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Richard N. Fogoros, M.D.

Getting Sick on Airplanes

By February 28, 2008

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This week, when a 44-year-old woman died aboard an American Airlines flight from Haiti to New York, questions quickly abounded in the media about whether she received adequate medical attention on board, and more specifically, whether she received oxygen quickly enough. (Family says no, American Airlines says yes.) Since the questions regarding this unfortunate lady's in-flight death apparently will be decided in litigation, I do not find it advisable to speculate on them here.

However, the attention this event has received makes this a good time to talk in general about what kind of medical help you can expect if you get sick on an airplane, and some general guidelines for flying if you have heart disease.

What kind of medical help can you expect on an airplane?

You may get lucky, but what you should expect is: None.

It is difficult to conceive of a worse place to become seriously ill than on an airplane at 35,000 feet. Sure, most major airlines stock their airplanes with defibrillators, oxygen, needles and syringes, and a few basic medications (like epinephrine, used to treat severe allergic reactions), but in reality if you really need any of this stuff on an airplane you're probably in big trouble.

If you have a truly life-threatening breathing problem, for instance, getting some oxygen might make you feel a little better, but it's very unlikely to make the difference between life and death.

And many of the people who survive cardiac arrests are the ones who, after they've been successfully defibrillated, are immediately whisked off to an intensive care unit so that whatever underlying problem caused the cardiac arrest in the first place can be aggressively treated. If you have a cardiac arrest on the street, or in a restaurant, or at home, this is what happens. But not in an airplane.

On most airlines, the flight crew has relatively minimal training in medical care, and cannot be expected to be adept at diagnosing and treating real medical emergencies. The first thing that happens if a medical emergency arises is the captain asks if there's a doctor in the house. There usually is, but not always - and even if there is, it's as likely to be a dermatologist or radiologist as a cardiologist or a pulmonary specialist. And if you're lucky enough to have the right specialist on board, there's often precious little he or she can do to help. Take it from one who has answered the call on more than one cross-country flight: Medical supplies on board are severely limited, and given the tight seats and narrow aisles in airplanes, there's not even enough room to perform decent CPR.

The pilot will look for a nearby airport if the emergency appears dire, but even under the best of circumstances it's going to be well over an hour before you can receive real on-the-ground medical attention. Sometimes (as was the case this week) that's just too long.

And just so you know, once a passenger actually dies, the standard operating procedure is to find a place to store the body (in addition to defibrillators, oxygen, etc., a body bag is usually kept on airplanes for just such occasions), and proceed to the original destination.

So when should you get on an airplane?

Since the rule if you get sick on an airplane is to hope for the best but expect nothing, you should fly only when you're reasonably certain that you're going to remain healthy for the duration of the flight. (In making this estimate, don't forget to add a couple of hours for stewing on the tarmac.) So, if you have any sort of relapsing illness, or if you've been having chest pains, episodes of dizziness, bouts of trouble breathing, or any other alarming symptom - see a doctor, and don't get on an airplane.

If you've got heart disease, here are some guidelines for safe flying.

And here is some advice on preparing for airline travel from About.com's First Aid Guide.

Comments
March 10, 2008 at 9:06 am
(1) ibivi says:

I was 44 when I had a heart attack. The paramedics treated me with great disdain because I couldn’t explain what was wrong with me. They told me to quite being a baby. They did not rush me to the hosptial. I actually had the heart attack while I was in the ER waiting for internists to come to see me as they couldn’t find anything in the preliminary tests they did. I did not have the classic symptoms of a heart attack as seen in men. After being in ICU for a few days I was tested for heart disease and it indicated that I did not have any coronary blockage. I was lucky though as I went to hospital that had just set up a cardiac program for women. They recognized that women’s symptoms of heart attack are more subtle and I was well care for as soon as the ECG showed that I had had a mild heart attack. That was 11 years ago.

March 22, 2012 at 10:04 pm
(2) HeesennyWricy says:
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