Data-Driven Estimation of the Impact of Diversions Due to In-Flight Medical Emergencies on Flight Delay and Aircraft Operating Costs.

INTRODUCTION: In-flight medical emergencies (IFMEs) average 1 of every 604 flights and are expected to increase as the population ages and air travel increases. Flight diversions, or the rerouting of a flight to an alternate destination, occur in 2 to 13% of IFME cases, but may or may not be necessary as determined after the fact. Estimating the effect of IFME diversions compared to nonmedical diversions can be expected to improve our understanding of their impact and allow for more appropriate decision making during IFMEs.METHODS: The current study matched multiple disparate datasets, including medical data, flight plan and track data, passenger statistics, and financial data. Chi-squared analysis and independent samples t-tests compared diversion delays and costs metrics between flights diverted for medical vs. nonmedical reasons. Data were restricted to domestic flights between 1/1/2018 and 6/30/2019.RESULTS: Over 70% of diverted flights recover (continue on to their intended destination after diverting); however, flights diverted due to IFMEs recover more often and more quickly than do flights diverted for nonmedical reasons. IFME diversions introduce less delay overall and cost less in terms of direct operating costs and passenger value of time (averaging around 38,000) than do flights diverted for nonmedical reasons.DISCUSSION: Flights diverted due to IFMEs appear to have less impact overall than do flights diverted for nonmedical reasons. However, the lack of information related to costs for nonrecovered flights and the decision factors involved during nonmedical diversions hinders our ability to offer further insights.Lewis BA, Gawron VJ, Esmaeilzadeh E, Mayer RH, Moreno-Hines F, Nerwich N, Alves PM. Data-driven estimation of the impact of diversions due to in-flight medical emergencies on flight delay and aircraft operating costs. Aerosp Med Hum Perform. 2021; 92(2):99105.

Characterization of In-Flight Medical Events Involving Children on Commercial Airline Flights.

STUDY OBJECTIVE: More than 4 billion passengers travel on commercial airline flights yearly. Although in-flight medical events involving adult passengers have been well characterized, data describing those affecting children are lacking. This study seeks to characterize pediatric in-flight medical events and their immediate outcomes, using a worldwide sample. METHODS: We reviewed the records of all in-flight medical events from January 1, 2015, to October 31, 2016, involving children younger than 19 years treated in consultation with a ground-based medical support center providing medical support to 77 commercial airlines worldwide. We characterized these in-flight medical events and determined factors associated with the need for additional care at destination or aircraft diversion. RESULTS: From a total of 75,587 in-flight medical events, we identified 11,719 (15.5%) involving children. Most in-flight medical events occurred on long-haul flights (76.1%), and 14% involved lap infants. In-flight care was generally provided by crew members only (88.6%), and physician (8.7%) or nurse (2.1%) passenger volunteers. Most in-flight medical events were resolved in flight (82.9%), whereas 16.5% required additional care on landing, and 0.5% led to aircraft diversion. The most common diagnostic categories were nausea or vomiting (33.9%), fever or chills (22.2%), and acute allergic reaction (5.5%). Events involving lap infants, syncope, seizures, burns, dyspnea, blunt trauma, lacerations, or congenital heart disease; those requiring the assistance of a volunteer medical provider; or those requiring the use of oxygen were positively correlated with the need for additional care after disembarkment. CONCLUSION: Most pediatric in-flight medical events are resolved in flight, and very few lead to aircraft diversion, yet 1 in 6 cases requires additional care.

Urological In-Flight Medical Events on Commercial Airlines.

PURPOSE: In-flight medical events are rare but may cause significant distress as access to care is limited. There is a paucity of data on in-flight urological medical events. We describe urological in-flight medical emergencies and report clinical and flight outcomes. MATERIALS AND METHODS: We reviewed all in-flight urological medical emergencies between 2015 and 2017 from MedAire®, a ground based medical support center that provides remote medical advisory services to approximately 35% of commercial airline passenger traffic worldwide. Our primary end point was the incidence rates of in-flight urological medical events. We also characterized the types of in-flight medical emergencies, in-flight management and their impact on flight status. Statistical analyses included Student's t-tests, chi-square analysis and analysis of variance. RESULTS: We identified 1,368 (1%) urological in-flight medical emergencies from a total of 138,612 in-flight medical emergencies, with an incidence of 0.5 per million passengers. The most common in-flight medical emergencies were lower urinary tract symptoms (35%), urinary retention (30%) and flank pain (21%). Among in-flight medical emergencies 883 (60%) resolved in flight, 273 (28%) required on-arrival medical evaluation and 21 (1.5%) resulted in flight diversions. Of the flight diversions the majority were due to urinary retention (12, 57%) and less commonly flank pain (6, 28%) and testicular/abdominal pain (3, 15%). CONCLUSIONS: The most common causes of urological in-flight medical emergencies are lower urinary tract symptoms, urinary retention and renal colic, the majority of which resolved in flight. These data are useful for informing flight personnel and emergency kit equipment needs to minimize the impact of these events when they occur.

Quality of Electrocardiograms Obtained in Flight by Airline Flight Attendants.

