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World-leading EMS team calls for life-saving aviation data sharing

Dec. 5, 2007, Aberdeen, Scotland – An award-winning medical team has called for the aviation industry to develop a uniform approach to collating information after medical emergencies occur in flight. Dr James Ferguson, a senior consultant at the university teaching hospital Aberdeen Royal Infirmary (ARI), and leading clinician for TheFirstCall, an advanced telemedicine services provider, presented the results of a five year clinical study at the Royal Society of Medicine in London this week. He told his peers that when it comes to air ground medical services, many in the sector are “still working on decisions based on assumptions made 20-30 years ago.”

Dr Ferguson was delivering the results of a five year study that the ARI has produced in conjunction with TheFirstCall, derived from data collected from all medical  emergencies that occurred in flights where TheFirstCall was called to assist. One of the findings, for example, was that older travellers are no more likely than younger people to need emergency care en route. Dr Ferguson says: “There is a misguided assumption that elderly people will be the cause of more emergency calls. We discovered that there is no relationship between old age and calls for assistance. In fact, the most common age group to experience difficulties is the 21-30 year-olds.”

Dr Ferguson has long advocated the use of ‘evidence based’ medicine, ie care based on looking at historical data, rather than ‘best guess’ diagnosis of symptoms as they present. He would like to see a standard industry-wide diagnostic form used when in-flight medical emergencies occur in order to provide the best medical care to improve patient outcomes and ultimately save more lives. Anonymous data taken from the forms should then be collated and made available to all EMS providers.

Is there a doctor on board? If so, that may be a hindrance.

Says Dr. Ferguson: “Statistically in something like 80% of long-haul flights, there is likely to be a medical professional on board. However, that person is not necessarily skilled in emergency care, which is a particular expertise. They are also frequently likely to have had a drink or taken a sleeping pill, so not in the best state to provide assistance. With a standardised alpha-numeric form it would be easy to download information to experts on the ground as quickly as possible. For example you could ask ‘is the person breathless’, where ‘breathless’ equates to A1, ‘very breathless’ equates to A2 etc. This would be invaluable where voice connections are poor.” TheFirstCall also discourages people on board from making quick diagnoses, preferring rather to treat the symptoms as they appear.

Lose the excess kit

Dr Ferguson also slams the use of generic on board medical kits designed decades ago to cater for every possible eventuality. He says: “When you have a bag full of powerful drugs, you can limit your options and cause more harm than good.  The vast majority of emergencies can be treated with simple remedies, like oxygen. I’d recommend putting a few everyday medicines in the bag, such as ibuprofen, an epi pen and Imodium to treat the most common illnesses that present on board.” These kits could be more rationally designed from the evidence of what is occurring on board.

The ARI evidence indicates that most emergencies are the result of pre-existing conditions. To reduce the likelihood of illness en route, Dr Ferguson recommends better passenger education for people travelling who are sick, alongside more up to date training for flight attendants; whom he believes should work with simple on board aids to help them cope with incidents that arise in flight. “Of course it is important that cabin crew can deliver mouth-to-mouth resuscitation,” he says, “but it is equally valuable that they know how to cope with diarrhoea, the most common traveller’s illness there is. Something like asthma will not present itself as ‘asthma’ on the journey. Rather someone will start to become breathless. A quick flip-through guide would help cabin crew to deliver the most appropriate help quickly.”

Dr. Ferguson’s findings are based on a lifetime of working in the remote emergency medical services field. EMS is part of his daily routine and when on duty he is the first person to pick up the phone when an emergency is called in. He says: “At ARI we work with people in remote locations, such as on aircraft and oil rigs, on a daily basis. The next nearest hospital to us is 60 miles away. We have had to develop remote emergency medical care skills as a necessity.”

TheFirstCall believes that a global data sharing system across the industry would save lives and make medical care efficient and could kick-start a wider global database. Says Roderick MacDonald, chief executive: “Such a system would benefit remote services providers across many industries. The aviation and the marine industries already collaborate on engines, safety and interiors development, so why not in something as crucial as healthcare?”