In-flight medical emergencies

Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study

BACKGROUND

In-flight medical emergencies (IMEs) are expected to increase as air travel normalized in the post-COVID-19 era. However, few studies have examined health professions students' preparedness to respond to such emergencies. Therefore, this study aimed to investigate medical students' knowledge, confidence, and willingness to assist during an IME in their internship program.

METHODS

This cross-sectional survey utilized an online, self-administered questionnaire-based survey targeted at medical students at two medical colleges in Saudi Arabia. The questionnaire comprised three parts: sociodemographic characteristics, knowledge about aviation medicine (10 items), and confidence (7 items)/willingness (4 items) to assist during an IME. Odds Ratios (OR) and 95% Confidence Intervals (95%CI) were computed to detect potential associations between the knowledge levels and the other independent variables. Responses to confidence and willingness questions were scored on a 5-point Likert scale.

RESULTS

Overall, 61.4% of participants had inadequate knowledge scores for providing care during an IME, and the proportion of participants did not differ between those who had or had not attended life support courses (60.4% vs. 66.7%, p > 0.99). Only frequency of air travel ≥ two times per year was associated with higher odds of adequate knowledge score [OR = 1.89 (95%CI 1.14-3.17), p = 0.02]. In addition, 93.3% of the participants had low, 6.3% had moderate, and 0.8% had high willingness scores, while 86.3% had low, 12.2% had moderate, and 1.5% had high confidence scores. There were no differences in the proportion of participants with low, moderate, and high willingness or confidence scores by attendance in life support courses.

CONCLUSION

Even though over 8 in 10 students in our study had previously attended life support courses, the overwhelming majority lacked the knowledge, confidence, and willingness to assist. Our study underscores the importance of teaching medical students about IMEs and their unique challenges before entering their 7th-year mandatory general internship.

Willingness and self-confidence of healthcare workers in Bahrain in assisting with in-flight emergencies

BACKGROUND

In-flight medical emergency (IFE) impose considerable challenges on healthcare workers (HCWs) because of limited resources, constrained environment, and medico-legal issues. This study assessed HCWs knowledge, willingness, and confidence in addressing in-flight medical emergencies.

MATERIALS AND METHODS

A cross-sectional study was conducted between June and August 2023 among nurses and physicians working in primary healthcare centers and governmental hospitals in Bahrain. Subjects were selected using stratified random sampling; a self-administered online questionnaire of high reliability (Cronbach alpha = 0.914) was used to collect the data. Logistic regression analysis were performed to determine association of knowledge, willingness, and confidence in dealing with in-flight emergencies with various characteristics of HCWs.

RESULTS

The study included 805 HCWs with mean age of 35.5 years (SD=9.2). The findings indicated deficiency in training, with <10% of participants trained on IFE. A considerable proportion of participants exhibited low levels of knowledge (88.3%) and confidence (75.9%) with IFE. Nonetheless, more than half of the participants expressed the willingness to assist in IFE (59.1%). Non-Bahraini healthcare professionals (odds ratio [OR] = 2.901, P < 0.001) had higher knowledge of IFE. Nurses (OR = 1.642, P = 0.047) and participants with longer work experience had higher willingness to assist in IFE. In addition, professionals who were non-Bahraini (OR = 3.249, P < 0.001), working in secondary care (OR = 1.619, 95% confidence interval P = 0.021), had had training on IFE (OR = 2.247, P = 0.004), and had encountered IFE before (OR = 1.974, P = 0.006) had greater self-confidence levels.

CONCLUSION

Considering the low levels of knowledge and confidence healthcare professionals in Bahrain had with regard to IFE, targeted training initiatives and educational programs are necessary to improve HCW's confidence and preparedness to deal with such emergencies.

Fatigue among Air crews on (Ultra)-Long-Range flights - A comparison of subjective fatigue with objective concentration ability

Introduction

Long duty times are common in the aviation industry, especially with the introduction of ultra long range flights (ULR). This article aims to compare the subjective fatigue assessment and concentration ability of flight crews with objective concentration and alertness tests during (U)LR-flights.

