Inflight Medical Care: An Update
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Inflight Medical Care: An Update

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    Final Report
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    A major concern in aviation medicine is the cabin inflight emergency that may result in the diversion of a flight. At the present time there is no convenient way to monitor the incidence of inflight medical emergencies because airline companies are not regularly required to report medical emergencies or resulting diversions. A survey of one major US airline revealed that one out of every one million passengers may be deplaned by an unscheduled landing because of a life-threatening medical emergency. During a two-year FAA survey of US domestic flights there were 2,322 inflight medical emergencies, averaging approximately three per day, which resulted in an annual diversion rate of approximately 9%. In a 1989 study, inflight emergencies among arriving passengers at the Los Angeles International airport were analyzed. During the six-month period of the investigation 0.003% of 8.5 million passengers developed symptoms in flight that required follow-up assistance on the ground, and 10% of these passengers required hospitalization. A survey of the status of inflight medical care aboard domestic US air carriers was undertaken to determine the impact of current changes in the airline industry. Information for the years 1990 to 1993 was obtained from two airlines and two inflight medical care delivery companies, representing a total of nine major US Part 121 air carriers. This sample accounted for approximately 65% of US domestic air carrier activity for the period 1990 to 1993. The information was reviewed to determine which category of inflight medical emergency occurred most frequently and which category accounted for the greatest number of diversions. The trend in the frequency of diversions for medical reasons was also assessed. The impact of inflight medical advice was then evaluated by comparing the number of diversions that resulted in hospitalizations to the number that did not. Our findings show that neurological, syncopal, and cardiac episodes respectively, were the most frequent categories of medical emergencies encountered inflight, while cardiac, neurological, and respiratory events, in that order, accounted for the most diversions. However, obstetrical-gynecological, cardiac, and neurological cases had the greatest probability of diverting. The diversion rate, expressed as a ratio of diversions to emergencies or diversions to enplanements, remained fairly constant. It appeared that flight crews complied with medical advice in 700 of cases, and diversions resulted in hospital admissions 86% of the time. Renewed interest in the problems of inflight medical care delivery from all segments of the air carrier industry and government has led to a great deal of research into the medical problems of patients flying with a variety of health problems. Several organizations are evaluating the inflight medical kit and its impact on medical care delivery inflight. Recently, the Air Transport Association and the FAA's Office of Aerospace Medicine have independently formed working groups to investigate this topic. This increased level of interest should result in greater cooperation within the aviation industry and a deeper understanding of all aspects of the problem.
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