New challenges in resuscitation medicine
The biggest challenge is the tight space in which a patient may be located, particularly in such areas as coach or lavatories. Aircraft in the U.S. with 60 or more seats are required to carry an on-board wheelchair, which is designed to allow access into the aisles and lavatory. (24) Some airlines carry mobility aids, such as transfer slings for short moves, but this equipment isn't mandated aboard aircrafts.
- During patient assessment and evaluation, auscultation in an aircraft using a stethoscope can be difficult due to ambient engine noise and instead require that systolic blood pressure be palpated.
- Aviation portable oxygen bottles (POBs) generally have only one of two fixed settings: "low flow" (2 lpm) and "high flow" (4 lpm) for first aid purposes and decompression emergencies, which is far lower than what is normally used in EMS settings. Even more unusual, oxygen tubing for the bag-valve mask resuscitations aren't required to be compatible with these on-board oxygen bottles.
- The AEDs on board aren't required to have ECG screen even though ACLS medications are provided; without an ECG screen, it may be more difficult for the EMS provider to determine which cardiac resuscitation algorithm and drug to use during a prolonged cardiac arrest. If an AED does have an ECG screen, it's typically limited to a leads II/paddles view.
- Glucometers aren't mandated in EMKs, despite the requirement to have dextrose 50%, which may make it difficult to identify hypoglycemic emergencies.
ConclusionDespite being in a pressurized metal container at 30,000 feet, U.S. commercial aircraft have well-trained crews with considerable equipment the EMT and paramedic can utilize in a medical emergency. EMS providers are well suited to being first responders of in-flight emergencies because the creativity and innovation they use every day at work will assist in providing appropriate patient care.
1. United States Federal Aviation Administration. Moving America safely: 2005 annual performance report. FAA, 2005. http://www.faa.gov/air_traffic/publications/media/APR_year2.pdf.
2. Sand M, Bechara FG, San D, et al. Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases. http://ccforum.com/content/13/1/R3.
3. Goodwin T. In-flight medical emergencies: an overview. Brit Med J. 321:1338–1341.
4. U.S. Department of Transportation. FAA. Advisory circular: Air Carrier First Aid Programs. FAA, 1995. http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgAdvisoryCircular.nsf/list/AC%20120-44A/$FILE/ac120-44a.pdf
5. FAA. Advisory circular: Emergency medical equipment training.
6. Aviation Medical Assistance Act of 1998.
7. Ruskin KJ, Hernandez KA, Barash PG. Management of in-flight medical emergencies. Anesthesiology. 108:749–755, 2008. http://journals.lww.com/anesthesiology/Fulltext/2008/04000/Management_of_In_flight_Medical_Emergencies.27.aspx.
8. FAA. Appendix A: First-aid kits and emergency medical kits. Code of Federal Regulations A121.1.
9. FAA. Subpart M: Airman and crewmember requirements. Code of Federal Regulations Sec. 121.391. http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgFar.nsf/FARSBySectLookup/121.391!OpenDocument&ExpandSection=2.
10. FSF Editorial Staff. Enhanced emergency medical kits increase in-flight options. Cabin Crew Safety 36.6 (2001): 1–6. www.flightsafety.org/ccs/ccs_nov-dec01.pdf.
11. Civil Aviation Authority. Defibrillators. Is it compulsory for airlines to carry a defibrillator on an aircraft? FAQ Details. www.caa.co.uk/default.aspx?catid=923&pagetype=70&gid=924&faqid=929.
12. Joint Aviation Authorities. JAR-OPS 1: Commercial Air Transportation (Aeroplanes). www.jaa.nl/publications/jars/jar-ops-1.pdf.
13. European Aviation Safety Agency. Notice of proposed amendment (NPA) no 2009-02B. www.easa.europa.eu/ws_prod/r/doc/NPA/NPA%202009-02B.pdf.
14. Bentley D. “Is there a doctor onboard?” International Travel Insurance Journal. www.medaire.com/doctor3.pdf.
15. Virgin Atlantic. Virgin Atlantic's Special Assistance. www.virgin-atlantic.com/tridion/images/factsheet_specialassistance_tcm4-426062.pdf.
16. Chiu Alexis. Man becomes first person to be saved by in-flight defibrillator. www.cjonline.com/stories/112698/new_flightsave.shtml.
17. FAA. Subpart K: Instrument and equipment requirements. Code of Federal Regulations Sec. 121.333. http://rgl.faa.gov/REGULATORY_AND_GUIDANCE_LIBRARY/RGFAR.NSF/0/5a99c617262ef7ab862570d70078ae87!OpenDocument&ExpandSection=-3.
18. Federal Aviation Administration. Appendix A to Part 121: First Aid Kits and Emergency Medical Kits. 2005. http://ecfr.gpoaccess.gov/cgi/t/text/textidx?c=ecfr&sid=85f4200801c3d7eeab7b83c94d88c21c&rgn=div9&view=text&node=14:220.127.116.11.18.104.22.168.10&idno=14.
19. FAA. Advisory circular: Emergency medical equipment
20. Air Canada. Air Canada aircraft medical kit 2008.
21. MedAire. Enhanced emergency medical kit contents. MedAire, 2007.
22. MedAire. MedAire strategically adds/deletes kit items.
23. Alcock C. Tempus adds video link to medical emergency kit. www.ainonline.com/news/single-news-page/article/tempus-adds-video-link-to-medical-emergency-kit/
24. Code of Federal Regulations. § 382.65 What are the requirements concerning