Is This an Inflight Medical Emergency? Continued from page 45 Head pain or “Headache” is a very com- mon symptom. There are various types of headaches including tension head- aches, migraine headaches, and sinus problems, which may cause head pain or “blocks” of nasal, ear, and other cavities in the head. This can cause pain in the ears, usually on descent, due to the passenger’s inability to clear the ears as the cabin pressure changes. Headache and pain in the ear and nose during cabin pressure change is so common you likely have either had one yourself at one time or another. If you have never flown with some nasal con- gestion and developed ear pain on the way down, then you are one of the lucky ones. If a passenger experiences ear pain during climb or descent, then all you can do is set the cabin rate of change to the lowest rate possible. An emergency descent and diversion really won’t help because cabin pressure is going to change even more rapidly. What type of head pain spells imminent trouble and should have you looking for a divert airport? Sudden head pain, in a passenger who says she doesn’t typi- cally have headaches, is concerning. Particularly wor- risome is head pain that is like nothing the passenger has ever experienced before. Of highest concern is sharp, or sudden pain, some- thing the sufferer often describes as a “thunderclap” of pain. This may signal bleeding into the brain and is a true medical emergency and danger to life. Very serious head pain may also be accompanied by nausea, vomiting, or a change in the alertness of the indi- vidual. If a passenger experiences all or some of these symptoms, then you should try to keep the individual calm, immediately contact your ground based medical support team (if you have one) and ask any other pas- senger with medical experience to help. If the above scenario occurs, then a speedy response is critical and emergency medical staff should be waiting for you when the mains touch the runway. Chest Pain is another symptom which can have a variety of causes, most often benign, but sometimes very scary. The chest can be the location of almost any type of pain imaginable, and the character of the pain can sometimes help determine the cause and its serious- ness, or it can make diagnosing the condition even more confusing. Chest pain that comes from difficulty breathing caused by asthma or other lung disorders may be described as achy or sharp. It may be hard for the passenger to localize or even characterize the pain. Some easy questions to ask are: “Have you ever had this pain before,” and “Do you know what causes it?” The answer may be as simple as, “I bruised my ribs on a mountain bike accident a week ago and it hurts to 46 breathe,” or “My asthma and hay fever have been act- ing up lately.” That would be good news and signal the condition is painful for the passenger, but he or she is not in need of urgent medical care. More ominous is sudden onset chest pain, espe- cially pain localized to the sternal or breastbone area, and is sharp or may be even described as “an elephant on their chest” feeling of pain. If the pain radiates from the chest to the arm or neck, and is accompanied by shortness of breath, and the passenger is sweaty and just looks ill, then be very suspicious that the passen- ger is having cardiac chest pain. This may indicate the heart muscle may not be getting adequate blood flow. In other words, it may be a heart attack. When this happens, ask the passenger if he has any history of heart problems. If the answer is ‘yes’, then you know that being in the sky is not the best place to be. Again, diverting is almost certainly your best Aviation Business Journal | Summer 2019