今日の臨床サポート

航空機(新幹線)内での医療行為

著者: 田辺利朗 京都山城総合医療センター 消化器内科

監修: 志賀隆 国際医療福祉大学 医学部救急医学/国際医療福祉大学病院 救急医療部

著者校正/監修レビュー済:2020/03/05
参考ガイドライン:
  1. 国際航空運送協会(IATA):IATA medical manual 11th edition(June 2018)

概要・推奨   

  1. 世界的に民間航空機における乗客数、便数は年々、増加傾向にある。明確な数字として集計されているわけではないが、機内における医療イベント件数も増加している。
  1. 航空機内における急病人発生の際の愁訴として、意識障害が最多であるとの報告が多い。そのほか、消化器症状、呼吸器症状、けいれん、などが主な愁訴として上げられる。
  1. 航空会社は状況によって、地上サポートを利用することもできる。無線で地上の専門家(救急医など)による医療支援を受けることのできるサービスであり、治療介入が必要な場合は積極的に活用する。緊急着陸の判断など、重要な決定に関しては彼等の判断に委ねる。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に はご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要と
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
田辺利朗 : 特に申告事項無し[2021年]
監修:志賀隆 : 特に申告事項無し[2021年]

機内医療イベントの発生頻度と原因疾患

発生頻度-概略  
  1. 世界的に民間航空機における乗客数、便数は年々増加傾向にある。明確な数字として集計されているわけではないが、機内における医療イベント件数も増加している。
  1. インバウンド(訪日外国人)、アウトバウンド(出国日本人)はともに増加傾向にある。日本は島国であり、航空機の利用が多く、日本においても機内医療イベントの増加が見込まれる。
  1. 短距離よりも長距離路線の方が、国内線よりも国際線の方が、医療イベント件数は多い傾向がある。
  1. 平成29年度航空旅客動態調査(国土交通省)によれば、航空機乗客の半数近くを50歳以上が占める[1]。格安航空会社(LCC)の台頭もあり、搭乗の敷居は低く航空機内での急病への対策を医師や航空会社は考えておく必要がある。
発生頻度(国内航空会社)  
  1. 日本航空(JAL)の統計によると、2017年度、国内線・国際線合わせて、646件の機内における急病人(軽症者も含む)が発生し、188件(約30%)でドクターコールを実施している。この航空会社での年間の便数を考えると、1000便あたり3件程度の急病人発生頻度、となる[2]
  1. 全日本空(ANA)の統計(1993年度から2000年度まで)では、国際線で1000便あたり平均5.43件の機内救急患者の発生があった、と報告がある[3]
  1. 短距離路線が中心となる航空会社での機内医療イベントは大手航空会社に比べ頻度は少なく、2万便に1例程度の頻度とされる[4]

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11月30日(火)までにお申込みいただくと、
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文献 

著者: Drew C Peterson, Christian Martin-Gill, Francis X Guyette, Adam Z Tobias, Catherine E McCarthy, Scott T Harrington, Theodore R Delbridge, Donald M Yealy
雑誌名: 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.).

PMID 23718164  N Engl J Med. 2013 May 30;368(22):2075-83. doi: 10.1056・・・
著者: Jochen Hinkelbein, Christopher Neuhaus, Lennert Böhm, Steffen Kalina, Stefan Braunecker
雑誌名: 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.

PMID 28260956  Open Access Emerg Med. 2017;9:31-35. doi: 10.2147/OAEM.・・・
著者: Christian Martin-Gill, Thomas J Doyle, Donald M Yealy
雑誌名: 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.

PMID 30575886  JAMA. 2018 Dec 25;320(24):2580-2590. doi: 10.1001/jama.・・・
著者: Mustafa Kesapli, Can Akyol, Faruk Gungor, Angelika Janitzky Akyol, Dilek Soydam Guven, Gokhan Kaya
雑誌名: 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.
PMID 26201833  J Travel Med. 2015 Nov-Dec;22(6):361-7. doi: 10.1111/jt・・・
著者: Jung Ha Kim, Smi Choi-Kwon, Young Hwan Park
雑誌名: 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
PMID 28395095  J Travel Med. 2017 Mar 1;24(2). doi: 10.1093/jtm/taw091・・・
著者: P W Groeneveld, J L Kwong, Y Liu, A J Rodriguez, M P Jones, G D Sanders, A M Garber
雑誌名: 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.