Method

The study examined different (U)LR-flights. Before, during and after the flights subjective fatigue and concentration ability of the flight crew was examined with visual analog scale and objective attention and concentration ability with the FAIR-2 test respectively the 3-min Psychomotor Vigilance Test. For statistical analysis we used a repeated ANOVA with a post-hoc-analysis and a Wilcoxon signed-rank test for connected samples.

Results

In total 28 crew members were examined. Subjective concentration ability declined and fatigue increased significantly over the course of flights. However, no significant changes were observed in the objective concentration tests performed before and after the flights.

Conclusions

The study found that fatigue significantly increased with flight time, particularly during night hours at the window of circadian low of the crews. However, objective concentration performance showed no significant deterioration over time. The study's results were consistent with previous research, except for the finding that objective concentration was still stable. The study also compared the findings to another profession and found similar results regarding the performance of complex tasks after long working hours while experiencing fatigue.

Pratical applications

This study helps to understand the effects of ultra long-range flight on fatigue and concentration of the air crew and can help to improve safety issues on such flights.

Suitability of aircraft wastewater for pathogen detection and public health surveillance

International air travel is now widely recognised as one of the primary mechanisms responsible for the transnational movement and global spread of SARS-CoV-2. Monitoring the viral load and novel lineages within human-derived wastewater collected from aircraft and at air transport hubs has been proposed as an effective way to monitor the importation frequency of viral pathogens. The success of this approach, however, is highly dependent on the bathroom and defecation habits of air passengers during their journey. In this study of UK adults (n = 2103), we quantified the likelihood of defecation prior to departure, on the aircraft and upon arrival on both short- and long-haul flights. The results were then used to assess the likelihood of capturing the signal from infected individuals at UK travel hubs. To obtain a representative cross-section of the population, the survey was stratified by geographical region, gender, age, parenting status, and social class. We found that an individual's likelihood to defecate on short-haul flights (< 6 h in duration) was low (< 13 % of the total), but was higher on long-haul flights (< 36 %; > 6 h in duration). This behaviour pattern was higher among males and younger age groups. The maximum likelihood of defecation was prior to departure (< 39 %). Based on known SARS-CoV-2 faecal shedding rates (30-60 %) and an equal probability of infected individuals being on short- (71 % of inbound flights) and long-haul flights (29 %), we estimate that aircraft wastewater is likely to capture ca. 8-14 % of SARS-CoV-2 cases entering the UK. Monte Carlo simulations predicted that SARS-CoV-2 would be present in wastewater on 14 % of short-haul flights and 62 % of long-haul flights under current pandemic conditions. We conclude that aircraft wastewater alone is insufficient to effectively monitor all the transboundary entries of faecal-borne pathogens but can form part of a wider strategy for public heath surveillance at national borders.

Changes in vital signs, ventilation mode, and catecholamine use during intensive care aeromedical evacuation flights

Introduction

Especially after (natural) disasters, local health systems are also destroyed or their ability to work is massively restricted. The transport of injured patients is therefore often necessary for further care. Numerous nations keep fixed-wing aircraft with intensive-care capabilities available for secondary transport, but little data on the transport is available to date.

Methods

An analysis of all flights with the German Air Force's intensive care fixed-wing-aircraft carried out in the context of humanitarian aid missions since 2002 with a focus on intubated patients was done.

Results

A total of 38 patients were transported. Two patients had to be intubated on or during transport. There were significant changes in the necessary positive end-expiratory pressure (PEEP) and the fraction of inspired oxygen. Circulatory parameters did not change.

Discussion

Overall, there are no clinically relevant deteriorations due to secondary transport with corresponding air transfers. Due to the hypobaric hypoxic conditions on board of all aircrafts, intubation in clinically borderline patients should be performed electively on the ground before flight.

