In-flight medical emergencies: creation of a novel simulation based medical student curriculum

Dear Sir

An estimated 20,000 in-flight medical emergencies occur in the United States annually (Silverman & Gendreau 2009). Aircraft cabins are loud, confined spaces, without direct access to established medical care (Mattison & Zeidel 2011). The reduced humidity and atmospheric pressure, and loss of personal mobility all present specific pathophysiologic considerations for physicians that respond to a fellow passenger in need (Silverman & Gendreau 2009). There are no United States medical school curriculum requirements specific to this community need.

We hypothesize that medical students do neither feel comfortable assisting during an in-flight medical emergency nor do they have an adequate fund of knowledge in this area. Additionally, we hypothesize that a focused curriculum, including a simulated medical emergency in a mock aircraft cabin, will improve both comfort and fund of knowledge.

Thirty-seven medical students completed a 90-minute curriculum on in-flight medical emergencies. The curriculum consisted of a lecture attended by the entire group and a simulation case. All participants completed a baseline questionnaire prior to learning the curriculum. This document included demographic information, self-assessment questions addressing their perceived knowledge of several aspects of in-flight medical emergencies, and fund of knowledge questions. Participants then completed the simulation case. After completing the simulation scenario, 22 students also completed a post-session questionnaire. Descriptive statistics were performed on the baseline questionnaire. Pre- and post-session questionnaire results were compared with t-tests.

Ten (27%) of the participants had been on an aircraft during a medical emergency, but only one (3%) of the participants had assisted in management of the emergency. One participant (3%) had prior training in flight physiology or in-flight medical emergencies. Students expressed poor initial self-assessment of knowledge, confidence and competence, with a mean Likert-type question response less than 3 (1 representing strong disagreement, 7 representing strong agreement). Initial mean score on fund of knowledge questions was 64% (95% CI: 59–69%). Of the paired responses, the mean fund of knowledge score increased from 61% to 91% (p < 0.0001) and all of the mean self-assessment responses increased (p ≤ 0.001).

The participants’ responses to both subjective and objective questions indicated that they were not optimally prepared to render aid during in-flight medical emergencies. Our curriculum improved their scores on objective and subjective questions, indicating they may be better prepared to respond to future in-flight medical emergencies. If replicated on a larger scale, medical schools should consider adding basic training for in-flight emergencies to emergency medicine curricula.