Guidance on management of in-flight medical events
Two hypothetical cases are described from the point of view of a volunteer physician. The chosen
scenarios may also apply to other similar situations.
Unconsciousness
When a passenger loses consciousness, what should be done?
First, ask the cabin crew to stay with you for any assistance that you might require. Then proceed to assess the patient as you would normally do elsewhere. As the great majority of these incidents are benign, the result of vaso-vagal syncope, by the time you have confirmed that the passenger has a good pulse and is breathing normally, the passenger will likely have regained consciousness. A few more minutes in a supine position and the passenger will be ready to return to his seat without further problem.
If the passenger does not regain consciousness quickly, ask the cabin crew to bring the emergency
medical kit and the defibrillator if one is available; also ask if the airline has access to a medical
ground provider. If so, ask him/her to initiate contact with that provider. Such providers can be an
invaluable resource; they are usually qualified in emergency
medicine, fully knowledgeable about
the on board medical supplies and can assist with decisions concerning a diversion, if required.
If the medical kit has arrived and the passenger is still unconscious and medical ground support is
not available, consult the list of contents of the medical kit to see if the medication you would like to
use is in it. If it is, the cabin crew should be able to assist you to find it. For instance, if hypoglycemia is suspected, most kits will have intravenous glucose available.
If the passenger does not recover, and you suspect a major cardiac event, you have to assess to the best of your ability if the passenger will continue to deteriorate or not, and start considering a
diversion. The captain has to be quickly informed to evaluate if a diversion is possible and if suitable medical facilities are available at the diversion point.
If the passenger’s pulse ceases and there is no AED, begin CPR and ask the cabin crew to assist. You can expect that all cabin crew have been trained in CPR.
If an AED is available, at least one cabin crew member will be trained in its use and the airline
protocol normally calls for them to manage the equipment. The volunteer physician is therefore not
expected to take over the AED, but to provide other professional assistance such as setting up an
intravenous line.
Assuming there is no close diversion point, the next question will be when to stop resuscitation.
IATA in consultation with subject matter experts has developed guidance material for that situation. (13) You may consider familiarizing yourself with this information before you fly in case you find
yourself is such a situation.