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Prevention of Medical Events During Air Travel: A Narrative Review

airplane on a runway

Prior to traveling, and when seeking medical pretravel advice, patients consult their personal physicians. Inflight medical issues are estimated to occur up to 350 times per day worldwide (1/14,000-40,000 passengers). Specific characteristics of the air cabin environment are associated with hypoxia and the expansion of trapped gases into body cavities, which can lead to harm. The most frequent medical events during air travel include abdominal pain; ear, nose, and throat pathologies; psychiatric disorders; and life-threatening events such as acute respiratory failure or cardiac arrest. Physicians need to be aware of the management of these conditions in this unusual setting. Chronic respiratory and cardiovascular diseases are common and are at increased risk of acute exacerbation. Physicians must be trained in these conditions and inform their patients about their prevention.

International tourism is one of the leading points of the world economy. In 2009, more than 59% of travel was by air, and according to the World Tourism Organization, tourism represents up to 50% of air travel, before business travel (15%) and travel to visit friends and relatives (27%). Since the establishment in 1919 of the first airline company, air traffic continues to increase, with an estimated average annual growth of 4%. In 2008, almost 2 billion people traveled by commercial airlines. With the increased number of passengers per year, the number of miles flown and passengers boarding is also increasing. In 2013, the maximum number of passengers authorized to board the airbus A380 was 853 per flight.

Medical issues during air travel are estimated at about 350 per day worldwide, corresponding to 1/14,000-40,000 passengers. Because of the specific characteristics of air cabin environment, air travel can exacerbate passengers’ underlying conditions, for increased risk of medical emergencies. However, unlike ground travel, air travel raises the question of the availability of advanced care in case of medical issues and their management.

Health care providers and travelers need to be aware of the potential medical issues associated with air travel and their prevention. Among all medical problems on board, some might be life threatening, such as cardiac issues. Some others are predictable and therefore preventable, such as pulmonary issues, which suggests that prevention of medical issues related to air travel is highly important in primary and secondary care.

General practitioners often provide pretravel medical advice, most commonly for immunizations and malaria chemoprophylaxis. They also frequently advise certain patient groups such as cardiovascular patients and pregnant women. General practitioners are often the first physicians consulted prior to departure. However, other sources for travel health advice include travel clinics, travel agents, pharmacists, family and friends, the Internet, books, brochures, and newspapers. This clearly illustrates the variety of sources consulted, and the fact that travelers are aware of the need to obtain information and be prepared prior to traveling.

Several studies have investigated the determinants of consulting a general practitioner prior to departure. Male sex, age <50 years, travel to a nonmalarial region, foreign nationality, and previous travel experience are negatively associated with the likelihood to consult. Frequency of pretravel consultations with specialized physicians other than general practitioners remains poorly documented.

In this context, 3 issues are currently debated: in-flight emergencies and their management, common underlying conditions at risk of exacerbation during the flight and their prevention, and the main situations justifying a priori specific care. In this paper, we review these 3 issues.

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-Diane Naouri, MD, MSc, Frederic Lapostolle, MD, PhD, Claire Rondet, MD, MCF, Olivier Ganansia, MD, Dominique Pateron, MD, MSc, Youri Yordanov, MD, MS

This article originally appeared in the September 2016 issue of The American Journal of Medicine.

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