国土交通省：令和3年度航空旅客動態調査-集計結果.
飛行機・新幹線内での医療ハンドブック. 医歯薬出版株式会社；2021.
日職災医誌, 50 : 325-330, 2002.
宇宙航空環境医学 Vol. 54, No. 3, 49-59, 2017.
Drew C Peterson, Christian Martin-Gill, Francis X Guyette, Adam Z Tobias, Catherine E McCarthy, Scott T Harrington, Theodore R Delbridge, Donald M Yealy
Outcomes of medical emergencies on commercial airline flights.
N Engl J Med. 2013 May 30;368(22):2075-83. doi: 10.1056/NEJMoa1212052.
Abstract/Text
BACKGROUND: Worldwide, 2.75 billion passengers fly on commercial airlines annually. When in-flight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events.
METHODS: We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered. We determined the incidence of and factors associated with unscheduled aircraft diversion, transport to a hospital, and hospital admission, and we determined the incidence of death.
RESULTS: There were 11,920 in-flight medical emergencies resulting in calls to the center (1 medical emergency per 604 flights). The most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%. Of 10,914 patients for whom postflight follow-up data were available, 25.8% were transported to a hospital by emergency-medical-service personnel, 8.6% were admitted, and 0.3% died. The most common triggers for admission were possible stroke (odds ratio, 3.36; 95% confidence interval [CI], 1.88 to 6.03), respiratory symptoms (odds ratio, 2.13; 95% CI, 1.48 to 3.06), and cardiac symptoms (odds ratio, 1.95; 95% CI, 1.37 to 2.77).
CONCLUSIONS: Most in-flight medical emergencies were related to syncope, respiratory symptoms, or gastrointestinal symptoms, and a physician was frequently the responding medical volunteer. Few in-flight medical emergencies resulted in diversion of aircraft or death; one fourth of passengers who had an in-flight medical emergency underwent additional evaluation in a hospital. (Funded by the National Institutes of Health.).
Jochen Hinkelbein, Christopher Neuhaus, Lennert Böhm, Steffen Kalina, Stefan Braunecker
In-flight medical emergencies during airline operations: a survey of physicians on the incidence, nature, and available medical equipment.
Open Access Emerg Med. 2017;9:31-35. doi: 10.2147/OAEM.S129250. Epub 2017 Feb 22.
Abstract/Text
BACKGROUND: Data on the incidence of in-flight medical emergencies on-board civil aircraft are uncommon and rarely published. Such data could provide information regarding required medical equipment on-board aircraft and requisite training for cabin crew. The aim of the present study was to gather data on the incidences, nature, and medical equipment for in-flight medical emergencies by way of a survey of physician members of a German aerospace medical society.
MATERIALS AND METHODS: Using unipark.de (QuestBack GmbH, Cologne, Germany), an online survey was developed and used to gather specific information. Members of the German Society for Aviation and Space Medicine (Deutsche Gesellschaft für Luft- und Raumfahrtmedizin e.V.; DGLRM) were invited to participate in the survey during a 4-week period (21 March 2015 to 20 April 2015). Chi-square test was used for statistical analysis (p<0.05 was considered significant).
RESULTS: Altogether, 121 members of the society responded to the survey (n=335 sent out). Of the 121 respondents, n=54 (44.6%) of the participants (89.9% male and 10.1% female; mean age, 54.1 years; n=121) were involved in at least one in-flight medical emergency. Demographic parameters in this survey were in concordance with the society members' demographics. The mean duration of flights was 5.7 hours and the respondents performed 7.1 airline flights per year (median). Cardiovascular (40.0%) and neurological disorders (17.8%) were the most frequent diagnoses. The medical equipment (78.7%) provided was sufficient. An emergency diversion was undertaken in 10.6% of the cases. Although using a different method of data acquisition, this survey confirms previous data on the nature of emergencies and gives plausible numbers.
CONCLUSION: Our data strongly argue for the establishment of a standardized database for recording the incidence and nature of in-flight medical emergencies. Such a database could inform on required medical equipment and cabin crew training.
小児内科Vol. 49 No.6, 2017-6.
Christian Martin-Gill, Thomas J Doyle, Donald M Yealy
In-Flight Medical Emergencies: A Review.
JAMA. 2018 Dec 25;320(24):2580-2590. doi: 10.1001/jama.2018.19842.
Abstract/Text
Importance: In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment.
Observations: In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical volunteers should identify their background and skills, perform an assessment, and report findings to ground-based medical support personnel through the flight crew. Ground-based recommendations ultimately guide interventions on board.
