Midair medical help

By JOHN KRON

Ten thousand metres above the Pacific Ocean is not the greatest place to suddenly notice that your left eye is swollen and the skin over your stomach is covered in large, red lumps.

Jeanie, a 26-year-old law student, didn't have any known allergies and all she'd eaten was the chicken served for dinner on the Air New Zealand jumbo heading from Sydney to Los Angeles. No one else was affected by the meal.

She buzzed the flight staff, who quickly contacted a doctor at Air New Zealand's 24-hour medical emergency service via the cockpit radio.

The doctor told them to give Jeanie (not her real name) an anti-allergy drug from the plane's medical kit, and monitor her symptoms, particularly her breathing, because allergic attacks can cause death by choking due to swollen airways.

And if she lost consciousness, they would have to immediately give her an adrenalin injection and re-direct the plane to the nearest airport, Honolulu.

Thankfully the anti-allergy medication did the trick and Jeanie arrived safely at Los Angeles six hours later. She was taken to hospital, and after recovering, came back home to investigate the cause of her allergic reaction.

Midair medical emergencies are not common, affecting an estimated eight in every million passengers.

But that still adds up to one emergency somewhere in the skies every 10 minutes, says Joan Sullivan Garrett, CEO of MedAire, a US company that provides 24-hour medical services for 40 airlines throughout the world.

About one in four emergencies is fainting or dizziness due to a vasovagal attack, which may be associated with excessive alcohol and reduced blood pressure due to sitting for many hours, but most often the exact cause is never identified.

"Though it can be a frightening experience, what we do know is that they are not life-threatening and most often resolve on their own without any serious medical consequences," says Ms Sullivan Garrett.

The second most common medical emergency is a gastrointestinal problem such as diarrhoea and vomiting (14 per cent), followed by cardiac events such as a heart attack (13 per cent), neurological events, and respiratory problems such as asthma attacks.

So if a medical emergency is going to strike you, which airline do you want to be flying with?

The best are those that have flight staff trained at a high level of first aid such as measuring blood pressure, carry appropriate equipment and drugs, and can access ground-based doctors who can give advice in emergency situations.

However, until five years ago the policy of many airlines, including major US and European airlines, was to simply land the plane at the nearest airport and rush the patient off to hospital.

Qantas was the first to see the folly of this approach with its flight paths over large oceans and Third World countries. It also recognised that even when flying above Australian hospitals, the time required to land and reach a hospital can take up to an hour, which is too long in many emergencies.

In 1991 Qantas introduced cardiac defibrillators (electric-shock machines) and set the standard for medical kits stocked with appropriate drugs and training flight staff.

Now many other airlines have modernised their approach. Last February, Joe, a 70-year-old tourist on a US airline flying from Florida to New Jersey, was found slumped in his seat by a flight attendant. He had no pulse and was not breathing.

The flight staff quickly pulled out the plane's cardiac defibrillator and shocked his heart back to life. By the time the captain called MedAire, Joe (not his real identity) was conscious and breathing again. The plane landed at the nearest airport so that he could be taken to hospital because he required medications to ensure his heart kept beating properly.

If this had happened five years ago Joe would be dead now. Instead he was back at home seven days later recovering from his heart attack - because the airline was prepared to care for medical emergencies in mid-air.

Health tips

Preparations you can make for a mid-air medical emergency if you have an existing medical condition:

* Tell the airline if you have significant health problems.

* Carry on board to your seat extra medication and equipment, such as insulin for diabetes and inhalers for asthma (with your prescription for customs check).

* If you use oxygen at home for heart or lung disease, ask the airline if they can provide inflight supply before making a booking.

Medical conditions too risky for flying

* Heart attack four weeks before flying.

* Severe heart disease.

* Severe lung disease.

* Recently punctured lung if air is still entrapped.

* Pregnancy beyond 35 weeks.

* Inner-ear infection with blockage of the Eustachian tube.

* Infectious diseases.

* Uncontrolled psychiatric disorder.