Does the thought of responding to an in-flight emergency ruin your air travel? Then tune in because on this episode, Angelica Zen, MD, Chief Resident of Internal Medicine at UCLA, recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane.
- Stay Calm! If you freak out, so will everyone else.
- Think outside the box and be prepared to improvise from available resources. (e.g. ask another passenger for a glucometer)
- Standard medical kit contains - manual BP cuff, stethoscope (cheap), gloves, oropharyngeal airways, CPR masks, bag-valve masks, IV set, 500 ml saline, needles, syringes, analgesic tabs, antihistamine (tabs or injection), aspirin, atropine, inhaler (bronchodilator), Dextrose 50%, Epi (1:1000 and 1:10000), IV lidocaine, nitroglycerin tabs, supplemental oxygen.
- Don’t forget to utilize the ground medical team!
- Legal repercussions very unlikely unless there is “gross neglect” or “intentional harm”. DON’T treat patients if YOU’VE BEEN DRINKING!
- Common emergencies in order of decreasing frequency - syncope and presyncope, dyspnea, acute coronary syndrome, altered mental status, psychiatric emergencies, stroke, cardiac arrest
Goal: Listeners will understand their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane.
By the end of this podcast listeners will:
- Be familiar with the contents of the standard medical kit
- Think outside the box to identify, improvise and utilize available resources for patient care
- Recognize the medical legal consequences of providing emergency medical care on a plane
- Confidently evaluate and manage common in-flight emergencies using the available resources
Dr. Zen reports no relevant financial disclosures.
02:06 Start of Interview
03:02 Rapid Fire Questions
07:08 Dr. Zen tells her story
17:27 Monitoring your patient in-flight
18:05 Contents of the standard in-flight medical kit
20:10 What Dr. Zen would have done differently
21:05 How to use available resources in-flight
22:20 Medical legal implications
26:07 How to respond to common in-flight emergencies and how to respond
27:35 Syncope and presyncope
29:52 Hypoxia altitude simulation test (HAST)
31:15 Altered mental status
33:19 Stroke and acute coronary syndrome
34:51 Dr. Zen’s take home points
Links from the show:
- Baby delivered in-flight by Angelica Zen, MD http://newsroom.ucla.edu/stories/
- Pharmacy article detailing supplies in standard medical kit on plane http://www.ashp.org/menu/News/PharmacyNews/NewsArticle
- Great review article on In-Flight Emergencies. Nable JV, Tupe CL, Gehle BD, Brady WJ. In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45. doi: 10.1056/NEJMra1409213.
- Article on the hypoxia (or high) altitude simulation test (HAST) https://www.ncbi.nlm.nih.gov/pubmed/18398121
- Interesting article: Passenger safely defibrillated 21 times during International Flight. Harve H1, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med. 2009 Apr;80(4):405-8.
- How Doctors Think by Jerome Groupman: Amazon.com link
- NEJM Physicians First Watch http://www.jwatch.org/medical-news