Conclusions and Relevance: In-flight medical emergencies most commonly involve near-syncope and gastrointestinal, respiratory, and cardiovascular symptoms. Health care professionals can assist during these emergencies as part of a collaborative team involving the flight crew and ground-based physicians.
Mustafa Kesapli, Can Akyol, Faruk Gungor, Angelika Janitzky Akyol, Dilek Soydam Guven, Gokhan Kaya
Inflight Emergencies During Eurasian Flights.
J Travel Med. 2015 Nov-Dec;22(6):361-7. doi: 10.1111/jtm.12230. Epub 2015 Jul 23.
Abstract/Text
BACKGROUND: This study evaluated the incidence and status of urgent medical conditions, the attitudes of health professionals who encounter such conditions, the adequacy of medical kits and training of cabin crew in data-received-company aircrafts suggested by Aerospace Medical Association, and the demographic data of patients.
METHODS: Data were collected from medical records of a major flight company from 2011 through 2013. All patients with complete records were included in the study. Numerical variables were defined as median and interquartiles (IQR) for median, while categorical variables were defined as numbers and percentage.
RESULTS: During the study period, 10,100,000 passengers were carried by the company flights, with 1,312 (0.013%) demands for urgent medical support (UMS). The median age of the passengers who requested UMS was 45 years (IQR: 29-62). Females constituted 698 (53.2%) among the patients, and 721 (55%) patients were evaluated by medical professionals found among passengers. The most common nontraumatic complaints resulting in requests for UMS were flight anxiety (311 patients, 23.7%) and dyspnea (145 patients, 11%). The most common traumatic complaint was burns (221 patients, 16.8%) resulting from trauma during flight. A total of 22 (1.67%) emergency landings occurred for which the most frequent reasons were epilepsy (22.7%) and death (18.2%). Deaths during flights were recorded in 13 patients, whose median age was 77 years (IQR: 69-82), which was significantly higher compared to the age of patients requiring UMS (p < 0.0001). A total of 592 (45%) patients did not require any treatment for UMS. Medical kits and training were found to be sufficient according to the symptomatic treatments.
CONCLUSION: Most of the urgent cases encountered during flights can be facilitated with basic medical support. "Traumatic emergency procedures inflight medical care" would be useful for additional training. Medical professionals as passengers are significantly involved in encountered emergency situations. Adding automated external defibrillator and pulse oximetry to recommended kits and training can help facilitate staff decisions such as emergency landings and tele-assistance.
© 2015 International Society of Travel Medicine.
Jung Ha Kim, Smi Choi-Kwon, Young Hwan Park
Comparison of inflight first aid performed by cabin crew members and medical volunteers.
J Travel Med. 2017 Mar 1;24(2). doi: 10.1093/jtm/taw091.
Abstract/Text
Background: Since the number of air travellers, including the elderly and passengers with an underlying disease, is increasing every year, the number of inflight emergency patients is expected to increase as well. We attempted to identify the incidence and types of reported inflight medical incidents and analyse the first aid performed by cabin crew members or medical volunteers in flights by an Asian airline. We also investigated the cases of inflight deaths and aircraft diversions.
Methods: We reviewed the cabin reports and medical records submitted by cabin crew members and inflight medical volunteers from 2009 to 2013.
Results: We found that inflight medical incidents increased annually, with a total of 2818 cases reported. Fifteen cases of inflight deaths and 15 cases of aircraft diversions during this period were also reported. First aid was performed by the cabin crew alone in 52% of the cases and by medical volunteers in 47.8% of the cases. The most commonly reported causes for first aid performed by the cabin crew and medical volunteers were burns and syncope, respectively.
Conclusion: : Since burns were one of the common reasons that first aid was provided by the cabin crew, it may be necessary to include first aid treatments for burns in the annual re-qualification training programme. Furthermore, the assessment of unconsciousness and potentially critical respiratory symptoms is very important for cabin crew members because those conditions can lead to inflight deaths and aircraft diversion.
© International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
Medical Manual Edition 11th. 2018.
Emergency medical kits on board commercial aircraft: a comparative study. - PubMed - NCBI [Internet]. [cited 2019 Dec 3]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=21075689
Advisory Circular Subject: EMERGENCY MEDICAL EQUIPMENT [Internet]. Available from: http://www.gpoaccess.gov/ecfr
緒方克彦, 藤田真敬. 宇宙航空医学入門. 鳳文書林出版販売; 2015.
P W Groeneveld, J L Kwong, Y Liu, A J Rodriguez, M P Jones, G D Sanders, A M Garber
Cost-effectiveness of automated external defibrillators on airlines.
JAMA. 2001 Sep 26;286(12):1482-9. doi: 10.1001/jama.286.12.1482.