Effectiveness of Telemedicine and Teledentistry after the COVID-19 Pandemic

Telemedicine has become increasingly important worldwide over the last two decades. As a new field, it became known especially during the COVID-19 pandemic; this review presents fields of activity with special attention to opportunities and risks. Numerous areas of application offer the possibility for broad use in the medical and dental care landscape in diagnostics, therapy, rehabilitation, and decision advice across a spatial distance. Technical and semantic standards are required, and profiles and guidelines are increasingly defined and organized. Medical/dental consultations have been established in various regions around the world as a response to pandemic challenges and have made video and online emergency consultations possible. Telemedicine applications are already regularly used in medical/dental emergencies, regardless of the pandemic situation, both for transport by train and by plane, from which patients benefit. However, legal hurdles are often still unresolved, but infrastructure challenges both for provider, user hard- and software also complicate deployment. Problems are particularly prevalent in the absence of necessary internet coverage or among socially disadvantaged and vulnerable groups who cannot afford expensive equipment or do not know how to use the technology. Broad access must be enabled, and hardware and software interfaces and updates must be regularly checked and updated. Telemedicine might also improve access to and delivery of oral and general health care support both for rural and urban areas with low costs. Even though dentistry and many medical specialties are still performed clinically by means of practical/manual examination, there are areas of diagnostics where telemedicine applications can provide good support. Therefore, as conclusions, access, and delivery of telemedicine applications in dentistry and medicine should be expanded and improved to provide access to all population groups.

Travelling with heart failure: risk assessment and practical recommendations

Patients with heart failure are at a higher risk of cardiovascular events compared with the general population, particularly during domestic or international travel. Patients with heart failure should adhere to specific recommendations during travel to lower their risk of developing heart failure symptoms. In this Review, we aim to provide clinicians with a set of guidelines for patients with heart failure embarking on national or international travel. Considerations when choosing a travel destination include travel distance and time, the season upon arrival, air pollution levels, jet lag and altitude level because all these factors can increase the risk of symptom development in patients with heart failure. In particular, volume depletion is of major concern while travelling given that it can contribute to worsening heart failure symptoms. Pre-travel risk assessment should be performed by a clinician 4-6 weeks before departure, and patients should receive advice on potential travel-related illness and on strategies to prevent volume depletion. Oxygen supplementation might be useful for patients who are very symptomatic. Upon arrival at the destination, potential drug-induced photosensitivity (particularly in tropical destinations) and risks associated with the local cuisine require consideration. Special recommendations are needed for patients with cardiac implantable electronic devices or left ventricular assist devices as well as for those who have undergone major cardiac surgery.

[Travelling with a pacemaker or implanted defibrillator]

There are no guidelines for patients travelling with implanted pacemakers or defibrillators. Only few publications deal with specific problems that this patient group might face. In this article different aspects of travelling with implanted electric devices are summarized. Patients with pacemakers and implanted defibrillators have nearly no limits when travelling. An exception to that rule is scuba diving, which mostly is limited because of the device. In general it is the underlying heart disease or arrhythmia that limits patients' travel activities. It is reasonable to travel after implantation only after wound healing is complete because arm movement on the implant site is limited and the risk of wound infection and lead dislocation is elevated in the early phase. However, if necessary, flying is possible 2 days after an uncomplicated implantation if pneumothorax can be excluded. Security checks can be passed safely by patients with pacemakers/defibrillators. Only repetitive movement of a handheld metal detector over the device should be avoided. When travelling to different time zones it might be reasonable to deactivate a programmed sleep rate (Medtronic, Biotronik). Patients at risk for ventricular arrhythmia (mainly patients with an implantable cardioverter-defibrillator) must make sure to take all possible preventive measures to avoid travelers' diarrhea. In case of infection early replacement of fluids and electrolytes is essential.

In-flight allergic emergencies

Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have concerns that this subject has not received the attention it warrants. There is a need to provide passengers at risk and airlines with the necessary measures to prevent and manage these emergencies. A review of the epidemiology, management and approaches to prevention of allergic and asthma emergencies during air travel is presented with the goal of increasing awareness about these important, potentially preventable medical events.

In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment

Background

Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society.

Materials and methods

Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (p<0.05 was considered significant).

Results

Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members’ demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers.

Conclusion

Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training.

[Aerosinusitis: part 1: Fundamentals, pathophysiology and prophylaxis]

The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part 1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part 2, diagnosis, conservative and surgical treatment will be discussed.