Aviation Medicine and the Airline Passenger (Hodder Arnold Publication)

225 Pages·2002·16.71 MB·English

by  Andrew R. C. Cummin

Aviation Medicine
and the
Airline Passenger
Edited by
Andrew RC Cummin MA DM FRCP
Consultant in Respiratory Medicine, Charing Cross Hospital, London
Honorary Senior Lecturer, National Heart and Lung Institute, Faculty of Medicine,
Imperial College of Science, Technology and Medicine, University of London
Lately, Senior Medical Officer (Research), Royal Air Force Institute of Aviation Medicine
and
Anthony N Nicholson OBE DSc MD(hc) PhD FRCP(Lond) FRCP(Ed) FRCPath FFOM FRAeS
Visiting Professor of Medicine, National Heart and Lung Institute, Faculty of Medicine,
Imperial College of Science, Technology and Medicine, University of London
Visiting Professor of Aviation Medicine, Department of Human Physiology and Aerospace Medicine,
King's College School of Medicine, University of London
Lately, Commandant and Director of Research, Royal Air Force Institute and School of Aviation Medicine
A member of the Hodder Headline Group
LONDON'NEW YORK.NEW DELHI
First published in Great Britain in 2002 by
Arnold, a member of the Hodder Headline Group,
338 Euston Road, London NW1 3BH
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© 2002 Arnold
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Whilst the advice and information in this book are believed to be true and
accurate at the date of going to press, neither the authors nor the publisher
can accept any legal responsibility or liability for any errors or omissions
that may be made. In particular (but without limiting the generality of the
preceding disclaimer) every effort has been made to check drug dosages;
however it is still possible that errors have been missed. Furthermore,
dosage schedules are constantly being revised and new side-effects
recognized. For these reasons the reader is strongly urged to consult the
drug companies' printed instructions before administering any of the drugs
recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN 0 340 80637 0 (hb)
1 2 3 4 5 6 7 89 10
Commissioning Editor: Joanna Koster
Production Editor: Anke Ueberberg
Production Controller: lain McWilliams
Cover Designer: Terry Griffiths/Mouse Mat Design
Typeset in 10/12 Pts Minion by Integra Software Services Pvt. Ltd., Pondicherry, India
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Printed and bound in Italy by Giunti
Contents
List of contributors v
Preface viii
1 Medico-legal issues: the Good Samaritan 1
Peter Martin
2 The cabin environment 8
Andrew RC Cummin and Anthony N Nicholson
3 Cosmic radiation 15
Robert MC Hunter
4 Pre-flight assessment and in-flight assistance 26
Andrew RC Cummin, Anthony N Nicholson and Michael Bagshaw
5 Immunization, and infectious and tropical diseases 31
Martin P Connor and Andrew D Green
6 Airsickness 41
JR Rollin Stott
7 Sleep disturbance and jet lag 49
Anthony N Nicholson
8 Obstetrical and gynaecological incidents 58
Geoffrey VP Chamberlain
9 Infants and children 66
Martin P Samuels
10 Breathlessness and chest pain in-flight 79
Andrew RC Cummin
11 Passengers with pulmonary disorders 87
Andrew RC Cummin
iv Contents
12 Coronary artery disease 99
J Simon R Gibbs
13 Defibrillation 107
Douglas A Chamberlain
14 Haematological disorders and transfusion 119
Paul LF Giangrande
15 Venous thrombosis 126
Paul LF Giangrande
16 Otolaryngology 132
David A Jonathan
17 Aviation dentistry 142
Andrew j Gibbons
18 Gastroenterology 147
Devinder S Bansi, Bob Grover and Andrew V Thillainayagam
19 Renal medicine 153
Paul E Stevens
20 Diabetes 163
Vincent McAulay and Brian M Frier
21 The neurological patient 180
Michael D O'Brien
22 Mental health: pre-flight and in-flight 185
E Graham Lucas
23 The elderly and passengers with physical difficulties 198
Francis G Miskelly
24 Carriage of the seriously ill 204
Colin AB McLaren
Index 211
List of contributors
MICHAEL BAGSHAW MB BCh MFOM DAvMed FRACS PAUL LF GIANGRANDE BSC MD FRCp(Lond) FRCp(Ed) FRCPath
Head of Medical Services, British Airways Health Director and Consultant Haematologist, Oxford
Services, Harmondsworth, United Kingdom Haemophilia Centre and Thrombosis Unit,
The Churchill Hospital, Oxford
DEVINDERSBANSI MD MRCP Honorary Senior Lecturer in Haematology,
Consultant Physician, Department of University of Oxford, United Kingdom
Gastroenterology, Charing Cross Hospital, London,
