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Airline study finds onboard illness, diversions rare

By Gene Emery

NEW YORK (Reuters Health) - Flying somewhere?

A new study of more than seven million commercial aircraft fights has concluded the odds of having a medical emergency on your plane are 604 to 1 and the chances of ending up at a different airport as a result are about 8,500 to 1.

The likelihood of someone dying during your flight: 240,000 to 1.

"We found that it's very rare for someone to die on board an aircraft," said Dr. Christian Martin-Gill of the University of Pittsburgh School of Medicine.

The analysis of in-flight emergencies was designed to provide recommendations to healthcare providers who are sometimes called on to help deal with in-flight emergencies "and raised awareness to what they might encounter when flying," he told Reuters Health in a telephone interview.

The study, published in the New England Journal of Medicine, is one of the largest to log such emergencies and track outcomes for the people who were in distress.

Dr. Melissa Mattison of Beth Israel Deaconess Medical Center in Boston, who was not involved in the research, called it "a great step forward" because it will help doctors and airlines know what they might have to deal with.

Data for the new study came from the STAT-MD Communications Center at the University of Pittsburgh, which provides live physician advice to airlines during in-flight medical emergencies. When the data were collected, from 2008 through most of 2010, the center was used by five airlines, accounting for 10 percent of all global air traffic.

The biggest problem in the air: fainting, which was responsible for 37.4 percent of the emergencies.

That was followed by respiratory problems (12.1 percent), nausea or vomiting (9.5 percent), heart problems (7.7 percent) and seizures (5.8 percent). Cardiac arrest, listed separately, was reported in 0.3 percent of cases.

In the vast majority of cases, there was a doctor, nurse or emergency medical technician on the plane to help. In 48.1 percent of the cases, the most-experienced person was a physician, in 20.1 percent of instances it was a nurse and in 4.4 percent of the cases it was a rescue worker.

If a doctor or EMS worker was helping, there was about a 9 percent chance that the plane would be diverted. With a nurse it was around 6 percent. Otherwise, the rate dropped to just under 4 percent. Martin-Gill said the varying rates probably reflect the fact that help from a physician is only sought in serious cases.

In all, a little more than 7 percent of the emergencies were considered serious enough to divert the plane.

There were 36 total deaths in the plane or, subsequently, in a hospital - 31 were from cardiac arrest, four followed an episode of fainting or light-headedness and one was a person who had breathing problems.

Mattison told Reuters Health in a telephone interview that the results revealed a few problems with the current system.

One is that the Federal Aviation Administration's standards for on-board first aid kits aren't as good as they should be.

The impact was seen in the data - flights that carried anti-nausea medicine, which is not required by the FAA, were less likely to be diverted than those that did not.

In addition, the kits are not consistent from airline to airline.

"When a patient has a cardiac arrest on the fifth floor of my hospital, the crash cart on the fifth floor looks exactly like the crash cart on the fourth floor. The users all know what to find in the second drawer," Mattison said. But every airline can organize its first aid kit in a different way, and some may include medicines that others don't.

In addition, there's no requirement that an airline have access to doctors on the ground for consultation in an emergency.

That should be an important issue for consumers, Mattison said.

"As a passenger, when you're booking your ticket you don't know if an airline has air-to-ground support to call in an emergency. There's no way of knowing any of this," she said.

"It needs to be the federal government that gets involved because the airlines haven't solved this on their own," said Mattison.

Martin-Gill said one lesson for passengers is to stay hydrated.

"The most common emergency was passing out or feeling like you're going to pass out," he said. Dehydration is often the cause.

The researchers said in many cases, fainting symptoms will improve by themselves in 15 to 20 minutes, and giving the passenger fluids, intravenously or orally when they regain consciousness, may be enough.

Cardiac arrest was the most frequent reason for diverting a plane. The study team logged 38 cases, including 22 diversions.

Sometimes a diversion isn't possible because the craft is over the ocean, Martin-Gill said. Sometimes it simply isn't wise to land the plane at a nearer airport unless there's a hospital in the vicinity equipped to handle the emergency.

Of the 11,920 emergencies, 26 percent ultimately resulted in someone being transported to the hospital and nearly 9 percent were admitted to the hospital.

Aspirin was the most common medication used for first aid; it was given in 5 percent of cases.

Automated defibrillators were applied in a little over 1 percent of the cases, but often they were simply used to monitor the passenger during flight. Only in eight cases were shocks administered.

SOURCE: http://bit.ly/16pomJs New England Journal of Medicine, online May 29, 2013.

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