Table 3.
Recommendations for Traveling Physicians or Other Health Care Providers during In-Flight Medical Emergencies.
| General Approach to In-Flight Medical Emergencies |
| Identify yourself and specify your level of medical training to the flight crew. |
| Patient assessment: |
| Identify the patient's chief problem and its duration. |
| Identify associated and high-risk symptoms (e.g., chest pain, shortness of breath, nausea or vomiting, or unilateral weakness or numbness). |
| Obtain vital signs (pulse and blood pressure). If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse. |
| Assess the patient's mental status and determine whether there are focal neurologic deficits. |
| If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED). For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities. (The airline may require contact with a ground-based consultant before use.) |
| Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed. |
| Initiate consultation with the ground-based consultant if not already initiated by the flight crew. |
| Recommendations for interventions, such as administration of medications or intravenous fluids, should be discussed with the ground-based consultant. |
| Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation. |
| Document the clinical presentation and care rendered. This information should be provided to medical personnel on arrival at the destination with the transfer of care. |
| Management of Syncope or Presyncope |
| Confirm breathing and pulse. |
| Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen. |
| Check vital signs. Most patients will be hypotensive immediately after the episode. |
| If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment. (A device may also be available in enhanced EMKs.) |
| Most patients will recover spontaneously within minutes. Give oral fluids when possible. |
| Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids. |
| Management of Chest Pain or Palpitations |
| Check vital signs. |
| Provide oxygen. |
| If chest pain may be cardiac in origin, consider administering aspirin. |
| If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes. Check blood pressure after each dose. |
| If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads. |
| If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions. |