Mile-high Medicine Part 1: Managing Medical Emergencies on Planes

Listen to episode #14 of NAVIGATE to learn what happens when there’s a medical emergency on a plane.

Mile High Medicine – Part 1:

 

 

Rodger Cook

0:00:04 – 0:01:29

Hello, welcome to navigate. I’m your host Rodger Cook, and today is the first part of a two part series titled Mile High Medicine. Today we’re joined by the Managing Director and Chief Medical Advisor for Flight Care Globa, Dr. Simon May. Flightcare Global provides a range of products to help manage medical events pre-flight, in-flight and on the ground. Their approach is both innovative, technology-based and cost effective. The team’s able to provide a high level of medical operation and account management experience and knowledge to support their clients wherever they are in the world. Joining Dr. May, we have World Travel Protection’s very own Dr. Neil Slabbert. Neil is the Regional Chief Medical Officer for the APAC region for World Travel Protection, and he’s an emergency physician and senior staff specialist in emergency medicine in Queensland, and holds an honorary contract with the Royal London Hospital in London’s air ambulance. He has contributed to international multicenter randomized controlled trials and pre hospital and emergency medicine and continues to pass on his wealth of knowledge and expertise as a teacher and trainer. And today we’re going to explore what happens when something goes wrong in the air on a commercial flight. What’s the responsibility of the aircrew? What support mechanisms do they have? And what happens when someone is sick? Dr. May, let’s start with you. When we talk about flight crew and the training they receive from a medical perspective, how thorough is and what sort of training would we expect our crews to have?
Dr Simon May

0:01:29 – 0:02:57

The training is different between countries. But generally, you know, there’s some basic competencies that all aircrew should have. So you know, whatever airline you’re going, whatever country they’re from, the crew will be trained in how to do CPR. The crew – the crew will be trained in how to manage a burn or a scold. And the crew will be very used to dealing with passengers who faint. Of course, we’ve got to remember that these are not medically medical people, they’re primarily there for our safety and service. Generally, cabin crew, as part of their regulated training have actually fairly extensive aviation first aid training. And the longer they’ve been doing the job, the more the more medical incidents they see on board and the better they get at it. If you put it into perspective, probably around one in every 40 flights has a medical incidents on board, that’s Australian data. And about one in 150 flights, you could classify that as a medical emergency. So throughout a cabin crew’s career, not only will they go their initial training, their recurrent training, which generally happens annually, but they’ll also see events out on the line and become comfortable managing the sick passenger. There are the tools that they have to help them such as ground-based medical assistance, and potentially the old ‘is there a doctor on board?’ or what we call medic medically qualified volunteers. But generally, cabin crew are actually pretty good at managing the sick passenger. But also in companies that use ground-based medical support, importantly, how to communicate with ground-based medical support, to get to get the best out of that communication.
Rodger Cook

0:02:58 – 0:3:04

And Neil, one for you – what would be the most common incident that the aircrew would have to contend with, whilst they’re in the air?
Dr Neil Slabbert

0:03:05 – 0:03:58

Most of the incidents, in fact, 35% were in passengers that were over 55 years old. The common incidents internationally that are seen are syncope or near syncope. Which means a near faint or a fainting episode or a collapse or near collapse. And that’s seen in approximately 35% of passengers. Then each roughly 10% are respiratory complications, nausea and vomiting or gastrointestinal upset. And then any cardiovascular compliance such as discomfort on the chest. And following that five to 6% are seizures onboard an aircraft
Rodger Cook

0:03:58 – 0:4:16

Obviously treating somebody who’s unwell on board the the primary consideration would be for their well being but the aircraft still has a has a flight path and it has a destination and there’s there’s requirement for to get for it to get there. So this there must be a consideration when aircrew are required to support someone who is unwell?
Dr Simon May

0:04:16 – 0:04:39

Yeah, look, there’s no such thing as cheap diversion and even, you know, an extra landing fee and a bit of extra fuel will mount to the 1000s. You know, big international diversions wide body aircraft with you know, 300 plus passengers on – some of whom then miss the connections – they can run into hundreds of 1000s of dollars US dollars in cost.
Rodger Cook

0:04:39 – 0:04:49

When a medical incident occurs in the air, clearly that the first concern really is for the person who’s unwell. That does place a lot of pressure on the aircrew to make sure they make the right decision.
Dr Simon May