Abstract/Text
CONTEXT: Installation of automated external defibrillators (AEDs) on passenger aircraft has been shown to improve survival of cardiac arrest in that setting, but the cost-effectiveness of such measures has not been proven.
OBJECTIVE: To examine the costs and effectiveness of several different options for AED deployment in the US commercial air transportation system.
DESIGN, SETTING, AND SUBJECTS: Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline strategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest aboard US commercial aircraft. Estimates for costs and outcomes were obtained from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare patients, AED manufacturers, and the Bureau of Labor Statistics.
MAIN OUTCOME MEASURES: Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survivors.
RESULTS: Adding AEDs on passenger aircraft with more than 200 passengers would cost $35 300 per quality-adjusted life-year (QALY) gained. Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40 800 per added QALY compared with deployment on large-capacity aircraft only, and full deployment on all passenger aircraft would cost an additional $94 700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100. Sensitivity analyses indicated that the quality of life, annual mortality rate, and the effectiveness of AEDs in improving survival were the most influential factors in the model. In 85% of Monte Carlo simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50 000 per QALY.
CONCLUSION: The cost-effectiveness of placing AEDs on commercial aircraft compares favorably with the cost-effectiveness of widely accepted medical interventions and health policy regulations, but is critically dependent on the passenger capacity of the aircraft. Placing AEDs on most US commercial aircraft would meet conventional standards of cost-effectiveness.
David Kodama, Bobby Yanagawa, Jim Chung, Ken Fryatt, Alun D Ackery
"Is there a doctor on board?": Practical recommendations for managing in-flight medical emergencies.
CMAJ. 2018 Feb 26;190(8):E217-E222. doi: 10.1503/cmaj.170601.
Abstract/Text
Howard J Donner
Is There a Doctor Onboard? Medical Emergencies at 40,000 Feet.
Emerg Med Clin North Am. 2017 May;35(2):443-463. doi: 10.1016/j.emc.2017.01.005.
Abstract/Text
It is estimated 2.75 billion people travel aboard commercial airlines every year and 44,000 in-flight medical emergencies occur worldwide each year. Wilderness medicine requires a commonsense and improvisational approach to medical issues. A sudden call for assistance in the austere and unfamiliar surroundings of an airliner cabin may present the responding medical professional with a "wilderness medicine" experience. From resource management to equipment, this article sheds light on the unique conditions, challenges, and constraints of the flight environment.
Copyright © 2017 Elsevier Inc. All rights reserved.
宇宙航空環境医学 Vol. 53, No. 4, 2016.
金谷庄藏、植田典浩、他：民間航空機搭乗中の機内圧変化と乗客の病態生理的変化に関する研究. 健康科学 1999;21：121-125.
宇宙航空環境医学 Vol. 60, No. 1, 10, 2023.
利雄近, 伸介三島, editors. The Art of Travel and Global Healthトラベル&グローバルメディスン: 渡航前から帰国後・インバウンドまで. 南山堂; 2017.
Paul J Edelson
Patterns of measles transmission among airplane travelers.
Travel Med Infect Dis. 2012 Sep;10(5-6):230-5. doi: 10.1016/j.tmaid.2012.10.003. Epub 2012 Nov 3.
Abstract/Text
With advanced air handling systems on modern aircraft and the high level of measles immunity in many countries, measles infection in air travelers may be considered a low-risk event. However, introduction of measles into countries where transmission has been controlled or eliminated can have substantial consequences both for the use of public health resources and for those still susceptible. In an effort to balance the relatively low likelihood of disease transmission among largely immune travelers and the risk to the public health of the occurrence of secondary cases resulting from importations, criteria in the United States for contact investigations for measles exposures consider contacts to be those passengers who are seated within 2 rows of the index case. However, recent work has shown that cabin air flow may not be as reliable a barrier to the spread of measles virus as previously believed. Along with these new studies, several reports have described measles developing after travel in passengers seated some distance from the index case. To understand better the potential for measles virus to spread on an airplane, reports of apparent secondary cases occurring in co-travelers of passengers with infectious cases of measles were reviewed. Medline™ was searched for articles in all languages from 1946 to week 1 of March 2012, using the search terms "measles [human] or rubeola" and ("aircraft" or "airplane" or "aeroplane" or "aviation" or "travel" or "traveler" or "traveller"); 45 citations were returned. Embase™ was searched from 1988 to week 11 2012, using the same search strategy; 95 citations were returned. Papers were included in this review if they reported secondary cases of measles occurring in persons traveling on an airplane on which a person or persons with measles also flew, and which included the seating location of both the index case(s) and the secondary case(s) on the plane. Nine reports, including 13 index cases and 23 apparent secondary cases on 10 flights, were identified in which transmission on board the aircraft appeared likely and which included seating information for both the index (primary) and secondary cases. Separation between index and secondary cases ranged from adjacent seats to 17 rows, with a median of 6 rows. Three flights had more than one index case aboard. Based on previously published data, it is not possible to say how unusual cases of measles transmission among air travelers beyond the usual zone of contact investigation (the row the index case sat in and 2 rows ahead of or behind that row) may be. The fact that several flights had more than one infectious case aboard and that all but two index cases were in the prodromal phase may be of importance in understanding the wider spread described in several of the reviewed reports. Although the pattern of cabin air flow typical of modern commercial aircraft has been considered highly effective in limiting the airborne spread of microorganisms, concerns have been raised about relying on the operation of these systems to determine exposure risk, as turbulence in the cabin air stream is generated when passengers and crew are aboard, allowing the transmission of infectious agents over many rows. Additionally, the characteristics of some index cases may reflect a greater likelihood of disease transmission. Investigators should continue to examine carefully both aircraft and index-case factors that may influence disease transmission and could serve as indicators on a case-by-case basis to include a broader group of travelers in a contact investigation.
