Are you prepared

1
Are you prepared?
Arizona Business Travel Association

• Joan Sullivan Garrett
• Chairman and Founder of MedAire, Inc.

2
Todays discussion

• In-flight medical emergencies
• What do the medical data reveal?
• The value of pre-flight medical assessments
• How to travel safely
• QA

3
Ever wonder?

• What happens at 39,000 feet

if you faint, become nauseous or experience
chest pain?
4
What if a female has complications

• and is 6-7 months pregnant?

Heres a real-life in-flight emergencythat en
route from Cairo to L.A.
5
Communication Specialist

• I got a call from an airline. They had a
  pregnant female on board.
• She was bleeding.

6
Pilot

• Were en route to Los Angeles and were over
  Omaha
• And we have a patient....lady...38 years
  old...female.
• Shes conscious. Shes 6 months pregnant.
• Shes traveling from Cairo.

7
Pilot

• Shes had what she considers to be a
  contraction...and lost quite a bit of blood.

8
Communication Specialist

• They did have a doctor on board, that felt they
  could continue on to California which was their
  destination.

9
Onboard Doctor

• Shes been fine today in her flight from Cairo
  and has been feeling the baby all day long until
  about an hour ago...right after they ate.
• She got up and she just had a large rush of
  bleeding which she felt to be something like a
  half liter.

10
Onboard Doctor

• ...and when I came in and evaluated her, her
  blood pressure looked fine...running about
  170...her pulse was about 70.
• We have her lying down, giving her a little
  oxygen for the baby.

11
Onboard Doctor

• The main issue is...number one...she says that
  when we try and set her up a little bit, she
  feels like shes having more bleeding.
• And number two...I couldnt really hear any
  heart tones on the baby.

12
Onboard Doctor

• She not feeling any fetal movement at this
  point....and when I try and just elicit some
  movement from the baby...just like palpation, she
  doesnt really feel anything.

13
Onboard Doctor

• If anything, she gets a little pressure or pain
  when we press on the baby.
• Shes feeling a little bit of discomfort...lets
  say in the Uterine area below the baby.
• But I wouldnt say any kind of major pain.

14
Onboard Doctor

• So...it seems to me she was probably stable to
  get from here to Los Angeles.

15
Communication Specialist

• And....I got my doctor on the line and he
  asked... Well what about the baby?
• The (onboard) doctor says, well its a good
  sized baby...shes about 7 months.
• Theres no fetal movement since the bleeding
  started.

16
Communication Specialist

• At that time, my doctor made the decision, that
  we recommended the diversion of the aircraft.

17
MedLink ER Physician

• The concern is that if she is really
  quote-unquote six months pregnant -- this child
  is still potentially deliverable at this age.

18
MedLink ER Physician

• It seems to me from the information youre
  giving me that we need to have her get medical
  attention as soon as possible -- this could be an
  early abruption.

19
MedLink ER Physician

• Give the control back to the pilot, and were
  going to....and well have our dispatcher talk to
  them about diverting to closest city.

20
Communication Specialist

• And the captain said, okay great.
• We took them down into Kansas City.

21
Airline Dispatch

• Okay....youve been released to destination
  Kansas City...IFR...youre going to be KNB
  16-50...go ahead.

22
Passenger

• When I became very sick...at the time...all I
  knew was that the plane was diverted to Kansas
  City, Missouri.
• And I was taken to a hospital.

23
Communication Specialist

• I called the hospital and talked to the charge
  nurse of the ER.
• I told her this is the situation...
• We have got a lady seven months pregnant, shes
  bleeding, I said she has lost about a liter and a
  half on the aircraft already...

24
Communication Specialist

• ...every time they stand her she loses even
  more.
• And I said there has been no fetal movement.
• And so she said...Well, Ill call in my team.

25
Communication Specialist

• Within an hour of the aircraft being on the
  ground, they had done a c-section, and the baby
  was in ICU and so was mom in ICU.

26
Passenger

• They have saved my life, as well as my babys
  life. My husband and I would like to thank
  them...to thank MedLink very, very much for
  that.

27
Passenger

• ...Everything turned out well, and my baby is
  here beside me in the hospital.
• Yes...hes beautiful you know!