0:04:49 – 0:05:14

Yeah, it does. And generally, the crew will be good at you know, managing the whole incident as a whole. The other thing to think about is this ground-based medical support so having somebody who’s objective on the ground, who’s experienced in this field, providing advice and decision support to the crew to get the best outcome, not only for the passenger or patients on board, but also for the operation as well.
Rodger Cook

0:05:14 – 0:05:26

You talked about the ground-based medical support. And that’s, that’s really where Flight Care Global come into, and how do you support the aircrew through that through through your organisation?
Dr Simon May

0:05:26 – 0:06:35

So what we’ve developed is we’ve developed an end-to-end technology platform. So what we do is we use technology to bring the expert clinician to the aircraft. So we have a user interface, which is an application, which can be used either in the cabin or in the flight deck, generally over Wi Fi, but the system will also work with a standard SATCOM voice call. And what that does, it basically takes some basic information about the flight, the flights position, the flight durations, or how long is left in the flight, and also some basic demographic and symptom information about the passenger. And that is transmitted directly into our case management system, which we call our command center, which is, which is our rear end system where our where our commissions work on the cases. And basically, we have direct communication between that command center in the aircraft through our technology, and we also feed in a lot of operational information. So, you know, this is a small part of medicine, and a big part of understanding the operations that you’re supporting.
Rodger Cook

0:06:35 – 0:06:55

You know, we’ve ascertained that the the aircrew are appropriately trained, they’re appropriately equipped, they’ve got ground-based medical support. And yet we still I’ve been I’ve been on aircraft where I’ve heard, you know, over the PA system, “Is there a doctor on board?” – this seems to be a normal operating procedure. It’s not without its complexities.
Dr Simon May

0:06:55 – 0:07:49

 

So there’s generally most flights, I’d say, have somebody either a doctor or nurse, paramedic, something like that on board. So the airlines that I’ve worked for in the past in excess of 80, or 90%, even have had somebody on board who could render assistance. Of course, the problem’s twofold. The problem is, you know, the background of the medically qualified volunteer, you know, involved in the case that could be a psychiatrist, rather than an emergency physician or a general practitioner. And also, there’s the competing interests. So, you know, they may be very uncomfortable in the situation with a sick passenger aboard an aircraft and just want to get that aircraft on the ground as soon as possible to resolve any, or absolve any responsibility. And the second thing is also they may want to get to their destination as well. So there may be that the competing interest actually, I need to get where I’m going to get to dinner or to get to my conference. So you know, there’s all those competing interests with with the medically qualified volunteer.
Rodger Cook

0:07:50 – 0:07:58

Neil – as a medical professional, what are some things that you would consider if you heard the, you know, ‘Is there a doctor on board?’ over the PA?
Dr Neil Slabbert

0:07:59 – 0:10:00

There’s a few considerations. I think one of the most important considerations is when the call is made. One, that’s an unfamiliar environment – two, you don’t know who you’re actually seeing whether it’s an adult or a child, and depending if you’re a medical specialist or not in what field you’re in, it may be something that you’re uncomfortable with or it’s outside your field of speciality. The other consideration is medico legal consequences around providing assistance. Fortunately, there are there there acts to encourage you to provide medical assistance. There’s a commonly known Good Samaritan Act. And certainly in Australia, there’s legislation to protect you should you have provided medical assistance. In the US, they put something similar called the Aviation Medical Assistance Act. It also, interestingly, depends on what the flag right on the aircraft so where the aircraft is registered. Interestingly, in the EU, there is a requirement as a medical professional to provide medical assistance. The reassuring thing is that most modern aircraft have now got Wi Fi onboard and all international, all airlines will have some sort of subscription to ground-based medical support. So in conjunction with ground-based medical support, in conjunction with potential wifi on an aircraft where things like an ECG can be WhatsApped to ground medical support, the correct help and the correct medical decisions can made.
Rodger Cook

0:10:01 – 0:10:08

So when the medical volunteer on board does stand up and provide assistance, what sort of equipment do they have to work with?
Dr Simon May

