Here are some excellent insights from Dr PAULO M ALVES who, as Vice-President (Aviation and Maritime Health) with MedAire Inc, assists with medical case reviews, staff training, medical industry presentations and client support. He is the former Medical Director for Varig Airlines in Brazil.
In-flight cardiac arrest: Would you put your hand up to help?
Imagine that you, as a flight nurse, are travelling on a commercial jet to meet a patient you will escort back next day on a repatriation mission. The case is simple and you are not carrying any special drugs or equipment.
En route, you hear an announcement asking for a medical volunteer. You alone step forward and there you see a passenger in cardiac arrest with flight attendants performing CPR. What do you need to know about sudden cardiac arrest (SCA) in-flight? What tools will be available?
SCA is an overwhelmingly emotional situation in the aircraft environment, particularly for relatives of the victim and crew handling the event.
Fortunately, in-flight SCAs are relatively rare
Providing in-flight medical advice to nearly 90 airlines over the past eight years, MedAire Inc estimates that an average of one in-flight death occurs in 5.7 million passengers, or 0.08 per billion for each kilometre a paying passenger is carried ("revenue passenger kilometres" or RPKs).
But considering the number of flights at any given moment, the absolute numbers are not exactly small. MedAire is involved in precisely 5.6 cases per month which represents the average over a period of nine years.
At cruising altitude, the vast majority of healthy passengers can tolerate a cabin pressure of 6,000-8,000 feet. However, cabin pressure can be a problem for those with cardiac or pulmonary conditions, particularly borderline risk factors.
Events leading to an in-flight SCA may begin well before the flight. Many air travellers have to walk longer distances and carry more weight than they are accustomed to. They also may be in a hurry, adding psychological stress to the equation.
The bottom line: passengers can easily cross their safety limit if they already have, knowingly or not, a subjacent health condition.
How "sudden"?
Necropsy studies of onboard deaths show different causes of expiration bearing no relation to the flight at all. Many are not necessarily "sudden" by definition - for example, a terminally ill patient seeking medical treatment or simply returning home to die. Some passengers, understandably, won't disclose and may even disguise their condition, afraid of being denied boarding.
Flight attendants are trained to perform lifesaving procedures such as CPR, but having an experienced medical person on board is always welcome in critical situations. As a flight nurse, you may be asked to step forward to assist a passenger other than your own.
The advent of automated external defibrillators, carried by many airlines, and enhanced medical kits have changed the way airlines cope with an unexpected in-flight cardiac arrest. Contents vary, but most medical kits have at least adrenaline (epinephrine), atropine and a resuscitation bag and mask. Emergency therapeutic oxygen is also available. As a result, people today have a greater chance of surviving in-flight SCAs.
Having a nurse on board is an invaluable resource to help crew directly. You can establish IV lines while working under the direction of a ground-based medical support team, a service that more and more airlines are consulting. The end result could be a life saved.