Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study

Figures & data

Table 1. Demographic and academic characteristics of medical students (n = 394).

Variables		n	%
Gender	Female	277	70.3
	Male	117	29.7
Type of medical school	Public	261	66.2
	Private	133	33.8
GPA	2.00 − 2.74	6	1.5
	2.75 − 3.74	69	17.5
	3.75 − 4.49	160	40.6
	4.5 − 5.00	159	40.4
Frequency of air travel	<1 time per year	184	46.7
	One time per year	105	26.6
	≥ 2 times per year	105	26.6
Having encountered an IME	Yes	56	14.2
	No	338	85.8
Having attended life support courses	Yes	331	84.0
	No	63	16.0
Having completed the emergency medicine rotation	Yes	159	40.4
	No	235	59.6

Table 2. Knowledge about in-flight medical emergencies of medical students (n = 394).

	Overall				Life support training				No life support training				OR (95%CI)	p
	n	%CR	Rank	%DCR	n	%CR	Rank	%DCR	n	%CR	Rank	%DCR
Aviation Pathophysiology
Q1: Commercial airplane cabins are typically pressurized to an altitude of sea level	97	24.6	9	53.6	80	24.2	9	53.7	17	5.1	8	10.2	0.86	0.63
													(0.48–1.57)
Q2: The aircraft cabin has a lower partial pressure of oxygen at altitude, with resultant mild hypoxia in healthy passengers	278	70.6	2		234	70.7	2		44	13.3	2		1.04	0.88
													(0.57–1.88)
Q3: Gas in body cavities can expand by 30% at low cabin pressure associated with cruising attitudes.	259	65.7	4		219	66.2	5		40	12.1	3		1.12	0.67
													(0.63–1.95)
Epidemiology
Q4: The most common medical emergency occurring during a flight	91	23.1	10	35.8	78	23.6	10	35.4	13	3.9	10	7.3	1.19	0.74
													(0.62–2.34)
Q5: Majority of in-flight medical emergencies end up requiring diversion of the airplane to the nearest medical facility	191	48.5	6		156	47.1	6		35	10.6	5		0.71	0.27
													(0.41–1.21)
Equipment availability/Support system
Q6: Cabin Crews are trained in basic life support	341	86.5	1	77.0	290	87.6	1	78.0	51	15.4	1	13.8	1.66	0.16
													(0.84–3.36)
Q7: Most airlines provide in-flight medical consultation services with ground-based physicians in the event of in-flight medical emergencies.	266	67.5	3		226	68.3	3		40	12.1	3		1.24	0.47
													(0.7–2.16)
Medicolegal responsibilities
Q8: Doctors are legally required to introduce themselves in the case of an inflight medical emergency	102	25.9	8	39.9	85	25.7	8	40.3	17	5.1	8	7.2	0.94	0.88
													(0.5–1.69)
Q9: The decision to divert the airplane to the nearest hospital in case of an in-flight medical emergency is usually made by which of the following?	117	29.7	7		95	28.7	7		22	6.6	7		0.75	0.37
													(0.43–1.31)
Q10: Medical assistance rendered by a capable physician is of little personal legal risk and is supported by experts in aviation medicine.	253	64.2	5		220	66.5	4		33	10	6		1.8	0.04
													(1.04–3.1)

%_CR= percentage of participants with correct answers to the question. %_DCR= percentage of correct answers in the domain.

Figure 1. The proportion of survey participants with (A) adequate knowledge, (B) confidence, and (C) willingness to assist during an inflight medical emergency. LST = Life support courses.

Table 3. Association between demographic/academic characteristics of medical students and their level of knowledge about in-flight medical emergencies (IME).

Variables		Knowledge level^§				OR (95%CI)	p
		Inadequate (n = 289)		Adequate (n = 171)
		n	%	N	%
Gender	Male	76	65	41	35	(Ref)
	Female	166	59.9	111	40.1	1.24 (0.8–1.92)	0.37
Type of medical school	Public	160	61.3	101	38.7	(Ref)
	Private	82	61.7	51	38.3	1.02 (0.66–1.55)	>0.99
GPA	2.00 − 2.74	5	83.3	1	16.7	(Ref)
	2.75 − 3.74	42	60.9	27	39.1	0.31 (0.03–2.58)	0.4
	3.75 − 4.49	94	58.8	66	41.3	0.28 (0.02–2.17)	0.4
	4.5 − 5.00	101	63.5	58	36.5	0.35 (0.03–2.66)	0.42
Age	20	18	60	12	40	(Ref)
	21	33	70.2	14	29.8	1.57 (0.59–4.17)	0.46
	22	38	61.3	24	38.7	1.06 (0.44–2.64)	>0.99
	23	45	53.6	39	46.4	0.77 (0.35–1.75)	0.67
	24	52	63.4	30	36.6	1.16 (0.51–2.69)	0.83
	25	24	55.8	19	44.2	0.84 (0.32–2.12)	0.81
	26	8	61.5	5	38.5	1.07 (0.27–3.92)	>0.99
	27	10	71.4	4	28.6	1.67 (0.44–5.65)	0.52
	28	6	75	2	25	2 (0.37–10.85)	0.68
	29	2	100	0	0	Inf (0.28-Inf)	0.52
	30	2	66.7	1	33.3	1.33 (0.14–20.76)	>0.99
	>30	4	66.7	2	33.3	1.33 (0.26–7.81)	>0.10
Frequency of air travel	<1 time per year	107	58.2	77	41.8	(Ref)
	One time per year	59	56.2	46	43.8	0.92 (0.57–1.51)	0.8
	≥ 2 times per year	76	72.4	29	27.6	1.89 (1.14–3.17)	0.02
Having encountered an IME	Yes	32	57.1	24	42.9	(Ref)
	No	210	62.1	128	37.9	1.23 (0.69–2.15)	0.55
Having attended life support courses	Yes	200	60.4	131	39.6	(Ref)
	No	42	66.7	21	33.3	1.31 (0.75–2.26)	0.4
Having completed the emergency medicine rotation	Yes	90	56.6	69	43.4	(Ref)
	No	152	64.7	83	35.3	1.4 (0.92–2.14)	0.11

^§Achieving ≥ 60% of correct answers in the knowledge domain was considered "adequate," mirroring the usual acceptable pass rate in academia.

Figure 2. Mean Likert-scale scores for seven questions to test the participants’ confidence and four questions to test the participants’ willingness to provide medical assistance during an IME.

Data availability statement

The data supporting this study’s findings are available from the corresponding author, M.A, upon reasonable request.