Published by Elsevier Ltd.
Transmission of infectious diseases during commercial air travel. - PubMed - NCBI [Internet]. [cited 2019 Dec 4]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=15767002
Sonja J Olsen, Hsiao-Ling Chang, Terence Yung-Yan Cheung, Antony Fai-Yu Tang, Tamara L Fisk, Steven Peng-Lim Ooi, Hung-Wei Kuo, Donald Dah-Shyong Jiang, Kow-Tong Chen, Jim Lando, Kwo-Hsiung Hsu, Tzay-Jinn Chen, Scott F Dowell
Transmission of the severe acute respiratory syndrome on aircraft.
N Engl J Med. 2003 Dec 18;349(25):2416-22. doi: 10.1056/NEJMoa031349.
Abstract/Text
BACKGROUND: The severe acute respiratory syndrome (SARS) spread rapidly around the world, largely because persons infected with the SARS-associated coronavirus (SARS-CoV) traveled on aircraft to distant cities. Although many infected persons traveled on commercial aircraft, the risk, if any, of in-flight transmission is unknown.
METHODS: We attempted to interview passengers and crew members at least 10 days after they had taken one of three flights that transported a patient or patients with SARS. All index patients met the criteria of the World Health Organization for a probable case of SARS, and index or secondary cases were confirmed to be positive for SARS-CoV on reverse-transcriptase polymerase chain reaction or serologic testing.
RESULTS: After one flight carrying a symptomatic person and 119 other persons, laboratory-confirmed SARS developed in 16 persons, 2 others were given diagnoses of probable SARS, and 4 were reported to have SARS but could not be interviewed. Among the 22 persons with illness, the mean time from the flight to the onset of symptoms was four days (range, two to eight), and there were no recognized exposures to patients with SARS before or after the flight. Illness in passengers was related to the physical proximity to the index patient, with illness reported in 8 of the 23 persons who were seated in the three rows in front of the index patient, as compared with 10 of the 88 persons who were seated elsewhere (relative risk, 3.1; 95 percent confidence interval, 1.4 to 6.9). In contrast, another flight carrying four symptomatic persons resulted in transmission to at most one other person, and no illness was documented in passengers on the flight that carried a person who had presymptomatic SARS.
CONCLUSIONS: Transmission of SARS may occur on an aircraft when infected persons fly during the symptomatic phase of illness. Measures to reduce the risk of transmission are warranted.
Copyright 2003 Massachusetts Medical Society
T A Kenyon, S E Valway, W W Ihle, I M Onorato, K G Castro
Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight.
N Engl J Med. 1996 Apr 11;334(15):933-8. doi: 10.1056/NEJM199604113341501.
Abstract/Text
BACKGROUND: In April 1994, a passenger with infectious multi-drug resistant tuberculosis traveled on commercial-airline flights from Honolulu to Chicago and from Chicago to Baltimore and returned one month later. We sought to determine whether she had infected any of her contacts on this extensive trip.
METHODS: Passengers and crew were identified from airline records and were notified of their exposure, asked to complete a questionnaire, and screened by tuberculin skin tests.
RESULTS: Of the 925 people on the airplanes, 802 (86.7 percent) responded. All 11 contacts with positive tuberculin skin tests who were on the April flights and 2 of 3 contacts with positive tests who were on the Baltimore-to-Chicago flight in May had other risk factors for tuberculosis. More contacts on the final, 8.75-hour flight from Chicago to Honolulu had positive skin tests than those on the other three flights (6 percent, as compared with 2.3, 3.8, and 2.8 percent). Of 15 contacts with positive tests on the May flight from Chicago to Honolulu, 6 (4 with skin-test conversion) had no other risk factors; all 6 had sat in the same section of the plane as the index patient (P=0.001). Passengers seated within two rows of the index patient were more likely to have positive tuberculin skin tests than those in the rest of the section (4 of 13, or 30.8 percent, vs. 2 of 55, or 3.6 percent; rate ratio, 8.5; 95 percent confidence interval, 1.7 to 41.3; P=0.01).
