In-flight medical dramas

Medical Matters: Flying off in the coming weeks for your annual get-away-from-it-all break? As a mode of transport, flying is very safe for the majority of travellers. But for anyone with health concerns and their doctors, a recently published British Medical Association (BMA) report - The Impact of Flying on Passengers' Health - is a valuable source of advice.

A very crude measure of how flying can affect our health is the frequency of in-flight medical emergencies. Two US studies from the 1980s suggest that medical incidents occur at a frequency of around one in 36,000 or so passengers.

A more recent study of passengers arriving at Los Angeles International Airport cross- referenced reports from the airport's first aid station, local paramedics and hospital emergency departments. They found 260 passengers of 8,735,000 arrivals had developed symptoms in flight. Some 137 of these required assessment in accident and emergency and 25 were admitted to hospital. In addition, seven passengers died during flight.

Nowadays, it is common practice for major airlines to contract with a ground-based medical assistance provider. A study of 1,132 in-flight medical incidents on board five major US airlines found that the most commonly reported problem was fainting (22 per cent of the total). Cardiac, neurological and respiratory symptoms were the most common serious complaints. Some 179 passengers required further hospital assessment; the majority of whom were admitted to hospital for an average stay of three days. Flights had to be diverted to the nearest airport in 145 cases (one per 1 million passengers). Almost half of these diversions were the result of passengers experiencing cardiac symptoms.

These figures suggest that the risk to the individual passenger of a serious in-flight medical event is very low. But when it does happen, how prepared are the airlines to deal with the problem? Under Joint Aviation Authorities (JAA) regulations, cabin crew must be trained in first aid and the use of first aid kits. However, the BMA report notes: "although airline training programmes have to be approved by the relevant authority, there are few requirements or guidelines on the standards that have to be achieved, either in the training programmes themselves or for the crew completing the courses".

Nor were the authors of the report entirely happy with the standards of medical equipment carried on board commercial aircraft. The contents of these, as specified by the JAA, is quite basic. Airlines are required to carry only an "extended" medical kit where the aircraft will, at some point in its journey, be more than 60 minutes flying time from a major airport. Such kits contain important items like injectable emergency drugs for use by doctors or nurses who happen to be on board.

The BMA says individual airlines should carry out a risk assessment based on the nature of its operations, the duration of flights and previous medical incident records in order to properly determine its needs in the area of in-flight emergencies.

What does the report say about the pre-flight assessment of passengers? It points out that while there are no studies suggesting old age is in itself a barrier to air travel, older passengers are more likely to have problems of chronic illness and reduced mobility.

"The security response to the increased threat of terrorism has created additional problems for passengers with some medical conditions," the report notes. This is especially relevant to the aged and the handicapped and poses a particular barrier for people who, because of their condition, must carry injectable medication (including sharp needles) in cabin luggage.

Dealing with some topical issues, much has been written about the prevention of deep venous thrombosis (a leg clot) related to air travel. Despite the many column inches, the latest report says there is limited evidence of the value of preventive measures such as taking aspirin or using pressure stockings. The report comes out marginally in favour of the use of heparin; however, this drug must be injected subcutaneously, a fact which limits its general use.

Doctors are warned to be careful should they become professionally involved in an air rage incident. "They should avoid administering sedative drugs as the individual may already have taken other medication or illicit drugs," the BMA advises. And despite the massive hype about SARS last year, there is no strong evidence to suggest the new infection spreads between passengers.

The important thing for those of you with a chronic illness is to discuss your flight plans with your family doctor. In the majority of cases, your safety while in the air will not be an issue - so off you go on your travels and enjoy yourselves!