.S., about 650,000 physicians provide direct medical care. However, only 1/3 specialize in primary care (family practice, general practice, internal medicine and pediatrics - in other words, family medicine.) Although all physicians (M.D., D.O.) experience four years of general medical training involving the full spectrum of medical care, 2/3 of these physicians, after completing additional years of specialized training, practice a specialty often limited to a group of patients with specific types of illnesses.

Obstetrics is a specialty limited to women of a certain age group. These patients may safely use air travel up to 36 weeks of gestation. However, only 11 of 12 thousand in-flight incidents in this study involved obstetrical concerns.

In 2/3 of the in-flight emergencies, trained medical professionals on the plane came forward to help. Half of the cases were treated by a physician and 1/5 of the patients were cared for by nurses.

About 1/3 of the incidents were related to fainting or lightheadedness. The conditions associated with air travel including time changes, fatigue, irregular meals, medications and alcohol use may precipitate fainting, etc.

Often the flight attendants, trained in basic medical situations, can assist passengers. Some medications and medical equipment are available on all flights, but only trained medical personnel can properly use them.

All flight crews are in contact with emergency medicine physicians by radio for consultation. Less than 10 percent of flights required changes in flight plans because of medical conditions.

Thankfully, I have never encountered an in-flight medical situation which required specific medical attention.

However, I have been involved in several episodes at summer events, church services and restaurants. One episode illustrates the usual situation.

While at a convention luncheon at a New York City restaurant, a woman asked me to see her husband who was experiencing chest pain and lightheadedness and had already taken a nitroglycerine pill for his angina. I listened to him and his heart sounds (ear to chest, no stethoscope available). His appearance was one of distress. Four physicians and I surrounded him as we tried to help him. When I turned around to ask for help, I realized that three of them were dermatologists and one a pathologist! However, they assisted me in facilitating a 911 call and subsequent emergency transfer and care at a nearby hospital. Thankfully, the man improved rapidly, returned to our meeting later, but he died of another unrelated cause a few years later.

Medical personnel are often available in these situations, but personal awareness of medical conditions and situations is of great importance and value.



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