Bon Voyage? A Primary Care Primer on the Risks of Commercial Air Travel

Now that the holiday travel season is upon us, more of your patients may be taking to the skies. But some of them may have more serious problems to contend with than long lines, delayed flights, and missing luggage.

The Federal Aviation Administration (FAA) Medical Institute estimates that the number of medical emergencies aboard commercial airline flights has risen from 19 to 35 per million passengers between 2000 and 2006.¹ Although this number does not seem particularly striking, it does not include problems in travelers on the ground, so it may underestimate the true magnitude of this issue. The FAA suggests that older passengers and longer flights contribute to this trend. It is also possible that the stress created by lengthy security clearances and delayed flights plays a role.

A recent attempt to survey various carriers about the exact number of medical emergencies was unsuccessful; there is no legal requirement to report these statistics. However, STAT MD, a University of Pittsburgh Medical Center initiative that provides emergency consultation to 8 airlines around the clock, estimated that it received about 1500 calls for in-flight medical issues in the first 7 months of 2008.¹ That is a more substantive number and therefore more disconcerting. How significant were the contents of these calls? About 6% of the calls led to an emergency landing so that the sick passengers could receive more intensive diagnosis and treatment.¹

IN-FLIGHT MEDICAL HAZARDS

Commercial aircraft are pressurized at 6000 to 8000 feet.² The result is hypoxia, which can be an important stressor for those with lung or cardiac disease and anemia. This stressor becomes more prominent as the duration of flights increases. Also, the expansion of gases in the lung with the decreased cabin pressure can turn a small pneumothorax into a critical medical emergency. Thrombosis is another by-product of longer flights and congested seating.

In addition to deep venous thrombosis and the risk of pulmonary emboli, there is an entity called “economy class stroke syndrome.” A literature review of 12 cases suggests that long flights, triggers to thrombosis, and a patent foramen ovale can paradoxically shift venous emboli into the arterial circulation and cause a stroke.³

IMPLICATIONS FOR PRIMARY CARE PROVIDERS

It may be worthwhile to keep a copy of a paper that comprehensively covers preflight clearance of patients for air travel if you are asked to provide that consultative service.² If you are on a plane, be a “good Samaritan” when someone asks, “Is there a doctor on the plane?” Finally, on a public policy level, the FAA should be encouraged to keep statistics and outcomes, with the assistance and transparency of the commercial airline industry, to inform both health care providers and the general public about all the potential complications of air travel. Better care and safety will require much more than our voluntary professional assistance when something acute and potentially catastrophic happens at 30,000 feet.

References:

REFERENCES:

1

. Bear D. Are new rigors of air travel taking a medical toll?

The Blade

. September29, 2008.

http://www.toledoblade.com

. Accessed November 11, 2008.

2

. Jorge A, Pombal R, Peixoto H, Lima M. Preflight medical clearance of ill andincapacitated passengers: 3-year retrospective study of experience with a Europeanairline.

J Travel Med

. 2005;12:306-311.

3

. Kakkos SK, Geroulakos G. Economy class stroke syndrome: case report andreview of the literature.

Eur J Vasc Endovasc Surg

. 2004;27:239-243.