This week’s article is not meant to address the truly frightening experience in which the pilot gets on the intercom system and says “Well folks, we’re having some engine problems and have to make an emergency landing.” I do, however, want to discuss the incidence and risks of experiencing a major medical emergency while flying. As many of you know I’ve spent a lot of time on airplanes. I commuted over 10 years between Los Angeles and New York in order to do the Today Show. And since I have family in Israel, I fly to Tel Aviv frequently. Then there are the flights I take to see programs we have established in the developing world for Save the Children. Despite my frequent miles (and happily, frequent flyer points!) I can count on one hand the times I have been asked to assist an ill patient while on board a flight. The rarity of these requests was mirrored in an article that came out in the May 30 issue of the New England Journal of Medicine titled “Outcomes of Medical Emergencies on Commercial Airline Flights”.
The authors point out that worldwide, 2.75 billion passengers flying on commercial airlines annually. They reviewed the records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communication center from January 1, 2008 through October 31, 2010.. Did you know that airlines partner with healthcare institutions to deliver real-time medical advice from an emergency call center to airline personnel. I felt this was both impressive and reassuring. The airlines that they surveyed represented approximately 10% of the global passenger flight volume on those dates. The Communication Center received calls for 11,920 in-flight medical emergencies among an estimated 744 million airline passengers during the study period. And there were over 7 million flights by these airlines, so the representative incidence was one in-flight medical emergency per 604 flights. (A lot of calculations went into these numbers; but no wonder I was rarely called on…even I have not taken that many flights!)
The following data was reported in the survey: The average age of the passengers that had medical emergencies was 48; their ages ranged from 14 days (who would take a 14-day-old baby on a plane, these were not medical flights) to 100 years (wow). The most common medical problems were syncope, (fainting), (37.4%), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). And when the airplane staff requested assistance from any medical personnel on board the response was quite good; it was provided by physicians 48.1% of the time, nurses 20.1%, EMS providers 4.4%, and other healthcare professionals 3.7% of the time for these medical emergencies.
Aircraft diversion, i.e.landing before the plane got to the scheduled airport in order to take care of the ill passenger occurred in 7.3% of the medical emergencies. Of the 10,914 patients from whom post-landing follow-up data was available, 25.8% were transported to a hospital by emergency medical service personnel, 8.6 % were admitted to a hospital and only 0.3% died. The most common reasons for admission were possible stroke, respiratory symptoms and cardiac symptoms.
As an OB/GYN, I’ve often wondered how often planes have had to make non scheduled landings because a pregnant passenger was miscarrying or in labor. Ican attest to the fact that I was never called on to help with this type of emergency while flying.(Delivering a baby during a flight would have been a remarkable experience for the mother, the other passengers and the flight attendants; and could have garnered free future flights for the newborn and me!) The office reported that of the 61 cases of obstetrical emergency symptoms in their study most ( 60.7%) occurred in pregnant women at less than 24 weeks of gestation who had signs and symptoms of possible miscarriage. Only 11 occurred in women who went into labor beyond 24 weeks, of which, 3 resulted in non scheduled landings (and there were no in-flight deliveries.) So altogether, obstetrical symptoms were rare causes of in-flight medical emergencies. This supports existing recommendations that air travel is safe for pregnant women (and the other passengers on the plane who have tight schedules) up to the 36th week of gestation.
Based on their assessment of this data the authors estimate that 44,000 in-flight medical emergencies occur worldwide each year. So although medical emergencies during commercial airline travel is rare, on a per passenger basis they do occur daily and physicians and other healthcare professionals who are in the plane at the time can be called on to aid ill passengers.
I think this article is reassuring both for passengers and medical personnel who happen to be on a plane when a medical emergency occurs. The fact that we can get real-time medical advice from an emergency call center is extremely helpful. The airlines have also improved the emergency kits available for use.
A word of advice: if you have a medical condition it would be a good idea to have a card in your wallet that indicates the diagnosis and current therapies that you receive. You should keep your medications with you on the airplane, in your purse or a case that is under your seat rather than stored in the over head compartment or suitcase down below. Don’t board if you feel sick (especially if you have the flu…think of others seated near you). Take all your regular meds on time, hydrate and if you can’t eat the food served on the plane (or they don’t serve it) bring your own! The friendly skies can be medically friendly if we all do our part.