United Kingdom ANDREW J GIBBONS MA MBBChir FRCS FDS
Senior Specialist in Maxillofacial Surgery, Royal Air
DOUGLAS A CHAMBERLAIN CBE HonDSc MD FRCP FRCA Force
Honorary Professor of Resuscitation Medicine,
University of Wales College of Medicine, Cardiff, J SIMON R GIBBS MA MD FRCP
United Kingdom Senior Lecturer in Cardiology, National Heart and
Lung Institute, Faculty of Medicine, Imperial College
GEOFFREY VP CHAMBERLAIN RD MD FRCS FRCOG HORFACOG of Science, Technology and Medicine, London
Lately, Professor and Chairman, Department of Honorary Consultant in Cardiology, Charing Cross
Obstetrics and Gynaecology, St George's Hospital Hospital, London, United Kingdom
Medical School, London
Honorary Consultant Obstetrician and ANDREW D GREEN MBBS FRCPath MFPHM DTM&H
Gynaecologist, British Airways Health Services, Armed Forces Consultant in Communicable
United Kingdom Disease Control, Surgeon General's Department,
United Kingdom
MARTIN P CONNOR MSc MBChB MRCPath DTM&H
Consultant Microbiologist, Department of Pathology, BOB GROVER BSC MBBS MRCP
Royal Hospital Haslar, Gosport, United Kingdom Specialist Registrar, Department of
Gastroenterology, Charing Cross Hospital, London,
ANDREW RC CUMMIN MA DM FRCP United Kingdom
Consultant in Respiratory Medicine, Charing Cross
Hospital, London ROBERT MC HUNTER MSC MBBS MFOM DAvMed
Honorary Senior Lecturer, National Heart and Head of Aeromedical Centre, Safety Regulation
Lung Institute, Faculty of Medicine, Imperial Group, Civil Aviation Authority, Gatwick Airport,
College of Science, Technology and Medicine, United Kingdom
London, United Kingdom
DAVID A JONATHAN MBBS FRCS
BRIAN M FRIER BSc MD FRCp(Ed) FRCp(Glas) Consultant in Otolaryngology, Frimley Park
Consultant Physician and Honorary Professor in Hospital, Camberley, United Kingdom
Diabetes, Royal Infirmary of Edinburgh, Edinburgh, Consultant Adviser in Otolaryngology, Civil
United Kingdom Aviation Authority, United Kingdom
vi List of contributors
E GRAHAM LUCAS MBChB FRCP(Ed) FRCPsych FFOM D(obst)RCOG MICHAEL D O'BRIEN MD FRCP
Emeritus Consultant Psychiatrist, Maudsley Physician for Nervous Diseases, Department of
Hospital, London Neurology, Guy's Hospital, London, United Kingdom
Consultant Psychiatrist, Foreign and
Commonwealth Office and Civil Aviation MARTIN P SAMUELS MD FRCP FRCPCH
Authority, United Kingdom Consultant Paediatrician and Senior Lecturer in
Visiting Professor, Postgraduate Medical School, Paediatrics, Keele University, Academic Department
University of Guildford, United Kingdom of Paediatrics, North Staffordshire Hospital, Stoke
on Trent, United Kingdom
PETER MARTIN HonCRAeS FRAeS
Honorary Solicitor, Royal Aeronautical Society, PAUL E STEVENS BSC MBBS FRCP
United Kingdom Consultant Nephrologist, Department of Renal
Medicine, Kent and Canterbury Hospital,
VINCENT McAULAY MBChB MRCP Canterbury, United Kingdom
Specialist Registrar in Medicine, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom JR ROLLIN STOTT MA MBBChir MRCP DAvMed DCH DIC
Principal Medical Officer, QinetiQ Centre for
COLIN AB McCLAREN ostj MBChB FRCA Human Sciences, Farnborough
Lately, Consultant Adviser in Anaesthetics, Lately, Senior Medical Officer (Research), Royal Air
Royal Air Force Force Institute of Aviation Medicine, United Kingdom
FRANCIS G MISKELLY MSC MD PhD MRCP ANDREW V THILLAINAYAGAM MD FRCP
Senior Lecturer, Faculty of Medicine, Imperial College Consultant Physician, Gastroenterology Unit,
of Science, Technology and Medicine, London Hammersmith Hospitals, London
Honorary Consultant Physician, Department of Honorary Senior Lecturer in Medicine,
General Medicine and Care of the Elderly, Charing Faculty of Medicine, Imperial College of Science,
Cross Hospital, London, United Kingdom Technology and Medicine, London, United Kingdom
ANTHONY N NICHOLSON OBE DSC MD(hc) PhD FRCp(uond)
FRCP(Ed) FRCPath FFOM FRAeS
Visiting Professor of Medicine, National Heart and
Lung Institute, Faculty of Medicine, Imperial College
of Science, Technology and Medicine, London
Visiting Professor of Aviation Medicine, Department
of Human Physiology and Aerospace Medicine,
King's College School of Medicine, London,
United Kingdom
But a Samaritan who was making the journey came
upon him, and when he saw him was moved to pity. He
went up and bandaged his wounds, bathing them with
oil and wine. Then he lifted him on to his own beast,
brought him to an inn, and looked after him there.
