A Systematic Review of Pediatric and Adult In-Flight Medical Emergencies

In-flight medical emergencies during commercial travel

BACKGROUND

Growing number of passengers travelling by air is associated with increased in-flight emergency medical events (IEMEs). However, there are scarce data regarding IEMEs during commercial travels. In this study, analysis of IEMEs occurring among adult and paediatric passengers during commercial international and domestic flights of a major airline company was targeted.

METHODS

Data regarding IEMEs recorded in all international and domestic flights of a major airline company between 1 January 2018 and 31 December 2020 were collected. Demographics, adult and paediatric IEMEs, in-flight deaths and aircraft diversions (ADs) were analysed.

RESULTS

Total number of passengers was 177 400 748 and a number of 22 541 (0.012%) IEMEs occurred. The frequency of IEMEs per 1 million passengers was 127. The number of male patients suffering from IEMEs was 8387 (37.2%), while the number female patients was 10 853 (48.1%). Median age of adult and paediatric patients were 43, [32-57], 4, [2-10], respectively. The most common cause of IEMEs in adult patients was headache (3424 IEMEs, 15.1%) and it was fever in paediatric patients (688 IEMEs, 3.05%). Multiple symptoms were present in 8449 IEMEs (37.4%). On-board doctors managed events in more than half of IEMEs (13 295 IEMEs, 58.9%). AD was required in 255 (1.13%) IEMEs. The most common reason for AD was chest pain (45 IEMEs, 17.6%) in adult patients. The most common reason for AD in paediatric patients was epileptic seizures (nine IEMEs, 3.5%). A total of 46 (0.2%) patients, including 2 (0.008%) paediatric patients, died.

CONCLUSIONS

Majority of IEMEs are not life-threatening conditions, which can be easily managed by cabin crew or on-board doctors without AD. Multiple symptoms can be present in a patient suffering from IEME. Ground-to-air medical assistance may help optimization of diagnosis and decision for AD.

Is there a doctor on the plane? A review of in-flight emergencies for the on-board radiologist

In-flight medical emergencies (IFME) are the acute on-service events involving illness or injury to a passenger with the potential for long-term health compromise. With the continuously rising number of flights available, both domestically and internationally, it is conceivable that the number of IFMEs will similarly continue to rise. Although most of these instances are relatively self-limited, the rare instance of a severe occurrence justifies preparation, both from in-flight staff and healthcare providers traveling on these flights. Given these events' sporadic nature and the variable availability of medical support, all physicians need to understand their in-flight ethical and legal capabilities, the available medical supplies, and the most likely etiologies to manage such situations successfully. Most radiologists rarely utilize the hands-on, clinical skills developed in medical school or internship for emergencies beyond allergic contrast reactions. Therefore, they may not be adept in caring for patients during an IFME. As such, we present a thorough overview and literature review for the radiologist regarding the management of various acute IFMEs, with consideration for ethical and legal precedence and a review of medical equipment available on-board.

The global incidence of in-flight medical emergencies: A systematic review and meta-analysis of approximately 1.5 billion airline passengers

BACKGROUND

Medical emergencies during short- or long-haul commercial airline flights have become more commonplace due to the aviation industry's contemporary growth, the popularization of commercial flights, and an increased aging of air travelers with significant comorbidities. However, the precise incidence of onboard medical events on commercial airlines and the most common medical conditions is unclear.

METHODS

In this systematic review and meta-analysis, we explored the incidence of in-flight medical emergencies among airline passengers and estimated the incidence rate by physiological body system, or organ class/syndrome for emergencies that may be associated with different body systems. We limited our search to cohort studies published between 1945 to October 31, 2020 in MEDLINE, Embase, Cochrane Library and official reports from the Federal Aviation Administration/International Air Transport Association, regardless of the language of publication. Only studies that evaluated the overall frequency of onboard medical events on commercial air carriers (in which they also presented the total number of annual revenue passengers) and the frequency of events by physiological body systems or organ class/syndrome were included. We excluded case reports and case series, systematic or narrative reviews, and studies addressing specific health-related conditions. Two independent investigators performed first- and second-phase study screening, abstracted data, and appraised risk of bias. We rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Using a quality effect model, we meta-analyzed data associated with the incidence of in-flight medical emergencies, all-cause fatality, incidence of medical events by medical condition category, frequency of en-route diversion, presence of medical personnel on board, and the use of an automatic external defibrillator. We also extracted data regarding the cost of flight diversion.

RESULTS

Of 18 individual studies with approximately 1.5 billion passengers, 11 reported the overall incidence of in-flight medical emergencies. Low certainty of evidence suggested that the global incidence of in-flight medical emergencies was 18.2 events per million passengers (95% CI 0.5 to 53.4 per million; I² = 100%, P < 0.001, very low certainty), and an all-cause mortality rate was 0.21 per million passengers (95% CI 0 to 0.76 per million; I² = 99%, P < 0.001, low certainty). The four most common categories of medical conditions or syndromes during flight were syncope, gastrointestinal events, respiratory and neurological diagnostic groups. The diversion rate was 11.1 per 100,000 flights (95% CI 5.9 to17.6 per 100,000 flights; I² = 97%, P < 0.001), with an average cost ranging from $15,000 to $893,000 per unplanned emergency landing across studies which examined this outcome.

CONCLUSIONS

In-flight medical events on commercial travels are extremely low with a corresponding very low in-flight mortality rate. Associated costs derived from en-route diversion might significantly influence airlines' budgetary equilibrium. Novel and modern standardized reporting systems or platforms should be internationally provided and enforced by health and aviation authorities to obtain higher quality patient-passengers datasets. Onboard volunteer medical providers must be aware of everyday life-threatening events during commercial flights and should consider the establishment of a connection between the aircraft and ground-based medical advisory services while assisting in-flight medical events.