In flight emergencies and when to land the plane

    NextPrevious

    In flight emergencies and when to land the plane

    You are on a flight, halfway across the Atlantic Ocean at the start of a much needed vacation, binge watching that new show everyone has been talking about but you’ve never had time to see.  Suddenly, the screen freezes and an overhead announcement interrupts your zen-like, screen-induced partial stupor.  “Is there a doctor on board?”

    The most common ‘emergency’ encountered during commercial flights is thought to be syncope and near-syncope (there are no formal rules about reporting).  This is usually due to some combination of decreased cabin pressure, increased insensible losses (lower oxygen pressure resulting in hyperventilation) and dehydration.  Usually elevating the legs and increasing PO hydration will improve symptoms.

    But what if there is a passenger who is truly, seriously ill?

    Unplanned landings have been estimated to cost up to $900,000.  Plus, it can be dangerous to divert from the flight plan and will likely cause scheduling nightmares for sometimes up to 100s of other passengers.  It is a really big deal.  The decision to make an unscheduled emergency landing should not be taken lightly, and ultimately belongs to the pilot of the aircraft.

    Nonetheless, the pilot may ask for your recommendation as a physician.  The following list (taken directly from the reference below), while not complete, is generally agreed upon by most entities to be justification for an emergency landing:

    1. Chest pain, shortness of breath, or severe abdominal pain that does not improve with use of the recommended initial interventions
    2. Cardiac arrest
    3. Concern for acute coronary syndrome
    4. Severe dyspnea
    5. Persistent unresponsiveness
    6. Stroke
    7. Refractory seizure
    8. Severe agitation

    References, including more on how to approach specific emergencies and some legal info:

    https://pulmccm.org/review-articles/in-flight-medical-events-emergencies-part-1/

    https://pulmccm.org/review-articles/in-flight-medical-events-emergencies-part-2/

    Martin-Gill C, Doyle TJ, Yealy DM. In-Flight Medical Emergencies: A Review. JAMA. 2018;320(24):2580–2590. doi:10.1001/jama.2018.19842

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    • Reach for the COWS

      Your patient in intake is miserable. Doubled over, complaining of pain everywhere, sweating, ill-appearing but not unstable. He tells you that the last time he used heroin was two nights ago, and he is askingRead more

    • Tis the season, summer edition

      As the late spring rains have begun to fade and the temperature rises mercilessly into the 80s and beyond, summer is finally upon us. And with summer comes a host of diseases for the emergencyRead more

    • Meet the newest member of your team

      We have a new resource in the Sinai ED. Say hello to your friendly ED pharmacist. In the past several years, the ED pharmacy has been centralized in a non-ED location. We all know wellRead more

    • In the spirit of roasts and fire-breathing dragons

      You’re on a lovely amble through the backcountry when suddenly you see smoke rising nearby and catch a whiff of a familiar scent that throws you back to your med school OR days: burning flesh.Read more

    • E-point Septal Separation in the Patient with Congestive Heart Failure

      Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%).  This isRead more

    • Lidocaine for cough?

      Whether it’s asthma, a U.R.I., or post nasal drip as the cause, cough is a common enough complaint encountered by emergency physicians everywhere. Of course you must always rule out the dangerous causes of coughRead more

    NextPrevious