Survival should not be left up in the air

MEDICAL MATTERS:Short-haul flights often lack medical equipment

THE ISSUE of in-flight medical emergencies has generated a number of letters to the editor in recent days. Readers were especially exercised about the lack of emergency supplies and equipment on aircraft operated by Irish airlines. All of the flights described were short haul.

Long-haul flights are a different matter entirely. A medical friend who flies from Europe to Australia a number of times a year told me recently that he has noticed the number of in-flight medical incidents is on the rise. Indeed, on one flight from Australia last year he had to deal with two passengers who became unwell.

A young man became acutely and moderately psychotic not long after take-off. Luckily, he responded to the sedation administered by my friend, who used medication located in the aircraft’s emergency medical bag.

But a couple of hours later my friend was called upon again to deal with an older woman who had become short of breath. She had low blood pressure but no other signs, suggesting a heart attack or other serious diagnosis.

The captain arrived on the scene to discuss the possibility of diverting to the nearest major airport if the woman’s condition warranted it. But she seemed to settle with some oxygen and, with my colleague monitoring her for the rest of the flight, they were able to continue to Heathrow.

The key to my friend’s successful flight from a medical perspective was the availability of quality diagnostic equipment and a good range of drugs for use in common medical emergencies aboard the aircraft. Not only did two passengers benefit, but he saved the airline thousands in additional fuel bills had a medical diversion been necessary. He was exhausted after his prolonged stint on call but could at least reflect on a double Good Samaritan intervention that had gone well.

A crude measure of how flying can affect our health is the frequency of in-flight medical emergencies.

A study from 10 years ago 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 that 260 passengers out of 8,735,000 arrivals had developed symptoms in flight. Some 137 of these required assessment in the emergency department and 25 were admitted to hospital.

A separate 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 one million passengers).

Other sources suggest about one in 12 in-flight medical emergencies is cardiac in origin; perhaps surprisingly a psychiatric diagnosis accounts for 6 per cent of cases. Stomach problems represent 14 per cent of incidents, most of which are milder cases of gastric infection.

But there is most definitely a gulf between the excellent facilities available when flying long haul and the questionably parsimonious attitude to equipment on aircraft tasked with shorter journeys.

The absence of defibrillators is impossible to justify. Yet authorities in Europe have come up with a half-baked excuse based on how far from a major airport the aircraft will be when flying.

There is well-established research to show that the interval between the onset of a heart rhythm disturbance called ventricular fibrillation – very common after a heart attack – and the delivery of the first shock from a defibrillator is crucial. Survival falls by about 10 per cent for every minute after collapse for patients with this common complication of cardiac arrest.

Portable defibrillators are now small and relatively light. Just because the European Aviation Safety Agency has not mandated their availability on short-haul aircraft does not prevent an individual airline from responding to technological progress. How about showing the way, Aer Lingus and Ryanair?

mhouston@irishtimes.com