0:10:08 – 0:11:21

Yeah, so many aircraft, and in some countries it’s regulated will have something called an emergency medical kit. It’s not regulated in every country. For example, in Australia, it’s not compulsory that you carry this medical kit on board. But that will often have things like passenger assessment equipment, so blood pressure, temperature, maybe even blood oxygen level equipment on in there, and also some, some basic treatments that can be used either by the crew on the instructions of ground-based medical support, or buy a medically qualified volunteer onboard the aircraft. Now, the best way of using a medically qualified volunteer on board the aircraft, we mentioned these medically qualified volunteers earlier, is actually in conjunction with the ground-based medical support provider. So what we do is we have the ground-based medical support provider, managing the case and making the decisions and the medically qualified volunteer on board the aircraft being their eyes, ears, and hands. So for example, if, for example, a passenger might need an injection, that’s something that the cabin crew probably wouldn’t be trained to do and probably shouldn’t be doing. But if there’s a medically qualified volunteer on board, who can give an injection that’s prescribed by the ground-based medical support, then that’s when things go really well.
Rodger Cook

0:11:21 – 0:11:26

And what would happen in the instance, if the medical trained volunteer recommended that the aircraft be diverted?
Dr Neil Slabbert

0:11:26 – 0:12:24

I think the important thing to realise with with a diversion is the overall decision lies not with the medical practitioner, but was the captain of the aircraft. And this – while the medical practitioner might be familiar with the route they’re flying, or the area they’re flying, it might be that the nearest airport isn’t an airport that’s able to support the aircraft. Just for example, I know with Airbus A380s, their runway needs to be a certain length and a certain width. So it might – the cost aircraft might not be able to land at the most suitable airport. The other consideration the captain would have to make is the welfare of the other sort of passengers on board. And of course, any diversion is a really, really costly exercise.
Rodger Cook

0:12:24 – 0:12:37

Have you ever been in this position, Simon, where you know, the call’s come over the PA for medical professional, and you’ve had to respond?
Dr Simon May

0:12:37 – 0:13:32

Yeah, quite a few times, I generally find that the best cure for that is a pair of earplugs. But we spent a number of years working for airlines, and sometimes the crew know who you are. So they would often tap me on the shoulder before they call our ground-based medical support provider. You know, I’ve been on a couple of flights in the last three years even where I’ve seen some fairly sick passenger. And it’s just a function of the fact that I was actually traveling quite a lot, you know, these things happen. As we say, one in every 40 flights as such, you know, more people are flying, as travel becomes accessible to the masses. People are traveling at older age, people are traveling with more controlled complex medical conditions. And really importantly, as well is people are traveling for medical treatment. So people may travel for surgery that they can’t get in their own country, and they can be quite unwell. And if they don’t tell the airline and the airline doesn’t risk manage that then these are the ones that can tend to get quite unwell on board the aircraft.
Rodger Cook

0:13:32 – 0:13:40

Neil, is there a role for the airlines here? Is there a role that they can play in making sure that support traveler health?
Dr Neil Slabbert

0:13:41 – 0:14:28

The airlines minimize their risk by following what are called the IATA International Air Travellers Association medical guidelines. And this is a comprehensive document which has a list of varying medical conditions where if you have suffered one of those recently, either you’re going to be not fit to fly. Or if, after a certain period of time, you may be fit to fly but you need a medical clearance from the treating practitioner who’s been looking after you to certify that you are fit to fly and you are healthy to actually undertake the flight.
Rodger Cook

0:14:28 – 0:14:34

And what about the traveller, Neil, what can what can they do to help support their own health and well being when they travel?
Dr Neil Slabbert

0:14:34 – 0:15:37

I think it’s important to realise that long haul flights, intercontinental flights, have become longer and longer. A few years ago, the longest intercontinental long haul flight was 12 to 13 hours. Some of the flights are now 16 to 17 hours. Probably the most important thing is if you have got underlying medical conditions and you’re on medication is to be aware of what the changing timezone can be just for having your medication, it can become hard when some of the medication you need to have morning, lunch, and night. So be aware of the times you need to have them. And then all the other things that you would normally have on a long haul flight, i.e. make sure you minimise your alcohol intake, drinking fluids. And probably importantly, you know, mustn’t just remain in your seat and move around, if you can.
Rodger Cook

0:15:37 – 0:16:10

As we start to open up and travel more, you know, obviously, it’s been a while since many people have travelled, particularly in this part of the world, and getting back into long haul flights – it’s gonna take some effort. What about those people who are nervous flyers, you know. Prior to the to the pandemic, they were probably already a little bit concerned about flying, they didn’t like being in the air, they didn’t like the process of in like being, you know, a steel tube with few 100 strangers, how do airline support and manage those people?
Dr Simon May

