[In-flight medical emergencies. American and European viewpoints on the duties of health care personnel].

Today almost 2 billion passengers fly commercially each year--and the number is increasing. Different investigations indicate one medical event per 33,600-50,000 passengers, corresponding to 33-22 events daily. The events seem to increase, which can be explained by an increasing number of elderly passengers over longer distances. Most events are not serious. Among serious events, cardiac (46 per cent), neurological (18 per cent) and respiratory (6 per cent) dominate. 13 per cent of all acute events result in a diversion--an unscheduled landing. Airline companies have the right to refuse passengers to which flying means an increased health risk. A person, capable of walking 50 metres on level ground or up one flight of stairs without experiencing severe shortness of breath or chest pain, can be considered "fit for flight". Assisting medical personnel should ask for an airline company "Liability Form--Medical Assistance" or "Doctor's Waiver". Most (western?) airline companies have first aid kits and emergency drugs on board. An increasing number of airline companies have around-the-clock direct connection to ground based medical assistance. This competence within emergency and aviation medicine should be recognised by medical professionals on board. The decision to carry out a diversion is always made by the captain, and the cabin crew is responsible for the ill. Medical professionals can and should assist the cabin crew in their care for ill passengers on board. We also have unique possibilities to inform our patients in advance, whenever flying means an increased health risk.