- Page navigation anchor for RE: Add naloxone to in-flight medical suppliesRE: Add naloxone to in-flight medical supplies
As emergency physicians with a subspecialty in aviation medicine, we agree with Dr. Rieb’s comment above that having naloxone on board is a necessary tool to treat the increasingly common medical emergency of opioid intoxication. Some airlines (United, British Airways, Air Transat, Qantas, Frontier and Alaska Airlines) do currently stock naloxone in their onboard emergency medical kits (EMKs), and Air Canada is currently in the process of rolling out naloxone in its EMKs. Each airline only stocks 1-2 vials, which is insufficient to treat a large overdose, but should be enough to reverse respiratory depression to make the diagnosis of opioid intoxication and divert the aircraft to definitive treatment.
We are not aware of any airline at this time that offers intranasal naloxone. And although there has been a call from the Association of Flight Attendants in the USA to be trained to administer naloxone as first responders, this is currently not the standard. The naloxone is typically stored in the EMK, which can only be released to a health care professional.Competing Interests: Medical consultant for Air Canada and Air Transat
- Page navigation anchor for Add naloxone to in-flight medical suppliesAdd naloxone to in-flight medical supplies
The recently published article on the management of inflight emergencies is timely (1). In twenty-five years of practice I have responded to half a dozen calls of “Is there a doctor on board?”Show More
One such case several years ago occurred when a passenger traveling to a funeral ingested a large amount of alcohol on top of his usual dose of a prescription opioid prior to the flight and became markedly impaired. I monitored him throughout the flight wondering if there was the opioid antagonist, naloxone, on board. The flight attendant I asked did not think so. Then last month, I was on a different flight when another passenger required medical assistance. In this case, I reviewed the medical kit myself and found that there was no naloxone in the emergency supplies, as the article by Kodama and colleagues confirms.
As a family physician certified in Addiction Medicine, I am acutely aware of the ability of naloxone to save the life of someone in an opioid-induced respiratory arrest. Given the rise in the number of travelers outlined by Kodama, coupled with the rising opioid overdose rates in British Columbia (2), and across North America, I believe it would be wise for airlines to add naloxone to their medical kits. People using potent opioids sometimes require 3-4 doses of naloxone for resuscitation (3). Naloxone nasal spray is effective and may be simplest to use for flight attendants, especially during turbulence (4). Otherwise, naloxone for injection would be approp...Competing Interests: None declared.
- Page navigation anchor for RE: Doctor on Board?RE: Doctor on Board?
This link to a MedPage article on the very same topic might be of interest to readers...Competing Interests: None declared.
- Page navigation anchor for RE: on flight emergencyRE: on flight emergency
I was called to assist 2 emergencies my last flight. A middle aged lady with SVT and man with an allergic reaction. I was appalled at the inefficient emergency kit that was provided to me. Disorderly, adult and pediatric things mixed, no oxygen cannula, no automatic BP cuff (hard to hear anything at 30,000 feet). Both patients arrived safely and escorted off by paramedics. Tried to work directly with airline to improve conditions, but their response was to grant me a mileage bonus to my account. I want to change the system to be standardized, easy to use, more efficient and user friendly but I hit a wall.Competing Interests: None declared.
- Page navigation anchor for What can be done for in-flight emergenciesWhat can be done for in-flight emergencies
David Kodama et al have brought out an important issue about the challenges of a doctor on-board a flight, who may be requested to volunteer his or her expert help to save a patient. Kindly allow me to extend my sincere compliments to them for highlighting this issue.
I have faced many mid-air in-flight situations, and have written about one such situation in one of my papers that was published a year ago . Yes, I had been trained to attend to in-flight emergencies, and have escorted patients in cramped up position onboard a single, or a twin-seater helicopter, as well as many patients together in larger helicopters. But then, mostly I was usually prepared and also had supplies of required medicines, and the necessary equipment as well.
It is a different situation when you are on an international flight aboard a fixed wing aircraft, with all eyes upon you once you volunteer despite having that gut feeling of having to face the lack of all that which might be required and which cannot be rushed in from anywhere. All that can be done is to make-do with whatever is available, and to innovate for what is not. I knew that there were some other doctors aboard, but I found myself all alone when it came to volunteering. It is a tricky situation for any doctor. Who would risk of being led to failure, or of being found wanting for skills and experience by all the co-passengers and the crew. And certainly you cannot close any doors or lo...Show MoreCompeting Interests: Upon a request to write a paper on emergencies, I had submitted a paper titled "Some Unusual Emergencies" to a journal last year. This recounts an emergency that was handled by me. I had a choice of staying quiet and having let the patient suffer the consequences, or I take the risk and volunteer my help. I took the risk and volunteered to help. The patient survived. Her family expressed their thanks to me and obviously the patient thanked me as well. What more, her eyes beamed and her face had a big smile for me while she she was carried away on a stretcher along with oxygen provided to her from a portable cylinder. It was an Air India Flight on the early morning of 06 November 1993 from Mumbai to Johannesburg, with a stopover at Dar e'salaam and then at Durban, where this patient was to disembark. The Captain of the flight and the cabin crew, besides all the co-passengers had given me a standing ovation, and a 2 litre special bottle of sparkling Champagne to this teetotaler.. As far as I am concerned, I will continue taking risks, whenever needed, for helping and saving people. What would anyone want to do with the skills and experiences, if not for extending help even in worst situations and without proper backup, necessary medicines or equipment? For me humanity will always come first. Here is the link for this paper :- Rajesh Chauhan (2017) Some Unusual Emergencies. Emerg Med Inves 2017. J136. DOI: 10.29011/2475- 5605.000036
- Page navigation anchor for RE: Retired physicianRE: Retired physician
I have been involved several times in in-flight emergencies but now I will soon no longer hold a medical license as I intend to retire. I'm not sure if I should still respond to emergency calls on board. I would certainly defer to a licensed physician if one were present but what if no one volunteers? I would still be better than nothing. I hope the authors will comment on this issue.
By the way, Air New Zealand has a fantastic medical kit, probably because they have so many long-haul flights.Competing Interests: None declared.
- Page navigation anchor for Medical kits on planes should be standardizedMedical kits on planes should be standardized
I have been in such situations on a number of trans-Atlantic flights. Flight crews rotate on different aircraft and are not especially familiar with the contents and locations of the meds in the kits. It is very time-consuming to search for the needed items/reading labels, etc. It would be extremely helpful if ICAO would
stanadardize the Medical Kits.Competing Interests: None declared.
- Page navigation anchor for RE: Is there a doctor on boardRE: Is there a doctor on board
Having recently responded to an in flight emergency I welcome this article and the helpful resources. I would add that physicians responding should also consider that their role may not have finished once the airplane has landed. There will be some hand-over to any other medical attendants / paramedics and possibly a request from either the patient or a relative for further information. Whilst on board an airline attendant took notes and recorded vital signs for the telemedicine sheet, however the attending physician is not provided with a copy which I would recommend the airlines consider. A later follow up request from a relative also means the consideration of obtaining written consent from the patient to provide medical details, in my case to the spouse.
In the article I would have liked to see some comments regarding the issue of declaring death in flight. My understanding being that the aircraft is then required to land within the airspace where death is declared rather than necessarily proceeding to the destination?
I can also verify the comments regarding the limited utility of a stethoscope on board. Indeed when I mentioned this to a physician colleague he told me of his experience, and on being unable to hear the heart sounds requested if the flight attendant would kindly ask the captain to turn off the engines for a minute. He was able to stop the attendant dutifully relaying the joking request.Competing Interests: Recent provider of in flight medical assistance Air Canada