Preflight Medical Screenings of Patients: Discussion
The findings in this report indicate that large numbers of patients referred for preflight medical screening are receiving medication, have a wide range of medical diagnoses, and were recently discharged from an acute care hospital. The largest group consisted of patients requesting in-flight oxygen therapy. The oxygen group consisted primarily of elderly patients with COPD who used supplemental oxygen prior to flight. Many were “frequent fliers” who generally had not used in-flight oxygen previously but who complained about flight-related dyspnea. Their upcoming flights were more than 3 h long, and many had either long layover times or several plane changes en route to their destinations, or both, which indicates the need to consider and, if appropriate, arrange oxygen therapy between connecting flights as well as during flight. Clinically significant sequelae in the patients who were cleared for flight did not apparently occur during or after flight.
This type of study has certain limitations. The study’s air carrier is atypical in that its patients were routinely referred to a contracted medical service (rather than to an in-house medical department) for preflight screening. However, this practice appears to be increasing each year in the air transport industry because of financial considerations. The carriers extensive national area of service and the large number of passengers flown annually are comparable to those of other major domestic air carriers. The study population flew on domestic flights, and we have no data regarding intercontinental air travel which would involve much longer durations of flight and of hypoxia. The 12-month study period was considered adequate for evaluating a large number of patients and for minimizing perturbations in flying frequency or habits of the public. Notably, the number of screenings in 1991 increased markedly from that in 1990, despite the Gulf War in early 1991. The screened patients were likely representative or similar to patients flying on other major domestic airlines, since large numbers of customers of all ages and from different areas of the country were evaluated. However, the total number of flying patients with significant medical conditions (with and without preflight screening) still is not clearly known. Thus, the data presented in this study likely underestimate the true number of flying patients in 1991. Even patients who are clinically stable prior to flight may develop in-flight processes that do not become clinically manifest until after arrival, such as with pulmonary embolism. The medical diagnoses were confirmed by experienced screening nurses who routinely contacted both the patient or relative, or both, and the physician or nurse, or both. Some patients and nurses were reluctant to volunteer complete medical information, but the cumulative database is sufficiently large and reflects major medical diagnoses. This aspect is less problematic in the oxygen group, since a medical indication was necessary for clearance and oxygen therapy. Nevertheless, some relevant aspects of the history may have been deleted. For example, smoking history was frequently neither available nor reported. Similarly, preflight lung function, arterial blood gas levels, and hemoglobin concentration of screened patients usually were not available.
Category: Preflight Medical Screenings
Tags: antiseizure medications, cardiac disorders, cardiac medications, oxygen therapy