July 25, 2024

Is there a doctor onboard?

Inflight medical kits are becoming increasingly sophisticated. Julie Baxter explores what’s being added and why...

Inflight medical emergencies are bad news for everyone. For the passenger suffering illness, of course, but also for fellow travellers impacted by the anxiety caused by the incident, the flight attendants forced into a medical role and ultimately the airline’s finance team. Airlines are heavily impacted if the incident results in a flight diversion.

The annual number of inflight medical emergencies is difficult to calculate as there is no official standardisation on defining and reporting data on medical events. Researchers have quantified it at around one incident in 600 flights, 16 events per million passengers, as well as one incident every 11,000 and 14,000 passengers.

While the data is unreliable, it is clear incidences are rising as more people travel, particularly on long-haul journeys that mean passengers are in the air for longer. Add to this that people expect to continue travelling well into old age, as well as with chronic illnesses and infirmities, and it is not surprising that many airlines have this issue on their radar for attention and action.

Being prepared

Regulatory recommendations ensure airlines have some level of medical preparedness onboard. Yet commitment to additional training or extended First Aid kits varies, a fact that adds to the challenges which qualified medics face if they decide to respond to the inflight public address of “Is there a doctor onboard?”

Standard medical kits supplied by the likes of MedAire, Selles Medical or Cabin Crew Safety include blood pressure cuffs, a stethoscope, glucose testing kits and thermometer strips to aid diagnosis plus treatment items such as syringes, needles, IV kits, tongue depressor, CPR masks, dressings, catheters, scalpel and umbilical cord clamps. Some carriers are also investing in more sophisticated medical equipment and support.

MediAire supplies inflight medical solutions including onboard products, training and workshops, and can provide medical support for crews through its MedLink service. Its latest partnership is with Starlux Airlines where Brian Lin, Chief Corporate Safety Officer, says: “Partnering with MedAire enables us to provide a premium service, ensure the safety and comfort of passengers, while maintaining compliance with international regulations.”

Ground support

Medaire’s comprehensive Advanced Aviation Medical Kit combines standard First Aid supplies with prescription medications needed to stabilise a patient until ground-based medical support is available. These additional medications can be administered with the assistance of MedAire’s MedLink doctors.

Bill Dolny, CEO of MedAire, says: “As first responders, crew members need to provide assistance quickly and accurately. Having a clinically and logically assembled medical kit to assist, saves valuable time when treating any type of medical incident. MedAire medical kits meet – or exceed – applicable regional regulations and are reviewed annually by an expert panel of aviation medical, regulatory and operational experts to ensure the best solutions.”  

Virgin Atlantic recently upgraded onboard safety equipment, bolstering support for sick passengers in a new partnership with medical tech provider CardioSecur. All flights are now equipped with the world’s smallest and lightest mobile electrocardiogram (ECG) kit, weighing just 50 grams and needing minimal stowage space. The goal is to save lives and reduce medical diversions. It claims to be the first airline worldwide to have an entirely ECG-equipped fleet.

CardioSecur provides expertise through an app which can help crew address serious inflight medical issues. The compact, intuitive system allows crew to send the results from 12-lead ECGs via wi-fi and satellite to a ground based medical service. Crew then receive feedback detailing medical steps and whether a diversion is necessary. 

Flight diversions

Prioritising this equipment makes sense as cardiovascular events are the single most common cause of medical flight diversions. Exact numbers of cardiac incidents are not avaialable but the Resuscitation Council UK believes that around 1,000 people die each year during commercial flights.

Since 2004, the Federal Aviation Authority (FAA) has required all US commercial airlines to carry Automated External Defibrillators (AEDs) but this is not a worldwide requirement.

Anecdotally, the most common complaints experienced onboard are chest pains, collapse from fainting or epilepsy, asthma, head injury from items falling out of overhead lockers, psychiatric problems triggered by fears of flying or other anxieties, abdominal pains and vomiting. Each year, several babies are unexpectedly born on aircraft in international airspace.

With the global rise in diabetes, hypoglycaemic episodes are increasingly common too, often because a passenger has injected insulin before boarding in expectation of a meal soon after take-off. And with allergies now affecting huge numbers of travellers, this too is something crew need clear training on.

To address these trends many major airlines beyond the US do now carry defibrillators, and train crew to use them, as well as oxygen, sedatives and anti-sickness medications. Glucose injections may also be available, and several airlines include glucagon injection and oral glucose gels in their medical kits to help counteract the rising number of diabetic incidents.

Chronic disease

Allergies are now Europe’s most common chronic diseases. Up to 20% of patients with allergies are in daily fear of an asthma attack, anaphylactic shock or even death from an allergic reaction.

Natalie Hopkins founded The Allergy Badge scheme to provide organisations with in-depth First Aid training on adrenalin pen administration. Offering fully-accredited training courses, she says: “Knowledge is key when travelling, specifically if the incident is mid-air or in the middle of the ocean. The cost implications of redirecting planes and ships can run into thousands of pounds and disrupt the travel plans for hundreds of travellers which entails further costs.”

She says the most common cause of allergic reactions onboard are allergens left on surfaces that have been contaminated by previous passengers. Ensuring hygienic wipe downs is important but she advocates for emergency auto-injectors to be carried.

“Allergies can develop at any time in a person’s life, triggered by up to 250 foods, and adrenaline pens can often be hard to come by, and regularly expire. Having a backup set onboard provides an extra safeguard if any passenger onboard has a severe allergic reaction and requires immediate treatment. It is a ‘must have’ option,” she argues.

Listed exemption

Understanding there is some confusion around crew administering medications, Hopkins explains that under the Human Medicines Regulations 2012, the operator or commander of an aircraft is a listed exemption from the restrictions on supplying prescription-only medicines. That means that aircraft can and should be carrying adrenaline pens for emergency use.

Kitt Medical is one if the providers offering an anaphylaxis kit. It includes an emergency set of adrenaline pens, on a subscription basis to ensure that they are updated, combined with unlimited access to online Continuing Professional Development (CPD) accredited anaphylaxis training.

Combining good quality products from medical brands and suppliers that understand onboard needs, with comprehensive crew training and effective emergency procedures is clearly going to become increasingly vital in the years ahead.