Vipin Malik, MD: What To Do During In-Flight Medical Emergencies

In-flight emergencies occur once in every 604 flights. With doctors traveling an awful lot these days - as evident by the big crowds at the annual CHEST 2017 meeting in Toronto, Ontario - doctors should be prepared to handle them appropriately. Vipin Malik, MD, sat with MD Magazine to help them do just that.

Vipin Malik, MD:

With increasing air travel, a lot of physicians are called upon while they're traveling to participate in any kind of in-flight emergencies. The big conditions that we all worry about are, of course, cardiac arrest, stroke, and respiratory issues as well.

One of the studies that was done back in 2013 and published in the New England Journal of Medicine did show that overall incidence of in-flight emergencies is one per 604 flights. Out of those, the majority of the in-flight emergencies were either syncope or pre-syncope, followed by respiratory illnesses.

48% of them were attended by physician passengers, and almost 7% of the flights were diverted to a different airport. Normally, airliners fly at about 30,000 feet, of course, that is not conducive to normal health. There is about 25% to 30% expansion in the gas in any cavity that is enclosed, as per Boyle's law, so if you have a patient who has cystic lung diseases, these cysts, if they're not communicating with the tracheo-bronchial tree can expand by about 35 or 40%. If they are thin-walled, they can rupture and cause numo-thorax, and that's where the problem lies.

It is important for us to recognize the patients who have cystic lung diseases. When they are traveling they are at a slightly higher risk than people who do not have cystic lung diseases, and that's where the talk went.

In the medical kit, there are a lot of helpful things that you can look at. There are, of course, IVs, needles, there's a tracheal catheter, and other things that can certainly be very helpful during in-flight emergencies. Again, this has to be coordinated with ground-based medical specialists that your pilot would call.

You have to remember that the responsibility of patient care lies with the airline crew, and whether to diver the flight or not depends on the pilot. All of that has to be done in consultation with the ground-based medical staff. But you can definitely provide your expert opinion. The best thing to do is, if you are called upon, you go and introduce yourself, tell them what your specialty is - maybe this is not your specialty but your medical background can actually help the ground-based medical staff in deciding what to do.

One of the big questions that people have is, "what about medical-legal risks?" For all practical purposes, Good Samaritan Law applies to it provided that you have not actually harmed the patient by wrong decision making.

So if you are working with the pilot and the ground-based medical staff you should be ok. There are certain countries in Europe that, in fact, mandate that you participate in taking care of the patient and if you don't then that's another problem.

But for all practical purposes, if you do find yourself in that situation, please make sure that you work with the cabin crew and the pilot and ground-based medical staff.