Surgical and Medical Emergencies Onboard European Aircraft

A new study demonstrates that although aviation is regulated by a variety of national and international laws, standardized documentation of in-flight medical and surgical emergencies (IMEs) is inadequate and needs further development.

Researchers at Ruhr-University Bochum (Germany) approached 32 European airlines and asked them to provide anonymous data on medical flight reports of in-flight medical and surgical emergencies for the years 2002 to 2007. The total number of incidents was correlated to revenue passenger kilometers (RPK). Additionally, on-board births and deaths, flight diversions, flight routes (continental or intercontinental), and involvement of a physician or medical professional in providing therapy were analyzed. However, only four airlines, of which two participated in the study, were able to provide information on a total of 10,189 cases.

A total of 613.03 billion RPK were analyzed; of all emergencies documented, 20.4% were on continental flights and 79.6% were on intercontinental flights. Syncope was the most common medical condition reported (5307 cases, 53.5%) followed by gastrointestinal disorders (926 cases, 8.9%), and cardiac conditions (509 cases, 4.9%). The most common surgical conditions were thrombosis (47 cases, 0.5%) and appendicitis (27 cases, 0.25%). In 2.8% of all in-flight medical and surgical emergencies, an aircraft diversion was performed. In 86% of cases, a physician or medical professional was involved in providing therapy. A mean of 14 in-flight medical and surgical emergencies per billion RPK was calculated. Surgical illnesses accounted for a minor percentage of all on-board emergencies. These included thrombosis (47 cases, 0.5%), appendicitis (27 cases, 0.25%), and gastrointestinal bleeding (1 case, <0.1 %). There were 2 births (< 0.1%) and 52 deaths (0.5%) reported.

"Worldwide, it has been reported that only 17% of all IMEs are documented, most of them inconsistently, which would seem to indicate that legislation for mandatory standardized documentation and the establishment of an international registry is needed,” concluded lead author Michael Sand, M.D., and colleagues of the department of general and visceral surgery.

As aircraft passenger load increases, so do IMEs on commercial aircraft. A variety of low-cost carriers has made air travel accessible to a larger portion of the population, contributing to increasing passenger load. Additionally, due to increased life expectancy in western countries, the average passenger age is also steadily rising. It has been estimated that by the year 2030, half of all aircraft passengers will be over 50 years of age. In addition to the continuous increase in the average age of passengers, flight-stress and changes in the cabin environment (temperature, humidity, or air pressure) and other factors associated with travel, such as the stress of increased security, decreased seat space, and increasing delays, can also trigger medical emergencies on board.

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Ruhr-University Bochum