Symptom-based categorization of in-flight passenger medical incidents.

INTRODUCTION: The majority of in-flight passenger medical events are managed by cabin crew. Our study aimed to evaluate the reliability of cabin crew reports of in-flight medical events and to develop a symptom-based categorization system. METHODS: All cabin crew in-flight passenger medical incident reports for an airline over a 9-yr period were examined retrospectively. Validation of incident descriptions were undertaken on a sample of 162 cabin crew reports where medically trained persons' reports were available for comparison using a three Round Delphi technique and testing concordance using Cohen's Kappa. A hierarchical symptom-based categorization system was designed and validated. RESULTS: The rate was 159 incidents per 106 passengers carried, or 70.4/113.3 incidents per 106 revenue passenger kilometres/miles, respectively. Concordance between cabin crew and medical reports was 96%, with a high validity rating (mean 4.6 on a 1-5 scale) and high Cohen's Kappa (0.94). The most common in-flight medical events were transient loss of consciousness (41%), nausea/vomiting/diarrhea (19.5%), and breathing difficulty (16%). DISCUSSION: Cabin crew records provide reliable data regarding in-flight passenger medical incidents, complementary to diagnosis-based systems, and allow the use of currently underutilized data. The categorization system provides a means for tracking passenger medical incidents internationally and an evidence base for cabin crew first aid training.

Retention of knowledge and skills in first aid and resuscitation by airline cabin crew.

The study was conducted to investigate the retention of CPR and AED skills, first aid knowledge and perceived levels of confidence for a sample of 35 cabin crew 12 months after recurrent training. The 35 cabin crew undertook a mock resuscitation scenario using the AED and bag-valve-mask carried in the medical kit. Of the 35 subjects, 33 subjects failed to use the bag-mask correctly, 18 performed chest compressions at the incorrect site, only 13 achieved the correct compression depth, only 20 placed the AED pads correctly, and the average time to first shock was 110 s after commencement of the resuscitation. While theoretical first aid knowledge was high, the participants held low levels of self-confidence in their CPR and AED skills. The results of this study indicate that cabin crew may not have sufficiently high levels of skill to manage a cardiac arrest adequately. This suggests that existing approaches to training of cabin crew require further investigation and modification.