CONCLUSIONS: The transmission of Mycobacterium tuberculosis that we describe aboard a commercial aircraft involved a highly infectious passenger, a long flight, and close proximity of contacts to the index patient.
Zhaozhi Wang, Edwin R Galea, Angus Grandison, John Ewer, Fuchen Jia
Inflight transmission of COVID-19 based on experimental aerosol dispersion data.
J Travel Med. 2021 Jun 1;28(4). doi: 10.1093/jtm/taab023.
Abstract/Text
BACKGROUND: An issue of concern to the travelling public is the possibility of in-flight transmission of coronavirus disease 2019 (COVID-19) during long- and short-haul flights. The aviation industry maintains that the probability of contracting the illness is small based on reported cases, modelling and data from aerosol dispersion experiments conducted on-board aircraft.
METHODS: Using experimentally derived aerosol dispersion data for a B777-200 aircraft and a modified version of the Wells-Riley equation we estimate inflight infection probability for a range of scenarios involving quanta generation rate and face mask efficiency. Quanta generation rates were selected based on COVID-19 events reported in the literature while mask efficiency was determined from the aerosol dispersion experiments.
RESULTS: The MID-AFT cabin exhibits the highest infection probability. The calculated maximum individual infection probability (without masks) for a 2-hour flight in this section varies from 4.5% for the 'Mild Scenario' to 60.2% for the 'Severe Scenario' although the corresponding average infection probability varies from 0.1% to 2.5%. For a 12-hour flight, the corresponding maximum individual infection probability varies from 24.1% to 99.6% and the average infection probability varies from 0.8% to 10.8%. If all passengers wear face masks throughout the 12-hour flight, the average infection probability can be reduced by ~73%/32% for high/low efficiency masks. If face masks are worn by all passengers except during a one-hour meal service, the average infection probability is increased by 59%/8% compared to the situation where the mask is not removed.
CONCLUSIONS: This analysis has demonstrated that while there is a significant reduction in aerosol concentration due to the nature of the cabin ventilation and filtration system, this does not necessarily mean that there is a low probability or risk of in-flight infection. However, mask wearing, particularly high-efficiency ones, significantly reduces this risk.
© International Society of Travel Medicine 2021. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Jinjun Zhang, Fei Qin, Xinyan Qin, Jianren Li, Sijia Tian, Jing Lou, Xuqin Kang, Huixin Lian, Shengmei Niu, Wenzhong Zhang, Yuguo Chen
Transmission of SARS-CoV-2 during air travel: a descriptive and modelling study.
Ann Med. 2021 Dec;53(1):1569-1575. doi: 10.1080/07853890.2021.1973084.
Abstract/Text
OBJECTIVES: To explore the potential of SARS-CoV-2 spread during air travel and the risk of in-flight transmission.
METHODS: We enrolled all passengers and crew suspected of being infected with SARS-CoV-2, who bounded for Beijing on international flights. We specified the characteristics of all confirmed cases of COVID-19 infection and utilised Wells-Riley equation to estimate the infectivity of COVID-19 during air travel.
RESULTS: We screened 4492 passengers and crew with suspected COVID-19 infection, verified 161 confirmed cases (mean age 28.6 years), and traced two confirmed cases who may have been infected in the aircraft. The estimated infectivity was 375 quanta/h (range 274-476), while the effective infectivity was only 4 quanta/h (range 2-5). The risk of per-person infection during a 13 h air travel in economy class was 0.56‰ (95% CI 0.41‰-0.72‰).
CONCLUSION: We found that the universal use of face masks on the flight, together with the plane's ventilation system, significantly decreased the infectivity of COVID-19.KEY MESSAGESThe COVID-19 pandemic is changing the lifestyle in the world, especially air travel which has the potential to spread SARS-CoV-2.The universal use of face masks on the flight, together with the plane's ventilation system, significantly decreased the infectivity of COVID-19 on an aircraft.Our findings suggest that the risk of infection in aircraft was negligible.
Sirish Namilae, Yuxuan Wu, Anuj Mubayi, Ashok Srinivasan, Matthew Scotch
Identifying mitigation strategies for COVID-19 superspreading on flights using models that account for passenger movement.