28
So how did telemedicine get started?

• In 1986 MedAires MedLink Global Response center
  was built based on a hypothesis

The first call came in 1987 when a gentleman was
having a heart attack while crossing the Atlantic
29
More than two decades later

• MedAire provides an integrated, life-saving
  solution including

Education for crewmembers on how to manage
illness injury Onboard equipment and
resources (medical kits defibrillators) Emerg
ency medical expertise via two Phoenix-based
telemedicine centers
30
MedAire serves thousands globally

• We focus on remote travelers
• 90 commercial airlines
• 3,000 business jets
• 330 luxury yachts
• 45 commercial shipping vessels

Our operations are based in Phoenix with a
global footprint on 7 continents
31
We also distribute medical equipment
Emergency medical kits
Defibrillators
32
So what do the data reveal?
33
Total airline case volume
In 2006, 17,310 cases were in-flight emergencies
34
MedLink case reporting

• Case data is documented in our proprietary case
  management system
• Data is aggregated into reports
• MedAires data entry accuracy rate is 99
• Stats are used to create or update kits, design
  first aid curriculum and educate physicians

35
Top in-flight medical categories
36
Outcomes of in-flight calls
37
Top 5 diversion categories
38
Age-related diversions
59 of diversions are for passengers age 51 and
older
39
AED use per million RPK
RPKs
RPK Revenue Passenger-Kilometers
40
AED success rate in 2006

• AED was used 144 times on unresponsive
  passengers
• A shockable rhythm was detected 10 times
• Of the 10, a rhythm was converted 3 times
• The 3 patients were admitted to hospital
• Of the three, two survived

41
Prevention better than cure

• The value of pre-flight medical assessments

42
Prevention prior to boarding

• Many airport/airline personnel trained to
  recognize illness injury
• In 2006, MedAire handled 10,000 fit-to-fly
  passenger medical assessments
• Many due to lung disease, heart complications,
  diabetes, recent surgery late-term pregnancy

43
Medical fit-to-fly assessments

• 26 advised not to travel by MedAires medical
  personnel
• 1 reason due to acute gastrointestinal (GI)
  symptoms
• Left untreated, GI complications, such as
  unresolved acute vomiting and diarrhea, can
  lead to increased dehydration, discomfort and a
  possible in-flight medical emergency

44
So how can you travel safely?
45
Consider your medications

• Always carry on prescription medications
• Enough quantity for unexpected delays
• Diabetics should bring insulin glucometer
• Ensure the pharmacy label your name, or you will
  not be allowed to bring a syringe or needle on
  board
• Asthma sufferers should bring an inhaler
• Stay hydrated (one glass of fluid per hour,
  avoid alcohol)

46
Ask for medical assistance

• When traveling with significant health problems,
  notify the airlines reservation desk
• Ask if they can accommodate you

Wheelchair assistance
Supplemental oxygen
47
Consider your environment
48
Request supplemental oxygen

• Did you know the aircraft cabin is pressurized at
  8,000 - 10,000 ft.?
• Those who use supplemental oxygen at home will
  likely need it in the air
• Call your airline well in advance
• Oxygen assistance is booked at the point of
  reservation and requires a physicians
  authorization
• Do not rely on the availability of the airlines
  emergency oxygen bottles

49
Limit alcohol intake

• Alcohol can contribute to dehydration
• You may experience fatigue and sleep interruption
  with excess alcohol intake
• Avoid dehydration by refraining from excessive
  alcohol or caffeine

50
Contagious disease

• Passengers with contagious illnesses should not
  fly
• Symptoms of concern
• fever, cough, rash, vomiting and diarrhea

51
Travel tips

• Fainting is the 1 in-flight medical situation
• Stand up from your seat slowly
• Minimize stress associated with travel
• Be flexible
• Allow time for added security and check-in
• By being prepared and building extra time in your
  schedule, you can enjoy a more relaxing trip

52
When in doubt

• Wash your hands often
• Use antibacterial wipes/gels
• Think like Frankenstein and Dracula
• Bottom line reschedule travel if youre not
  feeling well

53
Questions

• ?