Fangcang shelter hospitals are a one health approach for responding to the COVID-19 outbreak in Wuhan, China

Background Medical emergencies during short- or long-haul commercial airline flights have become more commonplace due to the aviation industry's contemporary growth, the popularization of commercial flights, and an increased aging of air travelers with significant comorbidities. However, the precise incidence of onboard medical events on commercial airlines and the most common medical conditions is unclear. Methods In this systematic review and meta-analysis, we explored the incidence of in-flight medical emergencies among airline passengers and estimated the incidence rate by physiological body system, or organ class/syndrome for emergencies that may be associated with different body systems. We limited our search to cohort studies published between 1945 to October 31, 2020 in MEDLINE, Embase, Cochrane Library and official reports from the Federal Aviation Administration/International Air Transport Association, regardless of the language of publication. Only studies that evaluated the overall frequency of onboard medical events on commercial air carriers (in which they also presented the total number of annual revenue passengers) and the frequency of events by physiological body systems or organ class/syndrome were included. We excluded case reports and case series, systematic or narrative reviews, and studies addressing specific health-related conditions. Two independent investigators performed first- and second-phase study screening, abstracted data, and appraised risk of bias. We rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Using a quality effect model, we meta-analyzed data associated with the incidence of in-flight medical emergencies, all-cause fatality, incidence of medical events by medical condition category, frequency of en-route diversion, presence of medical personnel on board, and the use of an automatic external defibrillator. We also extracted data regarding the cost of flight diversion. Results Of 18 individual studies with approximately 1.5 billion passengers, 11 reported the overall incidence of in-flight medical emergencies. Low certainty of evidence suggested that the global incidence of in-flight medical emergencies was 18.2 events per million passengers (95% CI 0.5 to 53.4 per million; I2 = 100%, P Conclusions In-flight medical events on commercial travels are extremely low with a corresponding very low in-flight mortality rate. Associated costs derived from en-route diversion might significantly influence airlines' budgetary equilibrium. Novel and modern standardized reporting systems or platforms should be internationally provided and enforced by health and aviation authorities to obtain higher quality patient-passengers datasets. Onboard volunteer medical providers must be aware of everyday life-threatening events during commercial flights and should consider the establishment of a connection between the aircraft and ground-based medical advisory services while assisting in-flight medical events.

The global incidence of in-flight medical emergencies: A systematic review and meta-analysis of approximately 1.5 billion airline passengers

Should every physician be ready to act as a community first responder

Air route alternation caused by unexpected events in abnormal or emergency situations often produces adverse consequences on an operator’s cognition and behavior in flight tasks. Under such a circumstance, it is especially necessary to examine the utility of the interaction displays usually designed based on the routine environment. This study was aimed to investigate the effects of air route alternation and display design on operators’ situation awareness (SA), task performance and mental workload during simulated flight tasks. Twenty-four participants attended an experiment where they were instructed to perform simulated flight tasks with three types of display designs in both air-route-as-planned and air-route-altered conditions. Subjective measures, behavioral measures and eye movement measures were adopted to assess the participants’ SA, task performance and mental workload. The results show that unexpected air route alternation increases mental workload as well as deteriorates the SA and task performance due to the gap between attention resource demand and supply. Reducing the demand of the operator’s attention resource should be the focus when coping with unexpected events in abnormal situations. In addition, reasonable information layout, such as a center-layout design of the critical decision-making information, is more important than information salience for improving the SA and task performance in abnormal situations. Nevertheless, indicators with a high-salience design, such as a more open window design and immersive design, are still worth recommending.

Effects of Air Route Alternation and Display Design on an Operator’s Situation Awareness, Task Performance and Mental Workload in Simulated Flight Tasks

Commercial Air Travel for Passengers With Cardiovascular Disease: Stressors of Flight and Aeromedical Impact.

Importance In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment. Observations In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical volunteers should identify their background and skills, perform an assessment, and report findings to ground-based medical support personnel through the flight crew. Ground-based recommendations ultimately guide interventions on board. Conclusions and Relevance In-flight medical emergencies most commonly involve near-syncope and gastrointestinal, respiratory, and cardiovascular symptoms. Health care professionals can assist during these emergencies as part of a collaborative team involving the flight crew and ground-based physicians.

/pdf/in-flight-medical-emergencies-a-review-34dn0mbk0u.pdf

In-Flight Medical Emergencies: A Review

https://jamanetwork.com/journals/jama/articlepdf/2734314/jama_martingill_2019_lr_190021.pdf

Aircraft Cabin Hypoxia and Adverse Medical Events-Reply.

Ground-based medical support (GBMS) utilizes specially trained medical personnel to provide medical recommendations for in-flight events and preflight passenger screenings. GBMS services are contracted by airlines and are most commonly provided by third-party entities that staff physicians and/or nurses experienced in flight physiology, aircraft operations, and emergency medicine. GBMS may also assist airlines in recognizing the need for public health notification for potential infectious disease involving international travel, as well as the management of occupational health issues such as pilot and crew fitness-to-fly assessments. During an in-flight emergency, airlines largely rely on the advice of GBMS medical providers for decisions regarding medical treatment and use of onboard medications or equipment, often with the assistance and further input of onboard medical volunteers. The decision to divert an aircraft, while influenced by the medical recommendation of GBMS, is ultimately made by the pilot in command and the airline’s dispatch center.

Ground-Based Medical Support

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In-Flight Medical Emergencies: A Review

Aircraft Cabin Hypoxia and Adverse Medical Events-Reply.

Ground-Based Medical Support