0:16:11 – 0:17:13

Yeah, look, often ground support, are good at teasing out the anxious flyer and you know, many people in their emergency medical kits will carry anxiolytic medicines to, to assist. So I’ve seen a number of times, you know, somebody start with a symptom, such as shortness of breath or chest pain, and on further questioning, it’s come down to the fact that it’s probably actually an anxious passenger. And then, you know, we actually do have stuff that can assist with the anxious passenger on board, the real cure for the fear of flying and the anxious passenger, of course, is dealing with it before the flight and, you know, confronting those fears. And there are actually programs in a number of airlines out there that are offered to anxious players to kind of desensitize them if you like. And they’re really good programs. One of the things we expect to see an increase in health related risk as the as the industry recovers from the pandemic. And one of the things towards the top of my list of things that we’re going to see is more anxious flyers, I think.
Rodger Cook

0:17:13 – 0:17:31

Yeah, absolutely agree. And I think, you know, obviously, as we step back out, you know, the travellers not sure what’s the country going to be like, when they arrive giving the COVID? And what are they going to meet when they get there’s just purely the lack of flying and the lack of opportunity to experience of late?
Dr Simon May

0:17:31 – 0:17:55

Yeah, I think a mixture of all three, you know, the context that you’re going overseas, you’ve not been overseas for a while, the world’s changed. And also you’ve not, you know, you might have been a bit of a nervous flyer before, we’ve not been on an airplane for a couple of years. And now you’re on an airplane wearing a facemask going out to a new world. So you know, we see that, you know, flight related anxiety is one of the things at the top of the list that we’re going to see, as we kind of come out of the pandemic.
Rodger Cook

0:17:55 – 0:18:05

It is definitely going to be a different flying experience from what people are used to, and how do you think the industry is managing this return to travel? Are they doing anything differently?
Dr Simon May

0:18:05 – 0:18:45

Yeah, look, I think, you know, a lot of it depends on, you know, what’s actually going on in the country where the airline is based, you know, there really is no international consistency around how people are managing borders, how people are managing travel. So, you know, we see some airlines who’ve been flying throughout the pandemic, who may be actually a little bit further towards normalcy than those that are just regaining flying, because they’ve got very used to it. You know, all the crew were vaccinated early, and they’re really, you know, finding their new normal. Whereas we’ve had airlines that have been grounded for months on end, who are now, you know, just coming back to flying, and, you know, just finding their way.
Rodger Cook

0:18:45 – 0:18:58

Yeah, absolutely. And it’s definitely a multi-speed recovery for the aviation sector. What do you see as being the biggest challenge for the airlines in supporting health and wellbeing for travellers in the next six months?
Dr Simon May

0:18:58 – 0:19:44

Yeah, well, I think the first thing is, you know, being aware of non-COVID health risks. So, you know, everyone’s going to be aware of COVID test, COVID vaccinations that check in, but like I said, there’s a lot of pent up demand from the determined traveller out there. So you know, you, you’ll get people that want to travel to have their significant surgery, you’ll get people that want to travel to visit, you know, friends and family overseas, who are actually sick. So the first thing is remembering those red flags, and also promoting to the, the broader passenger base that if you’ve got a medical condition, it’s not necessarily a bar to you traveling, but please do let your carrier know so a risk assessment can be done. And anything that can be done to facilitate your travel can be can be facilitated.
Rodger Cook

0:19:44 – 0:20:01

Some terrific insights there from your industry experts. I’d like to thank Dr. Simon May and Dr. Neil Slabbert for their contribution to today’s episode, and please like, subscribe and follow the NAVIGATE podcasts. Keep an eye out for the second of the series. That was Mile High Medicine, brought to you by World Travel Protection.

In the first part of this series on medical support in the air, host Rodger Cook focuses on commercial flights. What medical equipment is onboard the aircraft? What training and support do the aircrew have to help manage an incident? What’s the process behind the famous call “Is there a doctor onboard?”

We learn the answers to these questions and more with interviews from Managing Director and Chief Medical Advisor for Flightcare Global, Dr Simon May and Regional Chief Medical Officer – Asia Pacific for World Travel Protection, Dr Neil Slabbert.

Listen to the end of the episode for advice on how to manage your wellbeing during long non-stop flights and what types of travellers aircrew are anticipating in 2022.

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