When more than 192 million customers take to the skies in a given year on board Delta, in-flight medical events can occur, just as they do on the ground. In 2018, the airline reported about 11,900 medical events, or one medical event per 460 flights [1]. The most common problems are fainting or feeling dizzy and lightheaded (33%), nausea or vomiting (15 %), and respiratory (10 %) or cardiovascular symptoms (7 %) [2].
It's why Delta heavily invests in first aid and CPR training for its flight attendants, as well as invests in onboard medical equipment and expert consultation services when medical events do take place.
"Our flight attendants go through a very extensive training process as new hires where they learn CPR, how to use a defibrillator and all onboard medical equipment, among a number of other procedures," said Barbara Martin, General Manager—Occupational Health. "They also have recurrent training every year that includes emergency response."
Delta has equipped all of its aircraft with an automated external defibrillator (AED), enhanced emergency medical kit, first aid kit, oxygen, medical accessory pouch, Universal Precaution Kit – used to protect against and dispose of bodily fluids – and a medical communication headset. The airline's emergency medical equipment on board exceeds the minimum requirements set by the Federal Aviation Administration.
In addition to intensive flight attendant training, the available onboard medical equipment and the assistance of volunteer medical professionals on board the aircraft, Delta leverages the help of physicians on the ground through an airline consultation service called STAT-MD to provide support during onboard medical events. This service is backed by the resources of the University of Pittsburgh Medical Center (UPMC).
How does STAT-MD provide ground-based medical support?
Inside a control centre on the 13th floor in the Communications Center of UMPC Presbyterian Hospital, trained medical personnel sit behind walls of computer monitors and communications equipment standing at the ready to provide consultation during in-flight medical events on Delta and other large commercial U.S.-based and international airlines. The team also provides pre-flight screenings for customers if there are any medical concerns prior to boarding their flight. Delta has partnered with STAT-MD for nearly 20 years to provide ground-based medical support.
Medical recommendations come from a core group of select physicians, who are residency-trained and Board Certified in Emergency Medicine. In fact, physicians at STAT-MD have an eight-year average tenure and most still work in the emergency department when they aren't on duty providing ground-based support to airlines.
"STAT-MD is key to our overarching objective to achieve the best medical outcome for our customers," said Martin.
What's the process when a medical event occurs on an aircraft?
A flight attendant first notifies the captain.
The captain establishes radio communication with the flight’s designated dispatcher in the airline’s Operations and Customer Center.
The dispatcher contacts the medical coordinator at STAT-MD who gathers flight information, such as the flight number, destination and origin, and estimated arrival.
The medical coordinator then puts the physician on the line to administer the medical consultation.
The flight attendant relays information to and from STAT-MD via the captain or through headsets in the cabin.
"The key for us is information," said Dr. TJ Doyle, STAT-MD's Medical Director. "Delta uses what is known as a medical assistance form to gather key information about the passenger, such as symptoms, vital signs and significant medical history. When the physician gets on the line, the information is relayed to us, and typically we can make a pretty quick and informed recommendation."
To provide the best clinical outcome, STAT-MD has become familiarized with Delta's onboard medical equipment and capabilities and they also have one of Delta's emergency medical kits on hand to instruct medical volunteers on where to locate proper medications and equipment within the kit.
What happens in more serious situations?
"There are four criteria that we use to determine the difference between a medical event and a medical emergency," said Martin. "For example, 'Is CPR in progress? Has the AED delivered a shock? Is a baby being born? Is there uncontrolled or significant bleeding?'"
In the case of a medical emergency, the airline may consider a diversion or request a priority landing from air traffic control. The decision to divert is ultimately made by the captain and dispatcher with guidance from STAT-MD. As part of that calculation, multiple considerations are taken into account, including the customer's vital signs and proximity to the flight's destination. "The airline uses the expertise of STAT-MD to help mitigate unnecessary diversions," said Martin.
"If we recommend a diversion, we will suggest the best medical facilities in the area," said Doyle. "We keep a global database of all airports, two hospitals closest to the airport and what their capabilities are." STAT-MD regularly updates this list every year by calling hospitals and other medical facilities.
Depending on the circumstance and status of the customer, the airline may find it more suitable to continue the flight and have paramedics meet the flight upon arrival at its scheduled arrival city.
"With medications available on board, the AED and someone administering CPR, you're pretty much doing the equivalent of what the passenger would get in an ambulance," said Doyle.
With safety as Delta's top priority, the airline continues to leverage the dedicated professionals at STAT-MD for the benefit of customer health on all its flights.
[1] Based on Delta internal safety reporting system for Jan. 1 to Dec. 31, 2018, based on in-flight medical events reported to Delta's Health, Safety and Security department.
[2] "In-Flight Medical Emergencies: A Review" by C. Martin-Gill, T. J. Doyle, and D. M. Yealy, 2018, JAMA. 2018;320(24):2580-2590. doi:10.1001/jama.2018.19842