BACKGROUND: Handling cases of chest pain aboard commercial flights is challenging for crewmembers, onboard medical volunteers, and ground-based doctors providing remote advice. Obtaining an electrocardiogram (ECG) in-flight could help in dictating the management of such cases. The ability to diagnose or rule out ST-segment elevation myocardial infarction (STEMI) would have clinical and prognostic implications. The feasibility of obtaining good quality ECG tracings by flight attendants in flight is not known.METHODS: A series of 200 consecutive ECG tracings transmitted to a ground-based medical support provider were independently reviewed by four observers who ranked the ECG tracings according to a quality score (QS) criteria, as well as trying to identify or rule-out cases of STEMI.RESULTS: ECG quality was considered good enough to extract useful information in 170 of 200 tracings (85%). Seven cases of STEMI were identified. A STEMI was confidently ruled out in 104 cases. Additional abnormalities of variable clinical importance were also detected.DISCUSSION: ECGs are essential in the prehospital management of chest pain cases. ECGs obtained in flight by airline flight attendants were mostly of diagnostic quality, allowing confirmation or ruling out of STEMI, as well as detecting arrhythmias of clinical significance in case management.Alves PM, Lindgren JA, Streitwieser DR, Anzola E, Ahmed N, Nerwich N. Quality of electrocardiograms obtained in flight by airline flight attendents. Aerosp Med Hum Perform. 2019; 90(4):405-408.

In-Flight Injuries Involving Children on Commercial Airline Flights.

BACKGROUND: More than 3 billion passengers are transported every year on commercial airline flights worldwide, many of whom are children. The incidence of in-flight medical events (IFMEs) affecting children is largely unknown. This study seeks to characterize pediatric IFMEs, with particular focus on in-flight injuries (IFIs). METHODS: We reviewed the records of all IFMEs from January 2009 to January 2014 involving children treated in consultation with a ground-based medical support center providing medical support to commercial airlines. RESULTS: Among 114 222 IFMEs, we identified 12 226 (10.7%) cases involving children. In-flight medical events commonly involved gastrointestinal (35.4%), infectious (20.3%), neurological (12.2%), allergic (8.6%), and respiratory (6.3%) conditions. In addition, 400 cases (3.3%) of IFMEs involved IFIs. Subjects who sustained IFIs were younger than those involved in other medical events (3 [1-8] vs 7 [3-14] y, respectively), and lap infants were overrepresented (35.8% of IFIs vs 15.9% of other medical events). Examples of IFIs included burns, contusions, and lacerations from falls in unrestrained lap infants; fallen objects from the overhead bin; and trauma to extremities by the service cart or aisle traffic. CONCLUSIONS: Pediatric IFIs are relatively infrequent given the total passenger traffic but are not negligible. Unrestrained lap children are prone to IFIs, particularly during meal service or turbulence, but not only then. Children occupying aisle seats are vulnerable to injury from fallen objects, aisle traffic, and burns from mishandled hot items. The possible protection from using in-flight child restraints might extend beyond takeoff and landing operations or during turbulence.

Medical evacuations in the oil and gas industry: a retrospective review with implications for future evacuation and preventative strategies.

Background: Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken. Method: A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses. Results: A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac. Conclusion: This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.

Fatalities above 30,000 feet: characterizing pediatric deaths on commercial airline flights worldwide.

OBJECTIVES: We conducted this study to characterize in-flight pediatric fatalities onboard commercial airline flights worldwide and identify patterns that would have been unnoticed through single case analysis of these relative rare events. DESIGN: Retrospective cohort study of pediatric in-flight medical emergencies resulting in fatalities between January 2010 and June 2013. SETTING: A ground-based medical support center providing remote medical support to commercial airlines worldwide. PATIENTS: Children (age 0-18 yr) who experienced a medical emergency resulting in death during a commercial airline flight. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were a total of 7,573 in-flight medical emergencies involving children reported to the ground-based medical support center, resulting in 10 deaths (0.13% of all pediatric in-flight emergencies). The median subject age was 3.5 months with 90% being younger than 2 years, the age until which children are allowed to travel sharing a seat with an adult passenger, also known as lap infants. Six patients had no previous medical history, with one suffering cardiorespiratory arrest after developing acute respiratory distress during flight and five found asystolic (including four lap infants). Four subjects had preflight medical conditions, including two children traveling for the purpose of accessing advanced medical care. CONCLUSIONS: Pediatric in-flight fatalities are rare, but death occurs most commonly in infants and in subjects with a preexisting medical condition. The number of fatalities involving seemingly previously healthy children under the age of 2 years (lap infants) is intriguing and could indicate a vulnerable population at increased risk of death related to in-flight environmental factors, sleeping arrangements, or yet another unrecognized factor.

Cardiovascular events on board commercial maritime vessels: a two-year review.

BACKGROUND: Cardiovascular diseases (CVDs) are an important concern in merchant maritime operations. They are responsible for the majority of deaths at sea that are not related to injury or violence. The objective was to better understand the epidemiology of CVD in merchant maritime operations. MATERIAL AND METHODS: Retrospective review of medical events on board merchant maritime vessels over a period of two years, from a US-based telemedicine provider's database. RESULTS: A total of 1,394 cases were initially retrieved from the database. CVD was diagnosed in 29 cases and was the eleventh leading cause for accessing the telemedicine provider. Five deaths occurred in the study period, three of which related to CVDs. CVDs resulted in more diversions and the utilization of more urgent means of communication. DISCUSSION: CVDs present a challenge in maritime health. The current pre-employment system is not, in a reasonable cost/benefit balance, able to prevent on board events from occurring. The success of telemedicine depends heavily on the onsite resources, both human and material. Automated External Defibrillators (AEDs), along with other devices such as multi-parameter monitors, are tools generally available to address acute presentations of CVDs, but their applicability on board commercial ships is a matter of controversy. CONCLUSIONS: CVDs are an important concern in commercial maritime operations due to the need for subsequent evaluation and potential complications including the risk of sudden cardiac arrest. In this study, CVDs were probably responsible for three on board deaths. Additional research is warranted to provide more evidence about the best resources to have on board to handle CVDs more effectively.