Cologne, Germany (dpa) – When a passenger in row 16 suddenly turns pale, struggling for breath before slumping into his seat unconscious, the cabin crew has to go into action immediately.
Although medical emergencies in the air are very unusual, on-board medical care is increasingly being recognised as one of the most important problems facing modern airlines.
A rise in total passenger numbers has seen a proportionate rise in the size of so-called high-risk passenger groups, which include babies, the elderly and those in poor health. Airlines are now looking to develop new strategies in order to meet the health requirements of all passengers in their care.
Serious medical problems during a flight often spell an emergency landing and all the additional costs this entails. Landing fees, hotel accommodation and replacement tickets leave airlines with an annual bill of up to 220,000 dollars.
Britain’s Civil Aviation Authority is likely to demand changes too after the recent death of a young woman from a blood clot following a long flight, and a parliamentary committee will urge that airlines give more preventive advice on the condition.
The apparently healthy and active 28-year-old woman died after a flight from Sydney to London from DVT, also known as “economy class syndrome” or “jet leg”.
Medical experts say that middle-aged or elderly passengers, pregnant women, smokers and those with cardiovascular disease are usually most at risk from DVT, but for disaster to strike other factors usually have to come into play such as dehydration, a fatty meal or oral contraception.
In 1998, the German carrier Lufthansa had to deal with some 50 life-threatening situations caused by poor passenger health. In 37 cases, the aircraft involved was forced to make an emergency landing. In the United States, four such emergencies are reported in the air every day.
An effective method of dealing with airborne health crises is telemedicine, which enables doctors to treat patients by means of a videophone.
Medical equipment such as ultrasound scanners and biomonitors for monitoring heart and circulatory functions are maintained on board. “These applications have all been adapted from space travel,” reveals Eduard Mueller, spokesman for the German Aerospace Centre (DLR) in Cologne.
The DLR is currently working on a new telemedical system in co- operation with Lufthansa. In the event of an emergency, the crew will contact a specialist at the Tubingen University Clinic who will make a diagnosis and advise treatment from the ground.
In 1985, the American critical care flight nurse Joan Sullivan Garrett founded MedAire in Phoenix, Arizona. The company provides a 24-hour medical hotline for airlines.
MedAire’s satellite phone technology means pilots can consult a team of doctors drawn from 16 specialist disciplines. Another 50 specialists can be contacted should the need arise.
The doctors employed by MedAire are specially trained to explain medical situations and procedures in simple terms to the layman on board an aircraft.
The firm’s control centre in Phoenix keeps a record of some 5,000 airports to ensure patients’ immediate and effective treatment on the ground should the situation demand an emergency landing.
The lack of a German equivalent to MedAire is due to technical limitations. As Lutz Bergau, Lufthansa’s Frankfurt-based medical director, explains: “MedAire is particularly suitable for U.S. domestic flights because communication between aircraft and the control centre in Phoenix relies to a large extent on ground-based transmission.
“With intercontinental flights, which are dependent on satellite communications, the situation is more complicated. It is technically not possible to transmit an ECG on account of the large amount of data involved.
“We are reliant on oral communication, which we find unsatisfactory.” Bergau believes this problem can be overcome within the next two years, when the introduction of new technology to make videoconferencing possible on intercontinental flights.
In addition to its radio and satellite services, MedAire also provides training for flight crew. The firm puts the number of trainees at approximately 25,000 per year.
The course includes instruction on coping with emergencies caused by variations in passengers’ oxygen supply – the trigger for the majority of in-flight medical problems.
The air pressure within an aircraft cabin is equivalent to that at the top of a 2,500 metre-high mountain. The change in pressure can pose a risk to those suffering from chronic respiratory complaints who may suffer circulatory collapse and heart failure as a result.
Air recycling is seen by travel experts as another potential health problem. Airlines save on fuel costs by mixing fresh with recycled air passed through filters supposed to remove dangerous organisms.
With emergencies in mind, many airlines now carry a defibrillator on board as well as the standard first aid kit. This is a mobile device capable of applying a brief electric shock to restore a patient’s normal heart rate and can be operated by the cabin crew.
Although airlines are as yet not legally required to carry a defibrillator, all Lufthansa long-haul aircraft are now fitted with the device as standard.
Once on the ground, patients can be transferred to an airport hospital. Frankfurt airport maintains a well-equipped clinic which treats some 40,000 to 45,000 patients every year, of which 90 per cent are emergency cases.