Next day he produced two silver pieces, and gave them
to the innkeeper, and said, 'Look after him; and if you
spend any more, I will repay you on my way back'.
Gospel According to Luke
Chapter 10 Verses 33-35
The New English Bible, 1972
Preface
Over the years the medical concerns and well-being value to the specialists of many disciplines whose
of the airline passenger have been a rather neg- advice may be sought by their colleagues, to occupa-
lected aspect of aviation medicine. Aeromedical tional physicians who advise the employees of
practitioners have traditionally focused their their company on worldwide travel, to general
attention on the aircrew where they have striven to practitioners who day-by-day deal with the enquiries
ensure realistic medical standards and maintain of their patients, often elderly and perhaps disabled,
health and well-being. Indeed, even in countries and to those in the nursing and allied professions
with major international carriers, neither the who are involved in aviation medicine.
national regulatory authority nor the airlines has It will be of equal value to physicians who act as
claimed to have any statutory commitment to the 'Good Samaritans', particularly on long-haul flights,
health of the passenger, although most airlines give and the text gives sound advice on handling in-flight
advice on specific problems to the medical practi- events. In this way the book will be useful for those
tioner and provide extra assistance to the passenger. whose skills are not directly related to the problem at
Nevertheless, the potential hiatus in medical care hand, but, nevertheless, may be the only practitioner
has given rise to public concern and, in some on board. The lone psychiatrist may have to face an
countries, government institutions have now com- in-flight delivery, the dermatologist cope with a
mitted themselves to ensuring that adequate pneumothorax and the gynaecologist handle air
attention will be given to the healthy, as well as to the rage. We hope that the airlines will have the book
ill, passenger - at least in flight. It is widely accepted available on their flights, and that they will find it
that air travel does not have a serious impact on the useful in the training of their cabin staff.
health of the vast majority of passengers and that We are indebted to the authors who have brought
many complaints are concerned with comfort - their undoubted experience and expertise in acute
though the latter cannot be necessarily dismissed. medicine and in aviation medicine to this book, and
But, there are problems in a minority that need atten- we have worked closely with the authors to provide
tion, and these are likely to grow in importance with overall consistency of the text. We are indebted to
the increasing travel of the elderly and of those with a Mrs Janet James MBE who prepared the final manu-
clinical disorder or disability. script for the publishers and to Dr Joanna Koster,
Now that the book is at hand, we hope that it will Arnold Publishers, for her counsels and advice.
fulfil our aim to provide an authoritative text on
medicine as it applies to pre-flight assessment and Andrew Cummin
to in-flight assistance. The book is directed to the Anthony Nicholson
medical professional in its widest sense. It will be of April 2002
1
Medico-legal issues: the Good Samaritan
PETER MARTIN
Legal environment 1 The Aviation Medical Assistance Act 1998
The Good Samaritan 2 (United States of America) 5
Legal liability 3 The way ahead 5
What is an accident? 4 Conclusion 6
References 7
Good Samaritans, whether they be physicians or reasonably be treated on board with available equip-
others in the professions ancillary to medicine, who ment before the next scheduled landing. The practi-
give emergency medical services to fellow passengers, tioner should have evidence of qualifications, in
are often concerned about their legal liability, if, as a addition to documents providing evidence of iden-
result of medical malpractice or error in the giving of tity. A full record of what has been done for a patient
those services, the passenger treated dies or is should be made and indemnity from the aircraft
injured. The purpose of this chapter is to describe the commander or the station manager should be sought
legal environment in which the Good Samaritan may before leaving the destination airport. The names of
operate, and to explain the complicated liability the aircraft captain and station manager should be
issues that may arise for doctors and airlines from recorded, and reasons obtained if an indemnity has
the provision of emergency medical relief. The been refused. The insurers for the medical practi-
subject, which is highly legalistic, is not made easier tioner should be informed of any in-flight medical
to explain to lawyers, let alone laymen, by a remark- intervention on return home.
able lack of authority from the courts on the
relationship between the Good Samaritan, the
passenger and the airline. There is no universal
LEGAL ENVIRONMENT
system of air or medical malpractice law that governs
all the possible events which may occur in the course
of international carriage by air. This chapter The international carriage by air of passengers is
attempts to give an overview that may need to be subject largely not to common law or codified rules,
adapted to various international jurisdictions. but to rules established by the international legal
In the first place it is useful to provide a brief instruments, which together make up the so-called
summary of the general recommendations. When 'Warsaw System'. Indeed, many national legislatures
asked to act as a Good Samaritan, the medical prac- have subjected domestic carriage by air to rules based
titioner should ensure that any medical problems upon those of the system. The principal legal regimes
that exist before embarkation are referred to the that currently apply to international carriage by air
ground medical services, if at all possible. In flight, are the Warsaw-Hague regime which is a version of
the medical practitioner should refuse to intervene if the original Warsaw Convention (1929), as amended
not competent or incapacitated, and should seek an by the Hague Protocol (1955), and the original
immediate landing if the emergency cannot Warsaw regime itself. The system is of growing