“Is there a
doctor on board?” This is a very familiar announcement to us all. In-flight
medical emergencies are becoming very common as more and more people are now
opting for air travel, especially with the advent of many low-cost airlines.
In 2013,
the New England Journal of Medicine reported that around
44,000 in-flight medical emergencies occur worldwide every year. Around one
in-flight medical emergency will occur in every 604 flights. The top five
causes of medical emergencies were found to be syncope (37.4%), respiratory
symptoms (12.1%), nausea or vomiting (9.5%), cardiac symptoms (7.7%) and
seizures (5.8%). Data from the Lufthansa registry published in 2012 also
showed that one medical incident will occur for every 10,000 to 40,000
passengers on commercial aircraft will have a medical incident while on board (Dtsch
Arztebl Int. 2012 Sep;109(37):591-601).
Research has
shown physicians to be the primary responder in 40-50% of inflight emergencies,
nurses and paramedics in 5-25% of events and flight attendants alone in 45% of
incidents. Air Canada data showed that between 2014 and 2016, about 49-53% of
in-flight medical emergencies were managed by a physician, nurse or paramedic,
with the remainder managed by flight attendants alone (unpublished
observations) (CMAJ. 2018 Feb 26;190(8):E217-E222).
Around 1000
deaths reportedly occur each year in-flight. This number excludes ill patients
being transported from one destination to the other. Instead, this number
represents unexpected deaths in people who otherwise are either healthy or a
known-disease patient but fairly well controlled on medicines.
Similar is
the case with train travel. All these medical emergencies may also occur when
traveling by trains.
All airlines
by law are required to have automatic electric defibrillators (AEDs) on board
besides a first aid kit, which can be administered only by a doctor. All flight
crew should be trained to recognize common medical emergencies and certified in
first aid for medical emergencies. They should also be trained in
hands-only CPR, which can be life-saving, if the cardiac arrest is due to
ventricular tachycardia or ventricular fibrillation and, also the use of
AED.
According to
the Ministry of Railways, “all passenger trains also carry First Aid
Boxes containing essential drugs and dressing materials, which are provided
with the guards. Augmented First Aid Boxes with wide range of medicines,
disposable medical material, etc. have been provided with the Train
Superintendents/ Guards of Rajdhani/Shatabdi Express trains and some nominated
trains. Front line staffs deployed on trains are also trained in rendering
First Aid. The Station Masters of all stations have details of doctors, clinics
and hospitals, both Government and Private, in the vicinity of the station, so
that their services could also be availed, in emergencies…” (Press
Information Bureau, April 4, 2018)
Cardiac
arrest is the major cause of death in such situations. A victim of cardiac
arrest needs to be revived immediately. Any delay in starting cardiopulmonary
resuscitation (CPR) and in using a defibrillator to deliver a shock when needed
will reduce the person’s chance of survival. With each minute delay in
defibrillation from the onset of cardiac arrest, the probability of survival
decreases by 10% (Ont Health Technol Assess Ser. 2005;5(19):1-29).
CPR has to
start promptly, if the patient is to have a chance at a life. Immediate
first-aid can save the lives of many.
All exit
seats (or any other) in airplanes should be earmarked or reserved for doctors
or any other health care provider who is trained in first-aid training course,
including CPR and is well-versed with an AED. Similarly, few seats in a train
or a coach should be reserved for doctors or health care providers, so that
they can be identified immediately and be the “first responders” even in
out-of-hospital cardiac arrests.
They should
be given first preference for these seats.
A pilot
project of deployment of doctors in Duronto Trains was undertaken for a period
of two years. During the Pilot Project, it was noted that serious patient could
not be treated on board and had to be de-trained for medical treatment at a
hospital only because the medical equipments such as ECG machines etc. do not
function properly on the trains due to noise/ vibration etc. (Press
Information Bureau, April 4, 2018). The Ministry then decided to
discontinue deployment of doctors and para-medical staff in Duronto trains
having a run of less than six hours, but railways decided to deploy a
para-medic trained in Emergency Medical Response with all essential life-saving
medicines and equipment in place of a doctor in Duronto trains having a run of
more than six hours… (Hindu Business Line, August 22, 2013).
Currently,
it is not mandatory to have a doctor on board during air travel or travel by
train.
Having a
doctor on board does not automatically ensure survival; but, it does give the
person a fighting chance.
Dr KK
Aggarwal
Padma Shri Awardee
President
Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP
Publications
President Heart Care
Foundation of India
Immediate
Past National President IMA
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