Travel Med Infect Dis. 2022 May-Jun;47:102313. doi: 10.1016/j.tmaid.2022.102313. Epub 2022 Mar 16.
Abstract/Text
BACKGROUND: Despite commercial airlines mandating masks, there have been multiple documented events of COVID-19 superspreading on flights. Conventional models do not adequately explain superspreading patterns on flights, with infection spread wider than expected from proximity based on passenger seating. An important reason for this is that models typically do not consider the movement of passengers during the flight, boarding, or deplaning. Understanding the risks for each of these aspects could provide insight into effective mitigation measures.
METHODS: We modeled infection risk from seating and fine-grained movement patterns - boarding, deplaning, and inflight movement. We estimated infection model parameters from a prior superspreading event. We validated the model and the impact of interventions using available data from three flights, including cabin layout and seat locations of infected and uninfected passengers, to suggest interventions to mitigate COVID-19 superspreading events during air travel. Specifically, we studied: 1) London to Hanoi with 201 passengers, including 13 secondary infections among passengers; 2) Singapore to Hangzhou with 321 passengers, including 12 to 14 secondary infections; 3) a non-superspreading event on a private jet in Japan with 9 passengers and no secondary infections.
RESULTS: Our results show that the inclusion of passenger movement better explains the infection spread patterns than conventional models do. We also found that FFP2/N95 mask usage would have reduced infection by 95-100%, while cloth masks would have reduced it by only 40-80%. Results indicate that leaving the middle seat vacant is effective in reducing infection, and the effectiveness increases when combined with good quality masks. However, with a good mask, the risk is quite low even without the middle seats being empty.
CONCLUSIONS: Our results suggest the need for more stringent guidelines to reduce aviation-related superspreading events of COVID-19.
Copyright © 2022 Elsevier Ltd. All rights reserved.
COVID-19: A summary of current medical evidence relevant to air travel. Version 13 – 28 April 2022 https://www.iata.org/globalassets/iata/programs/covid/restart/covid-public-health-meausures-evidence-doc.pdf.
基礎からわかる旅客機大百科 (イカロス・ムック 航空知識入門編). イカロス出版; 2014.
Ruskin KJ, Hernandez KA, Barash PG. Management of in-flight medical emergencies. Anesthesiology. Lippincott Williams and Wilkins; 2008. p. 749–755.
Rahim Valani, Marisa Cornacchia, Douglas Kube
Flight diversions due to onboard medical emergencies on an international commercial airline.
Aviat Space Environ Med. 2010 Nov;81(11):1037-40. doi: 10.3357/asem.2789.2010.
Abstract/Text
INTRODUCTION: Each year, close to 2 billion passengers travel on commercial airlines. In-flight medical events result in suboptimal care due to a variety of factors. Flight diversions due to medical emergencies carry a significant financial and legal cost. The purpose of this study was to determine the causes of in-flight medical diversions from Air Canada.
METHODS: This was a review of in-flight medical emergencies from 2004-2008. Both telemedicine and Air Canada databases were crossreferenced to capture all incidents. Presenting complaints were categorized by systems. Descriptive statistics were used to analyze the data.
RESULTS: Over the 5 yr, there were 220 diversions, of which 91 (41.4%) of the decisions were made by pilots or onboard medical personnel. During this period there were 5386 telemedicine contacts with ground support providers, who on average recommended 2.4 diversions per 100 calls. The rate for diversions almost doubled from 2006 to 2007, with a sharp drop in telemedicine contacts during the same period. The four most common categories resulting in diversions were cardiac (58 diversions, 26.4%), neurological (43 diversions, 19.5%), gastrointestinal (GI) (25 diversions, 11.4%), and syncope (22 diversions, 10.0%). Only 6.8% of all diversions were due to cardiac arrest.
DISCUSSION: Medical conditions most commonly leading to diversions were cardiac, neurological, gastrointestinal, and syncope. Our study showed that a decrease in telemedicine contact during this period was accompanied by an increase in diversions, while increased pre-screening of passengers did not prove effective in decreasing diversion rates.
Kevin K C Hung, Emily Y Y Chan, Robert A Cocks, Rose M Ong, Timothy H Rainer, Colin A Graham
Predictors of flight diversions and deaths for in-flight medical emergencies in commercial aviation.
Arch Intern Med. 2010 Aug 9;170(15):1401-2. doi: 10.1001/archinternmed.2010.267.
Abstract/Text
Keith J Ruskin, Keith A Hernandez, Paul G Barash
Management of in-flight medical emergencies.
Anesthesiology. 2008 Apr;108(4):749-55. doi: 10.1097/ALN.0b013e31816725bc.
Abstract/Text
Mark A Gendreau, Charles DeJohn
Responding to medical events during commercial airline flights.
