Current Challenges of Using In-Flight Emergency Kits

Introduction:

In-flight medical emergencies can happen more as there are an increasing number of elderly patients traveling in flight. Older patients with comorbidities and less healthy travelers tend to fall sick during air travel. The number of medical incidents occurring on a flight has been estimated to be 159 per million passengers, according to a survey in 2014. Out of which emergencies ranged from 5 to 100 per million passengers and deaths less than one percent per million passengers.

What Are the In-Flight Emergencies?

In-flight emergencies can occur, ranging from unconsciousness to seizures. The most common in-flight incidents were transient unconsciousness, nausea, vomiting, diarrhea, and breathing difficulties. Serious in-flight incidents were unconscious patients with slow or no recovery, chest pain, seizure, and labor. A considerable number of patients who have medical issues during travel will require hospitalization.

What Are the Medical Equipment Available on a Flight?

The following are the medical types of equipment available inside the flight:

1. Oxygen: There is an emergency oxygen supply available in the flight for flight-related emergencies. This can be used when there is a limited supply of oxygen to the patients and also in conditions such as sudden decompression.

2. AED (Automated External Defibrillator): At least one AED should be available on a flight. AED in flight has resulted in 50 percent survival in patients with ventricular tachycardia and ventricular fibrillation (VT or VF). It also resulted in a 14 percent survival rate in passengers who had a cardiac arrest. This is used by the emergency responders and trained lay persons in an out-of-hospital cardiac arrest event.

3. Cabin Crew Operating Manual (First Aid): A manual on how to use first aid along with a first aid kit and emergency kit should be present in an easily accessible place. The first aid kit should include the following:

• Antiseptic swabs.

• Bandage adhesive strips.

• Bandage and gauze.

• Triangular bandage.

• Burn dressing.

• Sterile compress dressing.

• Sterile gauze dressing.

• Adhesive tape, standard roll.

• Skin closure strips.

• Hand cleanser.

• Cleaning towelettes.

• Pad with tape or shield for the eye.

• Scissors.

• Surgical adhesive tape.

• Splinter tweezers.

• Disposable gloves (several pairs).

• Thermometer (non-mercury).

• Resuscitation mask with one-way valve.

• First-aid manual (available in an accessible location).

• Incident record form.

4. Physicians Kit: According to the FAA (Federal Aviation Administration), United States-based airlines should carry emergency kits. These kits should be stocked with basic supplies like bandages and splints, and at least one of the kits should contain the following items. Along with this, supplies for pediatric and old patients must also be stocked such as-

• Assessment Supplies - Sphygmomanometer, stethoscope, and gloves.

• Airway and Breathing - Bag-valve masks (three sizes), CPR masks (three sizes), and oropharyngeal airways.

• Intravenous Access - Intravenous administration set, saline solution (500 ml), needles, and syringes.

• Medications - Non-narcotic analgesics, antihistamines (tablets and injections), aspirin. Atropine, bronchodilator inhaler, bronchodilator inhaler, dextrose(50 percent), epinephrine, intravenous lidocaine, and nitroglycerine.

What Do Flight Personnel Do During an Emergency?

The flight personnel uses the comprehensive standardized medical kit on board when there is an emergency. Expert medical advice is obtained through satellite phones available on the flight. In complex situations, the help of cabin crew who are trained and experienced is sought. The cabin crew is trained in such a way that they are competent in using all emergency and lifesaving equipment, such as first aid kits and emergency kits.

What Are the Considerations for Specific Medical Conditions?

• Syncope: A most common emergency that occurs during a flight is syncope. Syncope is characterized by mild initial bradycardia and hypotension. The affected individual occurs pale, ill, and diaphoretic with a slightly altered mental status. During this time, the patient is placed in the trendelenberg position, and the oxygen and blood glucose levels are checked. If the passenger does not wake up within 15 to 30 minutes, ground-medical support is sought.

• Dyspnea: Dyspnea accounts for about 10 percent of in-flight medical emergencies. The altitude of the aircraft is inversely proportional to the cabin pressure. Patients with known hypoxemia (low blood oxygen levels) should therefore travel with portable oxygen. Dyspnea can occur due to asthma, COPD (chronic obstructive pulmonary disease), pulmonary embolism, and toxic exposure.

• Chest Pain: Chest pain is also one of the prevalent medical emergencies accounting for seven percent of the cases. Chest pain can occur secondary to anxiety, acute coronary syndrome, musculoskeletal pain, bronchospasm, pneumothorax, and other pulmonary causes. In the incidence of a cardiac arrest, ground medical support should be notified, and basic life support should be initiated, with high CPR (cardiopulmonary resuscitation) and AED use.

• Neurological Conditions: Neurologic conditions like stroke and seizures have to be managed immediately. In the event of a stroke, a diversion is needed as the cause of the stroke is unidentified. Oral Benzodiazepines can be used for epileptic patients.

• Traumatic Injuries: Most injuries are minor, and immediate first aid can be done. The patients should be observed for loss of consciousness, bleeding, open wounds, and deformities.

• Psychiatric Symptoms: Anxiety, agitation, and psychosis can occur due to panic and other causes, such as psychiatric illness, alcohol consumption, delayed flights, and cramps. Verbal calming techniques should be followed, and security protocols to restrain the patients in the event of aggression and violent behavior.

• Allergies: Allergies account for about one percent of the total cases. Foods and other environmental allergens can cause allergic reactions, and in some passengers, anaphylaxis (life-threatening allergic reactions) can occur. Antihistamines and Epinephrine are given after obtaining the medical history of the patient.

• Obstetric Emergencies: They are the third most common emergency resulting in aircraft diversion. In case of labor pain and other obstetrical symptoms such as vaginal bleeding, and pelvic or abdominal pain, immediate diversion may be required. Careful monitoring of the passenger for vital signs is important.

What Are the Challenges Faced While Using Inflight Emergency Kits?

The challenges while using inflight emergency kits are:

1. Diagnosis of the exact condition can be difficult due to limited resources.

2. Minimal equipment in the first-aid kit.

3. Limited medical equipment to stabilize patients throughout the entire journey.

4. The unavailability of a physician or medical personnel to assist during in-flight emergencies.

Conclusion:

In-flight emergency estimation and management have become difficult as there is underreporting of information and there are no proper reporting systems. The current challenges of in-flight emergencies and the use of emergency kits can be made feasible by bringing about awareness and a proper reporting system. Facilities and equipment are limited, and there is a need to update them.