Doctors may be asked to respond to medical emergencies away from their usual place of work. The incidence and consequences of these emergencies is poorly understood and the legal implications give rise to concern. Most descriptions of medical emergencies in flight are case reports or anecdotes. As there appears to be no central collection of information relating to in-flight emergencies we surveyed all doctors in a university teaching hospital department to establish the nature of these emergencies and the proportion of these that were serious.
All consultants and trainees in anaesthesia at a large teaching hospital were surveyed over a 1-month period using a standardized questionnaire. All questionnaires were completed in the presence of one of the authors to maximize the response rate and to ensure a consistency in the reporting. The survey asked for the number of flights per year and details of any medical emergencies in which they were involved. They were also surveyed as to their qualifications, including ATLS, PALS and attendance at Advanced Life Support courses. Respondents were asked if they had been required to provide proof of their medical qualifications and whether they held insurance cover for Good Samaritan acts. They were questioned about the suitability of equipment available, documentation of the emergency and whether they would assist passengers from North America (in view of that group's perceived willingness to initiate litigation).
Twenty-two consultants, 15 Specialist Registrars (SpRs) and eight Senior House Officers (SHOs) completed a total of 45 questionnaires. The mean number of domestic flights taken per year was 7.1 and 3.4 international flights. Twenty medical emergencies arose, 12 of these were minor ranging from transient ischaemic attacks, three episodes of abdominal pain, to otitis media. Some of these minor complaints had developed prior to the passenger boarding the aircraft (abdominal pain and otitis media). In all cases advice and reassurance were all that were required.
There were seven serious medical emergencies including seizures, angina, hypoglycaemic coma, one respiratory and two cardiac arrests. Both patients died following cardiac arrest. In most cases advice and basic life support measures were sufficient. Advanced life support was administered in cases of respiratory and cardiac arrest. The availability of equipment, especially for airway and cardiovascular support, was a cause for concern for many respondents. One cardiac arrest occurred on a domestic flight and one on an international flight. Although oxygen, Ambu bags and adrenaline were available equipment for intubation was not.
Despite the severity of some of the medical conditions on no occasion did the doctor involved feel that the flight needed to be diverted. Most of these emergencies occurred on long haul flights over water where this option did not exist or the medical problem was resolved rapidly.
In only two of 20 requests for medical assistance were the qualifications of the responding doctor checked. This was limited to inspecting their passports. Requests for the doctors to document the emergency and their actions were rare. No record of the event was requested even after the death of one cardiac arrest victim. All the doctors that responded were insured in the UK. All were aware that by offering assistance they were at risk of litigation. Six respondents stated that they would not offer their assistance on a US airline and three would not assist passengers from the USA even on non-US airlines.
Medical emergencies appear to be more likely on long haul flights. The emergencies ranged from the trivial to the rapidly fatal. This survey suggests that more extensive guidelines and audit may lead to a better understanding of the problems and appropriate provision of equipment and follow-up. Airlines that seek medical assistance from doctors to treat other passengers should institute measures to increase the likelihood of a favourable outcome and protect the doctors by providing appropriate equipment, assistance and insurance. There is little published on the nature and management of in-flight emergencies although individual cases may be widely publicized . We recommend that these events are documented, that data from these emergencies are collected and published so that recommendations can be made for the provision of appropriate equipment and advice for the medical staff that respond. There are also no published lists of which airlines provide insurance cover for doctors responding to a medical emergency, although Lufthansa and British Airways do [1,2]. Several other airlines may also provide indemnity insurance but do not publicize the fact. In addition, the response of the medical defence organizations will depend upon the location in which actions are raised and by whom. Some will apparently cover all actions raised in the UK and others will cover actions raised elsewhere by non-Americans. The confusion arises because many of the States in the USA have Good Samaritan legislation which prevents litigation and therefore the legal position has not been tested extensively in the courts . Despite the confusion the response to this survey suggests that the majority of respondents would follow the advice of the GMC to 'offer anyone at risk the treatment that one could reasonably be expected to provide' .
1 Anonymous In-flight Incidents. Lancet
2 Mooney S. Airlines should protect Good Samaritan doctors. BMA News Review
3 Helminski F. Ghosts from Samaria: Good Samaritan laws in the hospital. Mayo Clin Proc
4 GMC. Good Medical Practice.
London: GMC, 1998: 3.