In-flight Medical Emergencies | Ethical Duty Done By Crew & Doctors - Aviation Professional

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Thursday, April 9, 2020

In-flight Medical Emergencies | Ethical Duty Done By Crew & Doctors

In-flight Medical Emergencies



The average healthy passenger tolerates air travel very well, however, the cabin environment may present significant challenges to those with medical problems. More people are traveling including the elderly and those with medical problems because of the changes in demography and attitude toward air travel. In one study [ on five different North American Airlines], the exact incidence of medical emergencies onboard airplanes is unknown, but they occurred in approximately 1 in 604 flights. It's difficult to estimate how often do medical emergencies arise, airlines are not mandated to report such issues. IATA provides guidelines to airlines and recommended that each airline needs to reporting of medical events, it determines what information needs to be documented. 


Many in-flight medical events occurred, in some events, the doctor was not traveling on the same aircraft. For sure, the cabin crew was managed the medical emergencies at a certain limit. The truth is, cabin crew are trained to a certain level of elementary first-aid capability, and they are not health care professionals. If there is no communication line to the ground health care, it's difficult for the Captain to decide whether or not the aircraft should divert for the medical situation. The ultimate diversion decision remains with the Captain, who also must account for fuel, weather, the safety of the landing site, and other operational factors besides the emergency. No doctor no quick assessment of the critically of the medical situation!!


For sure, many alternatives are using modern technology which may help in the in-flight medical events where the doctor is not on board. In this article, I am going to give you a summary of how airline deals with this kind of emergency, and what is the difficulties which may arise during responding to like this.

What does it mean " In-flight Medical Emergencies "?

In-flight Medical Emergencies are medical problems or events that occur during flight.

Legal and Ethical Considerations for Medical Volunteers 

In the United States, the Aviation Medical Assistance Act (also referred to as a “Good Samaritan” shield) protects passengers [doctors] who provide medical assistance from liability except in cases of gross negligence or willful misconduct. Medical volunteers who seek compensation in return for providing aid (such as money, seat upgrades, mileage points, or other items of value) may jeopardize their standing under existing immunity laws, although no case law related to this exists.
Flights outside of the United States are governed by a complex combination of public and private international laws, including the Warsaw Convention, Montreal Convention, and Tokyo Convention.
In addition to differences in “Good Samaritan” volunteer protections, which are not present in many other countries, the duty to respond also varies by country. For example, in the United States, Canada, England, and Singapore, there is no legal duty for an off duty medical professional to assist during an IME. Conversely, Australia and many European countries require physicians to render assistance during IMEs as defined by case law and civil law codes. 
Regardless of applicable laws, doctors often feel an ethical duty to act. According to one study, only 1 case has occurred in the United States involving a doctor being sued for assisting in an IME, and that case was dismissed without hearing.

Considering existing legal protections and international requirements, medical assistance rendered by a capable doctor is of little personal legal risk and is supported by experts in aviation medicine.

 What are the most common medical emergencies? 


The most common emergencies are syncope or presyncope, representing 37.4% of
consultations, followed by respiratory symptoms (12.1%), nausea or vomiting (9.5%),
cardiac symptoms (7.7%), seizures (5.8%), and abdominal pain (4.1%).5 Very few in-flight medical emergencies progress to death; the reported mortality rate is 0.3%.

What kind of training airline's cabin crew shall have?

ICAO, certain national aviation authorities, and IOSA require that aircrew have a minimum of training in aviation medicine. Airline's Medical Services can ensure that the training content is compliant with what is required by the different authorities.
Cabin crew must be well trained in First Aid to enable them to assist a passenger or fellow crew member who becomes unwell in-flight. They must be prepared for virtually any sort of medical emergency and many airlines now put the crew through a rigorous training program, to incorporate all aspects of First Aid including CPR and emergency childbirth. These training programs may be subcontracted out to specialist trainers or carried out “in house”.

What are the Functions of the Airline's Medical Service?


Medical Services provides important support for an airline. There are different models of Medical Services (in-house, outsourced, hybrid, etc.) and airlines chose the model that best fits their operations. The level of service will be influenced by many factors such as the size of the airline, the type of operations, the type of labor force, the culture, the labor laws, the availability and cost of the services, etc.

An airline may provide medical services in several domains, e.g. Aviation Medicine,
Occupational Health, Medico-Legal, and Primary Care. Within these domains it may provide any or all of the following functions:
  • Passenger health
  • Occupational health
  • Aircrew health and medical certification
  • Alcohol and other drugs programs
  • Health and wellbeing promotion
  • Health strategy and risk management
  • Primary care service

Medical events demand attention from airlines as a matter of business, safety, and service to the passenger. Taking care of passengers is something unique to the transportation industry and, in particular, to air transportation. Once a flight is airborne, there is no possible access to any established health care system. Therefore, the airline faces a dilemma in reaching a good balance between the immediate risk and cost of a diversion, versus the implied risk or even liability when deciding to continue a flight with an ill or injured passenger. Duty of care to a passenger is expected even when the event is not a result of an airline’s fault.

