Yes, there is a doctor in the house

It’s highly likely that some frequent fliers among Business Class’s readership have been woken from blissful slumber at 38,000ft by a flight attendant’s voice booming out over the PA system asking if there is a doctor aboard.

Our heart sinks, not just for the poor soul who is in dire need of medical attention, but also because our flight will probably be diverted and our trip disrupted.

And depending on a variety of circumstances, including where you land that could delay your arrival by 24 hours.

For the airline, the bill can be as high as $130,000 for each diversion.

And airlines have been warned that in-flight medical problems are set to increase as the Australian population ages and more people take to the skies.

Currently, it is estimated there is an in-flight medical incident involving one in every 11,000 to 14,000 passengers. That translated into 143,000 medical incidents last year.

Fortunately, most in-flight medical problems can be successfully dealt with by the aircraft crew, although flight diversions can be required. One study has shown that 70 per cent of medical cases were satisfactorily handled by cabin crew, with medically qualified passengers being asked to assist in more serious cases.

But with an ageing population, the problem is serious enough for the International Air Transport Association (IATA) to form a taskforce, with a meeting scheduled for this month in Singapore.

According to Dr David Newman, an aviation medical consultant writing in the Civil Aviation Safety Authority’s safety publication Flight Safety Australia, the most common in-flight emergencies are cardiac, gastrointestinal, neurological and respiratory illness.

According to IATA, one in every three million passengers died on an aircraft – mostly middle-aged men, with the main cause of death being heart disease.

With two billion passengers travelling each year, that amounts to about 660 deaths.

According to Dr Newman, about 5 per cent of travellers have chronic illnesses. To combat the problem, many major airlines are now using telemedicine, with the aircraft linked to a specialist ground-based medical centre.

Most international airlines carry on-board cardiac monitors and automatic external defibrillators.

Dr Newman suggests that: “Flying puts passengers under additional physiological stress from reduced oxygen levels, noise, vibration, dehydration and changes in pressure and temperature. Fatigue can also be a factor, particularly if the flight is long.”

Added to the cocktail, air travel today “imposes psychological stress on passengers, stress often amplified by the reason for the trip”.

According to trade journal Air Transport World (ATW), the decision on whether to divert an aircraft or keep flying is made easier because of companies such as MedAire.

The firm operates MedLink, a lifeline linking crew, onboard medical personnel (if any) and doctors on the ground.

Between January 1 and December 14 last year, MedLink received 25,143 calls from commercial airlines, 525 of which resulted in diversions.

Of those, 41 per cent of patients were admitted to hospital, 35 per cent were evaluated at hospital and released and 7 per cent died. Just 8 per cent were evaluated at the airport and released. But according to ATW in its April 2006 issue, those rates would fall if airlines fitted more complete medical kits. It cites Dr David Streitwieser, medical director of Arizona-based MedAire, who suggests that a $50 vial of glucagon raises the blood sugar and is critical for treating diabetics.

One of the problems airlines and MedLink have found, however, is that it’s often difficult to find a doctor to volunteer.

“They often fear being sued or perhaps have had a few drinks,” Dr Streitwieser said.

The chances of diversion may increase with larger aircraft and longer range flights. Next year, the 555-seat A380 starts service and Boeing’s 777-200LR and Airbus’s A340-500 can fly more than 19 hours non-stop.