When addressing the most frequent types of medical emergencies referred to above, as well as any involving vital functions, the issue of plane diversion arises. The desire to divert the aircraft stems from either the recognition that a patient is in immediate need of care and that expertise is not available on board or by radio, or the need for further evaluation of that condition. The decision to divert a commercial aircraft rests ultimately with the pilot. However, in 2321 cases representing 10.7 percent of all US domestic air carrier activity between 1990 and 1993, the crews complied with a physician's recommendation to divert 97 percent of the time. In addition to the time sensitivity of the patient's condition, this strategic decision involves issues of proximity to an airport suitable for the aircraft versus the original destination port, availability of adequate EMS resources (ALS versus BLS) to meet the diverted craft, and proximity of appropriate hospital resources to the diversion airport. Many US air carriers contract with in-flight medical consultation companies to assist crews and on-board medical personnel in making an appropriate diversion decision.
If the incidence of medical emergencies continues to increase, as it has from 1991 to 1993, on-board medical personnel will be called upon more frequently to become involved in patient care in this unique environment. On a more global scale, emergency physicians, by virtue of their expertise, should collaborate with the airlines to ensure optimal in-flight patient care.
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