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Correspondence |
University of California San Diego, San Diego, USA, E-mail: kkuczkowski{at}ucsd.edu
To the Editor:
It has been estimated that nearly 2 billion people travel on commercial airlines each year.1 As more elderly people (often with preexisting disease) take to the air the incidence of in-flight illnesses/medical emergencies is expected to increase. The management of in-flight medical emergencies requires an integrated emergency response system that ensures rapid notification of medical ground personnel (many airlines in the USA provide around-the-clock air-to-ground radio consultation either with their own medical department personnel or contracted medical consultants), assistance from appropriately trained flight crews (it is not uncommon for the flight attendants to receive training in first-aid, cardiopulmonary resuscitation, and operation of automated external defibrillators) and on board passenger volunteers (if available).1–3
Although serious life-threatening in-flight medical events and deaths are uncommon, it is becoming increasingly common that physician passengers on board are called to assist the flight crew if the medical emergency arises. The anesthesiologist’s unique skills in acute resuscitation combined with experience in critical care make members of our specialty particularly valuable in management of in-flight medical emergencies. However, there are a number of medicolegal and logistic concerns [about which passenger physicians (including anesthesiologists) might be concerned, but not fully informed] involved in caring for patients with in-flight medical emergencies. Having recently provided care to two fellow passengers during two in-flight (on board) medical emergencies in two different countries the author of this communication would like to share some of his findings on implications of participating (as an accidental medical care provider) in such events.
Most in-flight medical events are not serious with fainting, near-fainting, hyperventilation and dizziness accounting for the majority of such events.1 Cardiovascular events account for the majority (46%) of medical diversions.1 Cramped conditions, difficult access to the victim, lack of privacy, language barrier and cultural differences, noise and vibration all compound to increase the difficulties in the management of in-flight medical emergencies.1,4 In the United States, Canada and Great Britain physician passengers do not have a legal duty to render assistance to the victim/s of in-flight medical emergencies. In contrast, in Australia and many countries in Europe physician passengers do have such an obligation.1 To date no litigation has been brought against a passenger physician who has rendered assistance during an in-flight medical event. By international law, the country in which the airplane is registered has legal jurisdiction.1,4,A However, the country of citizenship of the plaintiff or defendant or the country in which the incident occurs can also have jurisdiction.1,4,A In the United States the Aviation Medical Assistance Act (an important step that reduces passenger physician’s concerns about medical liability) was signed into law in 1998.A The act provides limited "Good Samaritan" protection to any medically qualified passenger who provides medical assistance aboard an aircraft.A
In conclusion physicians (including anesthesiologists) rendering care during in-flight medical emergencies should be aware of the logistic and medico-legal implications of their involvement in these events.
Footnotes
Accepted for publication February 1, 2007.
A Aviation Medical Assistance Act of 1998, Pub L. No. 105-170, H.R. 2843, 105th U.S. Congress. Washington, D.C.: National Archives and Records Administration, 1998. 
References
1 Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002; 346: 1067–73.
2 Lyznicki JM, Williams MA, Deitchman SD, Howe JP 3rd; Council on Scientific Affairs, American Medical Association. Inflight medical emergencies. Aviat Space Environ Med 2000; 71: 832–8.[Medline]
3 Rayman RB, Zanick D, Korsgard T. Resources for inflight medical care. Aviat Space Environ Med 2004; 75: 278–80.[Medline]
4 Newson-Smith MS. Passenger doctors in civil airliners-obligations, duties and standards of care. Aviat Space Environ Med 1997; 68: 1134–8.[Medline]
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