Ogni anno viaggiano nel mondo su aerolinee commerciali 2,75 miliardi di passeggeri. Nel triennio 2008-2010 si sono verificate 11.920 emergenze denunciate durante il volo: 37,4% sincopi, 12,1% problemi respiratori, 9,5% nausea e vomito, e poi attacchi cardiaci, ictus, ecc. La morte si è verificata nello 0,3% dei casi in volo o dopo l’atterraggio. L’urgenza è stata soccorsa in volo nel 48,1% dei casi da passeggeri medici. Un quarto dei passeggeri che avevano presentato un’urgenza in volo è stato ricoverato in Ospedale all’arrivo.
Nella Tabella sono riportate le Raccomandazioni per i passeggeri medici che prestano aiuto ai passeggeri colpiti da malore in volo.
(Peterson DC et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med 368, 2075-83, 2013)
Recommendations for Traveling Physicians or Other Health Care Providers during In-Flight Medical Emergencies.
General Approach to In-Flight Medical Emergencies
Identify yourself and specify your level of medical training to the flight crew.
Identify the patient’s chief problem and its duration.
Identify associated and high-risk symptoms (e.g., chest pain, shortness of breath, nausea or vomiting, or unilateral weakness or numbness).
Obtain vital signs (pulse and blood pressure). If you are unable to assess blood pressure by means of auscultation, assess it by palpating the radial pulse.
Assess the patient’s mental status and determine whether there are focal neurologic deficits.
If the patient is in cardiac arrest, obtain and apply an automated external defibrillator (AED). For patients with a pulse but a suspected cardiac problem, consider using an AED if it has monitoring capabilities. (The airline may require contact with a ground-based consultant before use.)
Ask a flight attendant to obtain the emergency medical kit (EMK) and administer oxygen as needed.
Initiate consultation with the ground-based consultant if not already initiated by the flight crew.
Recommendations for interventions, such as administration of medications or intravenous fluids, should be discussed with the ground-based consultant.
Aircraft diversion, ground-based medical assistance, or both should be coordinated with ground-based consultation.
Document the clinical presentation and care rendered. This information should be provided to medical personnel on arrival at the destination with the transfer of care.
Management of Syncope or Presyncope
Confirm breathing and pulse.
Move the patient to an aisle or galley, place the patient in a supine position with legs raised, and provide oxygen.
Check vital signs. Most patients will be hypotensive immediately after the episode.
If the patient has diabetes, a glucometer from the patient or a fellow passenger may be used for glucose assessment.
(A device may also be available in enhanced EMKs.)
Most patients will recover spontaneously within minutes. Give oral fluids when possible.
Consider intravenous fluids only if the patient is persistently hypotensive and cannot take oral fluids.
Management of Chest Pain or Palpitations
Check vital signs.
If chest pain may be cardiac in origin, consider administering aspirin.
If systolic blood pressure is more than 100 mm Hg, consider administering sublingual nitroglycerin every 5 minutes.
Check blood pressure after each dose.
If the AED has monitoring capabilities, consider its use to evaluate the cardiac rhythm and evidence of ST-segment changes in the limb leads.
If symptoms resolve with the above measures, aircraft diversion is not typically required. Ground-based consultation can assist with diversion decisions.