Study outlines recommendations of physicians to manage in-flight medical emergencies

Practical recommendations for in-flight medical emergencies for healthcare professionals have been developed by physicians at St Michael’s hospital and published today in the journal CMAJ.

Credit: PHOTOCREO/ Michael Bednarek

Hearing the question “Is there a doctor on board?” 36,000 feet can make any physician anxious, and may provoke a dilemma of whether to answer, or hold on to see if any other qualified bystander will offer assistance.

According to the study authors, there are around 2.75 billion passengers flying on commercial airlines annually. In Canada, there were 133.4 million airline passengers in 2015 and a 27% raise from 2009.

This rise in patient traffic, in addition to longer flights that cause greater stress on the body and a larger number of older passengers and persons with pre-existing medical conditions, is responsible for the increase in in-flight medical emergencies in recent years.

Every health-care professional is likely to hear this call at some point while flying, but for most of us, treating patients on a plane is a completely unfamiliar scenario. We wanted to provide a better understanding of what to expect and how to respond if you're called to assist in one of these emergencies.”

Dr. Alun Ackery, St. Michael's Hospital

The current study developed recommendations, that are in collaboration with WestJet and Air Canada, present an overview of the environmental challenges of treating patients on a plane, the available medical equipment, the airlines’ procedures and policies along with the ethical and legal duties of physicians to reply to a call for assistance.

According to Transport Canada, every plane with a minimum of 100 passenger seats is legally required to carry a medical kit. The study authors said that although Transport Canada summarizes the basic requirements to be carried in the medical kit, each airline has the freedom to improve the contents as they see fit.

The authors showed the contents of Air Canada's medical kit in a video to allow guide health-care professionals to better understand the resources available during an in-flight emergency.

Dr. David Kodama, lead author of the recommendations and an emergency resident at the University of Toronto explained that every airline’s medical kit looks different and the contents inside are not always known, which enhances another layer of complexity to an already stressful situation.

According to the authors, Quebec is the only province in Canada that enforces a legal duty on physicians to assist passengers in a very serious condition. However, all jurisdictions have legislation that supports physicians who voluntarily provide assistance during medical emergencies at the site of an accident or in an emergency.

The Canadian Medical Protective Association and the Canadian Medical Association feels that physicians have an ethical responsibility to give their best medical assistance in an emergency.

Dr. Ackery commented: “We recognize that hearing the call go out for a physician on board a flight can be unexpected, but we do have an obligation to respond. We hope these recommendations will provide healthcare professionals with enough knowledge to make that call a little bit less anxiety-provoking in the future.”