AIR CHARTER OPERATIONS Is This an Inflight Medical Emergency? By Gregory Pinnell, MD F lying passengers under Part 91 and Part 135 is a complex dance of balancing your time manag- ing the aircraft: working with weather, sched- ules, baggage, and the myriad other details that must be handled in even the most routine flight. To complicate matters further, these pilots also may carry passengers with medical conditions they know nothing about. Decisions on what to do if a passenger develops medical symptoms must be made with limited information and, sometimes, in the most inopportune phase of the flight. Pilots may or may not have the time or resources to gain a medical opinion from experts on the ground as to what is the best course of action. No pilot likes to “wing it” when figuring a plan of action, but that may be the only and best choice at the time. In the medical field, we have an axiom—when you hear hoofbeats, think horses, not zebras. In other words, when you are trying to figure out what is wrong with the passenger—now patient—remember common things happen commonly. Medical events that happen in flight are no different. The good news is that most symptoms passengers experience in flight turn out not to be a seri- ous medical event and don’t require an immediate diver- sion to get medical help. More than half of all medical complaints involving passengers fall into routine problems such as: fainting or near fainting, respiratory problems such as asthma, nausea, and vomiting. These are usually not life- threatening conditions requiring immediate divert/ no-divert decisions. Even seizures, though dramatic in appearance, will usually resolve themselves in a few minutes and are not generally a threat to life. Aviation Business Journal | Summer 2019 Obviously, there are other much-more-serious medical problems that can occur, such as cardiac arrest, where a suddenly unconscious passenger is pulseless and not breathing. The crew response here is obvious and involves CPR if possible, an Automated External Defibrillator (AED) if your airplane is equipped, and then getting the aircraft to an airport where the passenger can be treated as soon as is safe and practical. But let’s look at some common passenger complaints of not feeling well where the decision-making may not be so clear, and you may not have medical support available from the ground. The medical problem may be quite benign or you may be wishing you were on the ground 10 minutes ago. In general, some type of pain is an extremely common symptom and is what we see in the medical office every day. To make a diagnosis, doctors want to know four things about the patient’s pain. First, where is the pain? What part of the body hurts? Second, what does it feel like: sharp, dull, achy? Third, does the pain radiate to other parts of the body? Fourth, how long has the patient felt pain there, and has it come on suddenly or gradually? Many times, the patient knows what is causing the pain because they have had it before and have a known condition. The location of pain in the body is a big clue to what’s wrong and how serious the condition may be. Let’s examine three areas of the body that doctors call “alarm” or danger scenarios and require prompt action. Continued on page 46 45
