Inflight arterial saturation: continuous monitoring by pulse oximetry.

The ability of newer airliners to fly at higher altitudes has resulted in an increased altitude exposure to both airline crews and passengers. This increase in altitude exposure has the potential to place some individuals at risk for desaturation. Using pulse oximetry, the arterial oxygen saturation of 42 airline crew members was continuously monitored on 22 regularly scheduled commercial flights. Mean nadir arterial oxygen saturations fell from 97.0% preflight to 88.6% at cruising altitudes. Pulse oximetry results revealed large variations between individuals. Individual nadir saturations ranged from 93% to 80%. Modern aircraft flight may result in desaturations even among healthy aircrew. The effects on human performance remain unknown.

Alcoholism and treatment in airline aviators: one company's results.

Airline transport pilots are at risk for alcoholism, although prevalence statistics are not known. (Alcoholism is used to mean alcohol dependence as defined in DSM-III-R.) Whether their prevalence of alcoholism is consistent with that of the general population's, less, or possibly enhanced by psychological vulnerabilities, is considered. However, the development and implementation of this job-based, peer-oriented alcohol treatment can be an asset to pilot career progression and airline pilot retention. According to a retrospective analysis of identified aviators, 87% of alcoholic pilots of this major airline returned to flight duties after substance abuse treatment. Relapse occurred in 13% of those accepting treatment. Early identification and treatment of the substance-abusing aviator can be enhanced by encouraging teamwork between pilots, union, airline management, flight surgeons, and employee assistance program professionals.

In-flight medical emergencies. One year of experience with the enhanced medical kit.

Recent regulations require commercial US aircraft to carry an enhanced medical kit. We reviewed kit use on United Airlines during the initial year of the regulations. We also surveyed passengers who became ill during flight and health care providers who used the new kit. The medical kit was used 362 times on 361 flights (once in every 1900 flights or one use for every 150,000 air travelers). Health care providers indicated that the kit was useful in more than 80% of emergencies and was occasionally lifesaving. In the emergencies in which the kit was used, 70% fell into one of seven major diagnostic groupings, including syncope/near syncope (29%), cardiac/chest pain (16%), asthma/lung disease/shortness of breath (10%), and allergic reactions (5%). With 450 million domestic air travelers per year, we would expect 3000 in-flight medical emergencies annually, and conclude that the enhanced medical kit is beneficial and propose that its effectiveness would be improved by the addition of a bronchodilator for inhalation.