FIRST-AID IN THE AIR

Background: First aid is commonly required during commercial aircraft flights, especially during international flights. An intimidating and sometimes threatening array of in-flight medical emergencies challenge the doctor, flight attendants and other passengers in such medical em ergencies. Cramped conditions, difficulties of access to the victim, l ack of privacy, cultural and language differences and noise and vibrat ion all compound to increase the difficulties of the normal first aid drills which are required in the management of in-cabin emergencies. D octors who fly as passengers are liable to be called upon to render fi rst aid in the air. We provide an analysis of the types of medical eme rgencies encountered during commercial air travel. Methods: We have re viewed all consecutive in-flight medical incident reports for QANTAS i nternational flights for 1993. All incidents requiring the attention o f a doctor were included. Results: A total of 454 significant medical incidents occurred. These included, in rank order, syncope (35%), angi na and cardiac emergencies (23%), gastrointestinal conditions (13%), r espiratory tract infections and asthma (9%) and anxiety and panic reac tions warranting medical intervention (5%). Conclusions: Syncope, the management of gastrointestinal symptoms and problems of angina compris e over half (58%) of the presenting symptoms which confront a fellow t raveller who may coincidentally be a medical practitioner. Problems of anxiety, sleeplessness, airport bustle, immobility, barotrauma, alcoh ol abuse and mild hypoxia are discussed in the context of precipitatin g factors which may trigger an in-flight emergency. Psychological prob lems are very common and challenge the first aider, whether or not he or she is medically trained. We emphasize the necessity for doctors an d nurses to be trained in first aid, as a distinct profession in its o wn right and a series of drills and skills which are distinctive from those of surgery-based health care. The 5% annual increase in air-pass enger traffic, predicted for the next two decades, highlights the impo rtance of special training for 'first aid in the air'.