Background: First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in-flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical emergencies. Cramped conditions, difficulties of access to the victim, lack of privacy, cultural and language differences and noise and vibration all compound to increase the difficulties of the normal first aid drills which are required in the management of in-cabin emergencies. Doctors who fly as passengers are liable to be called upon to render first aid in the air. We provide an analysis of the types of medical emergencies encountered during commercial air travel.
Methods: We have reviewed all consecutive in-flight medical incident reports for QANTAS international flights for 1993. All incidents requiring the attention of a doctor were included.
Results: A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angina and cardiac emergencies (23%), gastrointestinal conditions (13%), respiratory tract infections and asthma (9%) and anxiety and panic reactions warranting medical intervention (5%).
Conclusions: Syncope, the management of gastrointestinal symptoms and problems of angina comprise over half (58%) of the presenting symptoms which confront a fellow traveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcohol abuse and mild hypoxia are discussed in the context of precipitating factors which may trigger an in-flight emergency. Psychological problems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors and nurses to be trained in first aid, as a distinct profession in its own right and a series of drills and skills which are distinctive from those of surgery-based health care. The 5% annual increase in air-passenger traffic, predicted for the next two decades, highlights the importance of special training for "first aid in the air'.