March 25, 2013

There are more than 600 million flight operations worldwide in a given year. What are the chances of a medical emergency on board and what should the flight crew do if there is one?

“This is a dynamic situation,” said Paulo Alves, president-elect of the Airlines Medical Directors Association and vice president of aviation health for MedAire, an international organization that works with aircraft operators of all types to manage remote medical events. In 2012 alone, MedAire responded to more than 24,890 in-flight medical emergencies on commercial, charter, business and private flights.

The question of what to do in a medical emergency is answered differently by aircraft operators, but Alves believes it is a question that is becoming more pertinent.

“We didn’t used to have so much medical tourism,” he pointed out. “People travel today because they are ill, and they often do so by charter aircraft, trying to reach medical care in a different country.”

These travelers put unique pressure on the entire flight operation, according to Alves. Fixed-base operator employees booking or checking in passengers are often called upon to make “gate assessments” of passengers, noting those who may be coughing excessively, appear to be in great pain or some other form of difficulty. These employees are expected to be the first to ask whether the passenger is healthy enough to make the trip.

“We must have no problem saying, ‘Hey, you’re not fit to fly. You may be endangering your life,’” he said.

Alves calls himself a strong believer in safety management systems (SMS), noting that an SMS can define needed equipment, as well as general procedures to implement, in a medical emergency.

Although he believes it is almost impossible to prepare for every possible medical emergency, he strongly suggests carrying a robust first-aid kit and an automatic external defibrillator (AED) onboard.

“If someone is the victim of a sudden cardiac arrest,” explained Alves, a cardiologist, “there’s no way out. If you want to save someone from this sort of event, you want to carry an AED. There’s nothing else that will do.”

MedAire estimates the chance of an in-flight fatality at approximately one in 8 million. Though the odds are much less than being hit by lightning, Alves said, in-flight deaths still occur. In such cases, he deemed it of critical importance for flight crews to remember that only a doctor can pronounce someone dead.

“What [flight crews] can say is that they presume a person is dead,” he explained. That distinction is important in that it allows for the cessation of life-saving activities, such as CPR. But the actual determination of death should always be reserved for authorities on the ground, according to Alves, because such a pronouncement in flight could have legal implications for both the crew and the decedent.

For international crews, the question might well be whether to divert or to continue the flight to their original destination.

“The situation can be very difficult. That is one reason to have access to a ground-based medical service. We have a good idea of medical services around the world and, if necessary, how to repatriate a person’s remains,” Alves said.