N Engl J Med. 2002 Apr 4;346(14):1067-73. doi: 10.1056/NEJMra012774.
Abstract/Text
ICAO HEALTH-RELATED DOCUMENTS [Internet]. [cited 2019 Mar 30]. Available from: https://www.icao.int/SAM/Documents/2009/CASPCA1/CAPSCA ICAO Health-related documents.pdf
J I Sirven, D W Claypool, K L Sahs, D M Wingerchuk, J J Bortz, J Drazkowski, R Caselli, D Zanick
Is there a neurologist on this flight?
Neurology. 2002 Jun 25;58(12):1739-44. doi: 10.1212/wnl.58.12.1739.
Abstract/Text
OBJECTIVE: To analyze the frequency of neurologic events during commercial airline flights and to assess whether onboard emergency medical kits are adequate for in-flight neurologic emergencies.
METHODS: Collaboration of the Mayo Clinic's Departments of Emergency Medicine and Medical Transportation Service and the Division of Aerospace Medicine to provide real-time in-flight consultation to a major US airline that flies approximately 10% of all US passengers. We analyzed all medical events reported from 1995 to 2000 in a database that catalogs the air-to-ground medical consultations. All cases with potential neurologic symptoms were reviewed and classified into various neurologic symptom categories. The cost of diversion for each neurologic symptom was calculated and then extrapolated to assess the cost of neurologic symptoms to the US airline industry.
RESULTS: A total of 2,042 medical incidents led to 312 diversions. Neurologic symptoms were the single largest category of medical incidents, prompting 626 air-to-ground medical calls (31%). They caused 34% of all diversions. Dizziness/vertigo was the most common neurologic symptom followed by seizures, headaches, pain, and cerebrovascular symptoms. Whereas seizures and dizziness/vertigo were the most common reasons for diversion, loss of consciousness/syncope was the complaint most likely to lead to a diversion. The estimated annual cost of diversions due to neurologic events is almost 9,000,000 dollars.
CONCLUSION: Neurologic symptoms are the most common medical complaint requiring air-to-ground medical support and are second only to cardiovascular problems for emergency diversions and their resultant costs to the US airline industry. Adding antiepileptic drugs to the onboard medical kit and greater emergency medical training for in-flight personnel could potentially reduce the number of diversions for in-flight neurologic incidents.
Joseph I Sirven
"Is there a neurologist on this flight?": An update.
Neurol Clin Pract. 2018 Oct;8(5):445-450. doi: 10.1212/CPJ.0000000000000505.
Abstract/Text
Purpose of review: Neurologists are being asked to offer their services in response to in-flight medical conditions. This review updates the latest understanding of how neurologists should manage in-flight neurologic emergencies should they be called upon to serve. A review of the existing literature was conducted for sharing of best practices in this unique scenario.
Recent findings: In-flight neurologic emergencies are on the rise. This article provides a synthesis of current best practices for in-flight emergencies including epidemiology, airline responsibility, available health care equipment on jetliners, legal ramifications of helping, and pathophysiology of why in-flight neurologic emergencies are so common.
Summary: In-flight neurologic emergencies are common and all physicians are increasingly being asked to respond to in-flight emergencies. Understanding one's responsibility, available equipment, and how to best prevent these scenarios with one's own patients may help to make this complex situation more manageable.
Saara M Kotila, Lara Payne Hallström, Niesje Jansen, Peter Helbling, Ibrahim Abubakar
Systematic review on tuberculosis transmission on aircraft and update of the European Centre for Disease Prevention and Control risk assessment guidelines for tuberculosis transmitted on aircraft (RAGIDA-TB).
Euro Surveill. 2016;21(4). doi: 10.2807/1560-7917.ES.2016.21.4.30114.
Abstract/Text
As a setting for potential tuberculosis (TB) transmission and contact tracing, aircraft pose specific challenges. Evidence-based guidelines are needed to support the related-risk assessment and contact-tracing efforts. In this study evidence of TB transmission on aircraft was identified to update the Risk Assessment Guidelines for TB Transmitted on Aircraft (RAGIDA-TB) of the European Centre for Disease Prevention and Control (ECDC). Electronic searches were undertaken from Medline (Pubmed), Embase and Cochrane Library until 19 July 2013. Eligible records were identified by a two-stage screening process and data on flight and index case characteristics as well as contact tracing strategies extracted. The systematic literature review retrieved 21 records. Ten of these records were available only after the previous version of the RAGIDA guidelines (2009) and World Health Organization guidelines on TB and air travel (2008) were published. Seven of the 21 records presented some evidence of possible in-flight transmission, but only one record provided substantial evidence of TB transmission on an aircraft. The data indicate that overall risk of TB transmission on aircraft is very low. The updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contract tracing and risk assessment.