In this context, it is strongly recommended [ by ICAO & IATA] that the airline maintains good and regular contact with the local and national public health authorities and align each other’s emergency response plan for public health emergencies. Among other things, this relationship is very profitable for both parties to deal with contact tracing when required.

How Airline handle In-Flight Medical Emergencies?

In-flight medical events (IFMEs) represent a challenge for airlines. The problem starts with the definition of a medical event. Different airlines utilize different criteria to categorize medical events and no internationally accepted standard exists. This means that airlines handle medical events differently.

The following is an example set by me to explain how airline handle In-flight medical events (IFMEs): 

Step 1: Application of routine safety practices( according to airline safety policy)

In this step, a call from passengers experiencing an in-flight medical emergency. The cabin crew starts preparing to respond to the event. Flight purser who has had proper training in crew resource management (CRM), will effectively reallocate resources during a medical event to ensure their actions account for all aspects of the event and the welfare of the other passengers. flight purser must inform the Captain to get proper instructions

Effectively manage the event by the setting of the prioritization and delegation, has the best chance of maintaining situational awareness and decreasing the opportunity for error. 

Step 2: Preparing In-Flight Medical Supplies

The limited medical supplies available on aircraft often challenge doctors who offer to respond to in-flight medical events. However, several important medical resources are available.

The crew needs to be trained and updated on the use of the aircraft emergency medical equipment. Most international aircraft now carry both First Aid Kits and Emergency Medical Kits. The crew must be familiar with the contents and their use, even if they do not use them themselves. Any onboard passenger doctor who comes forward to assist during an in-flight medical event will rely on the crew’s familiarity with the equipment to assist with the management of the sick passenger.

Note: Special thing which I need cabin crew does is keeping cabin secured during like these events.

Step 3: Asking for doctor help on-board 

Serious events do occur during flight, which requires immediate emergency care. In this case, doctor help is a must. Flight purser will initiate P.A to ask for a doctor on board to help.

A doctor who wishes to respond to in-flight medical emergencies must first determine if they are sufficiently capable of providing care. During a flight, some doctors do not expect to be on duty and so may have consumed alcoholic beverages to an extent that would potentially render them unsuitable to respond. When it is appropriate to become involved in a medical emergency during flight, the doctors should state his or her qualifications to the passenger and flight personnel. If circumstances allow, the volunteer doctors should obtain the patient’s consent for evaluation and treatment. Additionally, with the multilingual nature of commercial air travel, especially on international flights, the provider may need to enlist a translator’s
assistance.

Step 4: Transporting the patient to a more spacious area [ In some cases only] 

The aircraft cabin environment could not be more different than a typical examination room. It is cramped, loud, and dim, and lacks privacy- all of which pose challenges when treating a patent. Most patients can safely be managed in their seats. However, the patent needs to be transported or more space is required for a comprehensive examination, options include a patient in the aisle or, perhaps most useful, transporting the patient to a more spacious area of the aircraft, such as the galley. Experts recommended that the cabin lighting must be turned on full.

Step 5: Communication To ground-based medical services

Some airlines now have in-flight access to ground-based medical services that the crew can contact using available communication systems. These services are provided by physicians who are trained in remote medical care. Such systems are invaluable as they not only provide experienced medical advice relevant to air travel but also assist the captain of the aircraft in making decisions about a potential medical diversion. Using such telemedicine systems to minimize the risk of diversion will not only save the airline cost, the passenger's inconvenience but also helps the sick passenger, who, even if unwell, does not want to be hospitalized in a foreign place with all the problems and difficulties that entails.

Step 6: Aircraft diversion decision 

If a passenger has critical medical needs, Doctor [ in-flight medical volunteers] can recommend flight diversion, which should also be discussed with ground-based medical staff. However, as emphasized earlier, the captain makes the ultimate decision to divert, taking into account other operational factors that affect the safety of the aircraft and its occupants. 

Step 7: Care on arrival 


After the aircraft lands, if the passenger must be transported to a hospital, providers
should supply prehospital personnel with requisite transfer-of-care communication. Doctor [ in-flight medical volunteers ] who have performed a significant medical intervention might find it appropriate to accompany the patient to the hospital.



Airlines must have 24/7 clearance service for passengers with medical conditions, this service is usually in conjunction with reservations. This function ensures that the traveling ill passenger meet established standards and policy, and will minimize the chance of deterioration in-flight. It will also specify if any extra support (attendant, oxygen, etc.) is needed. 

Flying during coronavirus outbreak will change health, safety and quality regulation. I am sure in the coming months, we will hear that the medical services department is a must in airline organizational structures. as same as the safety and quality departments. 
Finally, a medical emergency plan must be included in the airline's emergency response manual. see you in the next article, Maged.



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