PMID 11572741  JAMA. 2001 Sep 26;286(12):1482-9. doi: 10.1001/jama.286・・・
著者: David Kodama, Bobby Yanagawa, Jim Chung, Ken Fryatt, Alun D Ackery
雑誌名: CMAJ. 2018 Feb 26;190(8):E217-E222. doi: 10.1503/cmaj.170601.
Abstract/Text
PMID 29483330  CMAJ. 2018 Feb 26;190(8):E217-E222. doi: 10.1503/cmaj.1・・・
著者: Howard J Donner
雑誌名: 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.
PMID 28411936  Emerg Med Clin North Am. 2017 May;35(2):443-463. doi: 1・・・
著者: Paul J Edelson
雑誌名: 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.
PMID 23127863  Travel Med Infect Dis. 2012 Sep;10(5-6):230-5. doi: 10.・・・
著者: 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
雑誌名: 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
PMID 14681507  N Engl J Med. 2003 Dec 18;349(25):2416-22. doi: 10.1056・・・
著者: T A Kenyon, S E Valway, W W Ihle, I M Onorato, K G Castro
雑誌名: 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.

PMID 8596593  N Engl J Med. 1996 Apr 11;334(15):933-8. doi: 10.1056/N・・・
著者: Rahim Valani, Marisa Cornacchia, Douglas Kube
雑誌名: 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.

PMID 21043302  Aviat Space Environ Med. 2010 Nov;81(11):1037-40. doi: ・・・
著者: Kevin K C Hung, Emily Y Y Chan, Robert A Cocks, Rose M Ong, Timothy H Rainer, Colin A Graham
雑誌名: Arch Intern Med. 2010 Aug 9;170(15):1401-2. doi: 10.1001/archinternmed.2010.267.
Abstract/Text
PMID 20696972  Arch Intern Med. 2010 Aug 9;170(15):1401-2. doi: 10.100・・・
著者: Keith J Ruskin, Keith A Hernandez, Paul G Barash
雑誌名: Anesthesiology. 2008 Apr;108(4):749-55. doi: 10.1097/ALN.0b013e31816725bc.
Abstract/Text
PMID 18362607  Anesthesiology. 2008 Apr;108(4):749-55. doi: 10.1097/AL・・・
著者: Mark A Gendreau, Charles DeJohn
雑誌名: N Engl J Med. 2002 Apr 4;346(14):1067-73. doi: 10.1056/NEJMra012774.
Abstract/Text
PMID 11932475  N Engl J Med. 2002 Apr 4;346(14):1067-73. doi: 10.1056/・・・
著者: J I Sirven, D W Claypool, K L Sahs, D M Wingerchuk, J J Bortz, J Drazkowski, R Caselli, D Zanick
雑誌名: 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.

PMID 12084870  Neurology. 2002 Jun 25;58(12):1739-44. doi: 10.1212/wnl・・・
著者: Joseph I Sirven
雑誌名: 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.

PMID 30564499  Neurol Clin Pract. 2018 Oct;8(5):445-450. doi: 10.1212/・・・
著者: Saara M Kotila, Lara Payne Hallström, Niesje Jansen, Peter Helbling, Ibrahim Abubakar
雑誌名: 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.

PMID 26848520  Euro Surveill. 2016;21(4). doi: 10.2807/1560-7917.ES.20・・・
著者: Katrin Leitmeyer, Cornelia Adlhoch
雑誌名: 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.

PMID 27253070  Epidemiology. 2016 Sep;27(5):743-51. doi: 10.1097/EDE.0・・・
著者: Susan P Baker, Joanne E Brady, Dennis F Shanahan, Guohua Li
雑誌名: 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.

PMID 20027845  Aviat Space Environ Med. 2009 Dec;80(12):1001-5. doi: 1・・・
著者: Danielle Silverman, Mark Gendreau
雑誌名: 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.

PMID 19232708  Lancet. 2009 Jun 13;373(9680):2067-77. doi: 10.1016/S01・・・

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