[Flight and altitude medicine for anesthetists-part 3: emergencies on board commercial aircraft]. / Flug- und Höhenmedizin für Anästhesisten - Teil 3: Notfälle an Bord von Verkehrsflugzeugen.

The demographic trend of industrialized societies is also reflected in commercial airlines' passengers: passengers are older nowadays and long-haul flights are routine mode of transport despite considerable chronic and acute medical conditions. Moreover, duration of non-stop flight routes and the number of passengers on board increase. Thus, the probability of a medical incident during a particular flight event increases, too.Due to international regulations minimum standards for medical equipment on board, and first aid training of the crews are set. However, it is often difficult to assess whether a stopover at a nearby airport can improve the medical care of a critically ill passenger. Besides flight operations and technical aspects, the medical infrastructure on the ground has to be considered carefully.Regardless of the amount of experience of a physician medical emergencies on board an aircraft usually represent a particular challenge. This is mainly due to the unfamiliar surroundings, the characteristics of the cabin atmosphere, the often existing cultural and language barriers and legal liability concerns.

[Aviation and high-altitude medicine for anaesthetists: part 1: physical basics and pathophysiology]. / Flug- und Höhenmedizin für Anästhesisten - Teil 1: Physikalische Grundlagen und Pathophysiologie.

Air travel has become a natural part of modern life. Both the environment, they take place in and the physical changes humans are exposed to must not be underestimated. Changes of pressure and volume of gases in higher altitudes induce specific physiological reactions, whereas limitations to compensate need to be acknowledged. It is the artificial environment of the aircraft cabin that allows travel in usual flight levels. Nevertheless, mild hypoxia and its sequeale have to be considered.

In-flight medical emergencies.

BACKGROUND: One in every 10 000 to 40 000 passengers on commercial aircraft will have a medical incident while on board. Many physicians are unaware of the special features of the cabin atmosphere, the medical equipment available on airplanes, and the resulting opportunities for medical intervention. METHODS: A selective literature search was performed and supplemented with international recommendations and guidelines and with data from the Lufthansa registry. RESULTS: Data on in-flight medical emergencies have been collected in various ways, with varying results; it is generally agreed, however, that the more common incidents include gastrointestinal conditions (diarrhea, nausea, vomiting), circulatory collapse, hypertension, stroke, and headache (including migraine). Data from the Lufthansa registry for the years 2010 and 2011 reveal the rarity of cardiopulmonary resuscitation (mean: 8 cases per year), death (12 cases per year), childbirth (1 case per year), and psychiatric incidents (81 cases per year). If one assumes that one medical incident arises for every 10 000 passengers, and that there are 400 passengers on board each flight, then one can calculate that the probability of experiencing at least one medical incident reaches 95% after 24 intercontinental flights. CONCLUSION: An in-flight medical emergency is an exceptional event for the physician and all other persons involved. Physician passengers can act more effectively if they are aware of the framework conditions, the available medical equipment, and the commonly encountered medical conditions.

Leisure pilot license proposed for Europe: do you want such pilots crossing your flight path?

In a Notice of Proposed Amendment, the European Aviation Safety Agency proposes to introduce a Leisure Pilot License (LPL). Holders of a LPL for airplanes will be allowed to fly single-engine piston airplanes with a maximum takeoff mass of 2000 kg or less, carrying a maximum of three passengers. In this commentary paper, we express significant concern about the flight safety consequences of the proposed aeromedical requirements of the LPL. We argue that the proposed minimum age, validity period of the medical certificate, and issuance of certificates by general practitioners may increase the flight safety risk. Major revision of the proposed LPL regulation is recommended.

Determinants of malaria prophylaxis among German travelers to Kenya, Senegal, and Thailand.

BACKGROUND: Malaria chemoprophylaxis is a mainstay of malaria prevention in travelers. Adequate pretravel advice forms the basis for efficient malaria prophylaxis. This study assessed the determinants for seeking pretravel advice and evaluated the quality of advice from each source and its influence on the patterns and outcome of malaria prophylaxis intake. METHODS: In March and April 2004, a self-administered questionnaire was distributed by cabin crews to passengers flying back to Germany from three popular tourist destinations: Kenya, Senegal, and Thailand. To evaluate the quality of advice and actual intake, figures were assessed against the official recommendations of the German Society of Travel Medicine and International Health (DTG). RESULTS: A total of 1,001 passengers were included in the study (Kenya, 492; Senegal, 131; and Thailand, 378), of which 81% had sought any kind of pretravel health advice. Travelers' age and time of pretravel consultation were associated with the source of information consulted. Seventy-five percent of travelers from Senegal and Kenya received DTG compliant advice compared to only 17% of travelers from areas with low malaria risk in Thailand. Travelers returning from Kenya and Senegal had used correct chemoprophylaxis in only 65 and 47% of trips, respectively. In multivariate analysis, the factors determining correct intake among Senegal and Kenya travelers were receiving pretravel advice (from nonmedical professionals: OR 4.4, 95% CI 1.9-10.0 and from medical professionals: OR 15.4, 95% CI 7.3-32.4), a correct risk perception (OR 2.9, 95% CI 1.9-4.5), 2 to 3 weeks of travel abroad (vs a duration >3 wk: OR 2.2, 95% CI 1.3-3.8), and travel to Kenya (OR 1.9, 95% CI 1.1-3.1). CONCLUSIONS: Malaria prevention among a large proportion of German travelers to tropical destinations is inadequate. Public health efforts should be made to raise awareness among travelers, travel agencies, and medical institutions in Germany.

Tropical medicine and travel medicine: medical advice for aviation medical examiners concerning flight operations in tropical areas.

Medical stress factors in the tropics include the climate itself, factors related to travel (jet lag, means of transport), insects, low standards of hygiene, infectious diseases, socio-economic problems, and psychosocial stress. This chapter from the Joint Aviation Authority Aviation Medical Regulations explores these stresses as they relate to aircrew and the aviation medical examiners who treat them.