Travel Medical Emergencies: Expect the Unexpected

For passengers and cabin crew alike, experiencing a medical emergency in a foreign country is a major concern, but for airline pilot Mark Zaccola, that nightmare surfaced when he suffered a life-threatening problem while on a mission to Israel five years ago.

While dining with his fellow crew members in a Tel Aviv hotel, he suddenly felt chest pains and started to sweat. He went back to his hotel room to call his company’s medical provider. “That was my first mistake,” he told the audience during a panel discussion on managing sudden medical issues at the NBAA’s Schedulers & Dispatchers Conference, held in April in San Diego. “Never go somewhere alone when you think you’re having a heart attack because I could have ended up dying in my room and no one would know.”

Zakula named Aircare International, whose company he had recently contracted as his medical provider. “In less than a minute the emergency doctor was with me on the phone,” he said. After hearing Zakula’s symptoms, the doctor on demand advised him which hospital he should go to.

Then he informed his assistant that he was going to the hospital, got off, and called a taxi for another mistake. “Don’t take a taxi to go to the hospital when you have a heart attack, call an ambulance just in case,” he explained, adding that his co-pilot and flight attendant insisted on accompanying him.

After a series of tests, Zakula was informed that he was indeed having a heart attack and would need two procedures. Because payment was required at the time, Aircare guaranteed payment as part of its Zacola employer plan. That came to nearly $35,000 for six nights in the hospital, two medical procedures, and an emergency room visit. After that, Zakula returned to the United States, this time only riding in the back of the plane to watch movies, rather than taking his seat on the flight deck.

Given his previous experience as a volunteer in a trauma center, Zakula advised crew members to get training to detect signs of serious illness. “It’s unexpected, but when it happens, you’re ready, it’s just instinct.” He also stressed that medical care systems around the world may be very different from what is expected in the United States.

Aircare’s Vice President of Operations, Carl Camps, noted that in Zakula’s case, it was important for him not to have to worry about how to pay for his care right away “because most of the international countries you go to, they won’t accept your medical insurance.” Crews should know the benefits and services they provide to international travelers.

His company’s primary concern is determining the level of care available in that country and whether a patient needs medical care in a more appropriate location. In cases of illness on board, diversion options based on quality of care should be included in each flight plan, and the crew should be aware of how to contact medical providers during the flight.

Medical kits on board

Additionally, on those aircraft carrying medical kits, Camps stated that crews should be aware of their contents and use. “When you have department meetings, pull out that medical kit so everyone can get it,” he said, and suggested operators order a trial kit from their provider for this. “If you don’t know what you have, how are you going to use it?” Some providers will help coordinate training days with potential scenarios that staff will have to contend with that require the use of the medical kit.

Zakula added that when his company has traveled to remote destinations in Africa, the medical kit will be improved to include intravenous syringes, sterile sutures, and even operating equipment because while a doctor may be found, they may not have the supplies needed. Depending on the destination, medications such as antimalarials must be pre-loaded and most providers will pre-load prescriptions for specific medications that may be required of individual passengers. In addition, medicines have expiration dates and should be replaced periodically along with the batteries in some devices. While keeping track of these expiration periods is another task for the flight crew, according to Zaccula, some providers will keep track of such things and send alerts and renewals automatically.

Dennis Goffin, Director of Passenger Services for Travelers Indemnity, explained that her management relies heavily on initial situational planning, with medical awareness being a primary consideration, particularly in the era of Covid. Vaccination status and testing protocols will vary from country to country, and understanding what quarantine and transportation regulations apply is vital should a team member become ill.

In each destination, the department evaluates the available caregivers and in cases of international flights, it will actually explore the ground routes to the hospital from the airport and hotel. Part of preparing for the unexpected is deciding how to contact emergency medical services in each country because the number “911” is not universally recognized.

During the lull caused by the COVID virus in aviation, the Goffin department has taken the initiative to make all flight attendants emergency medical technicians (EMT) through a program at a local college. “It really opened up options for us when there is an unexpected medical emergency,” Goffin said, adding that this would now allow them to act as medical escorts to help transport sick passengers. It also allowed for additional medical equipment to be carried on board because flight attendants are now trained to use it.

As part of advance planning, Camps suggested that passengers should present any pre-existing health conditions and medications to their medical provider. By understanding the level of privacy involved, and adhering to federal law to protect sensitive patients’ health information, Aircare offers a secure application that travelers can access to upload their information directly to its operations center, bypassing the airline’s flight division or aircraft operator entirely. If they are disabled, information will be accessed to help guide their care until they reach appropriate medical help. In such cases, Zakula noted that having a reliable internet connection on the plane is invaluable, allowing symptoms to be reported. His company even carries a device as part of its medical suite that can monitor a patient, automatically transmitting their vital signs online to an emergency room doctor. “If you don’t have it, consider getting it,” he said.

In cases where the crew believes that a passenger may have difficulty getting on the plane, Camps indicated that there are services that will meet the plane on arrival or departure and assist them.

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