In-flight emergencies for the obstetrician and gynaecologist: what to expect when called to action Wasim Lodhi FRCOG, a Mark Popplestone MFOM, b Christine Friedman BSc, c Roberto De Martino, d Wai Yoong MD FRCOG a,* a Consultant Obstetrician and Gynaecologist, North Middlesex Hospital, London N18 1QX, UK b Consultant Occupational Physician, British Airways Health Service, Harmondsworth UB7 0GB, UK c Medical student, St George’s University School of Medicine, Grenada, West Indies d Training Captain, British Airways Global Training Academy, Heathrow Terminal 4, London TW6 2SY, UK *Correspondence: Wai Yoong. Email: waiyoong@nhs.net Accepted on 4 September 2017. Published Online 21 June 2018. ‘Is there a doctor on board?’ Over 2 billion passengers travel on commercial airlines every year. While flying is one of the safest modes of transport, medical emergencies do happen in the air. According to a 2013 study, 1 these occur in 1 in 604 flights and passengers who are medical doctors are asked for assistance in just under half of these cases. Physicians of any specialty should be ready and willing to assist in an in-flight emergency if requested. After reading this commentary, the question, ‘is there a doctor on board?’ should no longer be unnerving for the obstetrician and gynaecologist to hear mid-flight. ‘What will the emergency entail?’‘Will it be within the realm of my practice?’ Whatever the physician’s specialty, it is natural to worry about the nature of emergency consultation requests. It is rare for obstetric or gynaecological events to occur in flight. Fewer than 3% of flight emergencies are obstetric or gynaecological in nature; 2 thus, if called upon, obstetricians and gynaecologists should be prepared to assist in ‘out of specialty’ events in 97% of cases. Of all in-flight emergencies, 65% were attributed to exacerbations of pre-existing medical conditions. 3 According to British Airways (BA) in 2013, ground-based medical advisors (MedLink) are most often called upon during long-haul flights for neurological (26%; including syncope, headaches, seizures and strokes) or gastrointestinal (25%) reasons (Table 1). Data from BA in 2013 (n = 1936 events) revealed that most emergencies were non-life-threatening and were managed without having to request a doctor or divert the aircraft. After initial medical assessment, only 26 cases (1.3%) resulted in aircraft diversion. Thus, regardless of specialty or the nature of the in-flight emergency, a competent doctor should be able to manage the situation. Of the 1936 cases, 32 were obstetric or gynaecological in nature: 14 were attributed to nonpregnancy- related vaginal bleeding, including two cases of post- hysterectomy haemorrhage. Eighteen cases were related to early pregnancy; mostly pain and/or bleeding, with one miscarriage at 17 weeks of gestation. The only obstetric or gynaecological case requiring flight diversion was suspected premature rupture of membranes at 26 weeks of gestation; however, subsequent assessment rejected this diagnosis and the patient completed her journey the following day. ‘Will I have to handle the issue by myself or will I have assistance?’‘Will I have the necessary equipment when at cruising altitude?’‘What if the aircraft has to divert?’ During an in-flight emergency, doctors asked to assist can access help from cabin crew, who receive mandatory annual training in first aid and basic life support. Cabin crew also know how to administer oxygen and use an automated external defibrillator. First aid kits are available on every aircraft; cabin crew are familiar with their contents and know how to use them (Box 1). Furthermore, an onboard medical kit that is meant for use only by trained medical professionals contains medical equipment and drugs to manage acute medical conditions (Box 2). The attending doctor should decide on the equipment or medication to be used and the crew should bring the appropriate kit. Lastly, the doctor can seek expert advice from an emergency medicine physician via contracted ground-to-air medical advisory services such as MedLink. Together, the doctor and MedLink staff will determine whether or not the flight should be diverted. Experienced cabin crew should liaise with MedLink before calling for a doctor on board. Diverting is costly and is rarely necessary. 148 ª 2018 Royal College of Obstetricians and Gynaecologists DOI: 10.1111/tog.12490 The Obstetrician & Gynaecologist http://onlinetog.org 2018;20:148–150 Commentary