1. Top 10 in-flight medical emergencies

2. Important Do no harm Do no harm 70% incidents managed by crew 70% incidents managed by crew Practice within limits of training and knowledge Practice within limits of training and knowledge

3. Chest Pain Careful history Careful history Differential same as on ground Differential same as on ground Antacid may help exclude indigestion Antacid may help exclude indigestion MI suspected MI suspected Aspirin, opioid, oxygen Aspirin, opioid, oxygen Cardiac monitor may be available with link to ground based advisory service Cardiac monitor may be available with link to ground based advisory service

4. Collapse Usually due to simple faint Usually due to simple faint Remain calm Remain calm Check pulse BP Check pulse BP Epilepsy no increased risk when flying Epilepsy no increased risk when flying Crew are trained to manage fits Crew are trained to manage fits Aircarft carry parentral diazepam Aircarft carry parentral diazepam

5. Life threatening collapse Crew trained in basic CPR Crew trained in basic CPR Many carry defibrillators Many carry defibrillators Crew will be trained in use Crew will be trained in use Doctor’s role IV access & giving drugs Doctor’s role IV access & giving drugs

6. Asthma Commonest life threatening condition on aircraft Commonest life threatening condition on aircraft Induced by realisation tha tinhalers are in baggage hold Induced by realisation tha tinhalers are in baggage hold Oxygen available and usually injectable bronchodilator and adrenaline Oxygen available and usually injectable bronchodilator and adrenaline May carry inhalers but not nebulisers May carry inhalers but not nebulisers

7. Head injuries Items falling from overhead luggage compartment Items falling from overhead luggage compartment Little a Dr can do except perahps advice re need to divert Little a Dr can do except perahps advice re need to divert

8. Mental health problems Anxiety Anxiety Phobias Phobias Major psychiatric illness Major psychiatric illness Conformation of diagnosis and reassurance Conformation of diagnosis and reassurance Diazepam/lorazepam might be available be cautious as may have drunl xs alcohol or taken other illicit drugs Diazepam/lorazepam might be available be cautious as may have drunl xs alcohol or taken other illicit drugs

9. Abdominal problems D & V common D & V common Doctors role is providing diagnosis Doctors role is providing diagnosis Advsing on need to divert Advsing on need to divert

10. Diabetes Hypoglycaemic episodes frequent Hypoglycaemic episodes frequent Glucose injections usually available Glucose injections usually available

11. Allergic reactions Anaphylaxis occurs rarely Anaphylaxis occurs rarely Adrenailine and antihistamine sometimed injectable steroid carried Adrenailine and antihistamine sometimed injectable steroid carried Passengers with known allergies may have own epipen Passengers with known allergies may have own epipen

12. Obs and Gynae Several babies born on board every year Several babies born on board every year Drs have very little roll to play except provide reassurance and uterine contractant such as ergometrine Drs have very little roll to play except provide reassurance and uterine contractant such as ergometrine

13. Miscarriage Occur occasionally Occur occasionally Examination facilities limited Examination facilities limited Monitor general condition is only real possibilty Monitor general condition is only real possibilty

14. Diverting Aircraft Cardiac problems28% Cardiac problems28% Neurological problems20% Neurological problems20% Food poisoning20% Food poisoning20%

15. Liability In UK no legal duty for Dr to offer assistant in an emergency In UK no legal duty for Dr to offer assistant in an emergency GMC considers that such a duty exists GMC considers that such a duty exists Law varies from country to country Law varies from country to country Several airline have indemnity to cover Drs that come forward Several airline have indemnity to cover Drs that come forward MDU covers its members MDU covers its members

16. Liability US Aviation medical assistance act 1998 US Aviation medical assistance act 1998 Protects Drs that act in good Samaritan situations Protects Drs that act in good Samaritan situations Gives legal protection for airlines Gives legal protection for airlines

17. Medlink Direct communication between flight crew and MedAire Direct communication between flight crew and MedAire Instant expert advice Instant expert advice List of Airports suitable for diversion List of Airports suitable for diversion Once MedAire contacted Dr is relieved of liability Once MedAire contacted Dr is relieved of liability Captain makes decision to divert Captain makes decision to divert MedAire has insurance cover MedAire has insurance cover