Katrin Leitmeyer, Cornelia Adlhoch
Review Article: Influenza Transmission on Aircraft: A Systematic Literature Review.
Epidemiology. 2016 Sep;27(5):743-51. doi: 10.1097/EDE.0000000000000438.
Abstract/Text
BACKGROUND: Air travel is associated with the spread of influenza through infected passengers and potentially through in-flight transmission. Contact tracing after exposure to influenza is not performed systematically. We performed a systematic literature review to evaluate the evidence for influenza transmission aboard aircraft.
METHODS: Using PubMed and EMBASE databases, we identified and critically appraised identified records to assess the evidence of such transmission to passengers seated in close proximity to the index cases. We also developed a bias assessment tool to evaluate the quality of evidence provided in the retrieved studies.
RESULTS: We identified 14 peer-reviewed publications describing contact tracing of passengers after possible exposure to influenza virus aboard an aircraft. Contact tracing during the initial phase of the influenza A(H1N1)pdm09 pandemic was described in 11 publications. The studies describe the follow-up of 2,165 (51%) of 4,252 traceable passengers. Altogether, 163 secondary cases were identified resulting in an overall secondary attack rate among traced passengers of 7.5%. Of these secondary cases, 68 (42%) were seated within two rows of the index case.
CONCLUSION: We found an overall moderate quality of evidence for transmission of influenza virus aboard an aircraft. The major limiting factor was the comparability of the studies. A majority of secondary cases was identified at a greater distance than two rows from the index case. A standardized approach for initiating, conducting, and reporting contact tracing could help to increase the evidence base for better assessing influenza transmission aboard aircraft.
Susan P Baker, Joanne E Brady, Dennis F Shanahan, Guohua Li
Aviation-related injury morbidity and mortality: data from U.S. health information systems.
Aviat Space Environ Med. 2009 Dec;80(12):1001-5. doi: 10.3357/asem.2575.2009.
Abstract/Text
INTRODUCTION: Information about injuries sustained by survivors of airplane crashes is scant, although some information is available on fatal aviation-related injuries. Objectives of this study were to explore the patterns of aviation-related injuries admitted to U.S. hospitals and relate them to aviation deaths in the same period.
METHODS: The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) contains information for approximately 20% of all hospital admissions in the United States each year. We identified patients in the HCUP NIS who were hospitalized during 2000-2005 for aviation-related injuries based on the International Classification of Diseases, 9th Revision, codes E840-E844. Injury patterns were also examined in relation to information from multiple-cause-of-death public-use data files 2000-2005.
RESULTS: Nationally, an estimated 6080 patients in 6 yr, or 1013 admissions annually (95% confidence interval 894-1133), were hospitalized for aviation-related injuries, based on 1246 patients in the sample. The average hospital stay was 6.3 d and 2% died in hospital. Occupants of non-commercial aircraft accounted for 32% of patients, parachutists for 29%; occupants of commercial aircraft and of unpowered aircraft each constituted 11%. Lower-limb fracture was the most common injury in each category, constituting 27% of the total, followed by head injury (11%), open wound (10%), upper extremity fracture, and internal injury (9%). Among fatalities, head injury (38%) was most prominent. An average of 753 deaths occurred annually; for each death there were 1.3 hospitalizations.
CONCLUSIONS: Aviation-related injuries result in approximately 1000 hospitalizations each year in the United States, with an in-hospital mortality rate of 2%. The most common injury sustained by aviation crash survivors is lower-limb fracture.
ILCOR [Internet]. [cited 2019 Mar 30]. Available from: https://www.ilcor.org/home/
日本旅行医学会, editor. 旅行医学質問箱. メジカルビュー社; 2009.
Danielle Silverman, Mark Gendreau
Medical issues associated with commercial flights.
Lancet. 2009 Jun 13;373(9680):2067-77. doi: 10.1016/S0140-6736(09)60209-9. Epub 2009 Feb 21.
Abstract/Text
Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Environmental and physiological changes that occur during routine commercial flights lead to mild hypoxia and gas expansion, which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, cosmic-radiation exposure, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight medical events are increasingly frequent because a growing number of individuals with pre-existing medical conditions travel by air. Resources including basic and advanced medical kits, automated external defibrillators, and telemedical ground support are available onboard to assist flight crew and volunteering physicians in the management of in-flight medical emergencies.
交通医学 70(5/6), 112-117, 2016-11.
交通医学 74 (3/4) 91-97, 2020.
医学のあゆみ 270(2): 175-180, 2019.
医学のあゆみ 270(2): 185-190, 2019.
