Managing medical emergencies at 36,000 ft: A guide to Air Canada’s in-flight emergency medical kit

>Hi, my name is Alan Ackery, and I'm an emergency physician at St. Michael's Hospital.

>And my name is David Kodama, and I'm an emergency medicine resident at the University of Toronto.

Ackery: Today we're going to be talking to you about a

article that was published in the CMAJ in regards to in-flight medical emergencies.

Kodama: To supplement that article, today we'll be providing you with a

detailed tour of Air Canada's medical kit, which will be provided to you in

response to an in-flight medical emergency.

Ackery: We hope that this video will provide you some information and tools the next time

that you are called upon in an in-flight emergency.

Kodama: In the event of a medical emergency, a flight attendant or member of the flight crew

will provide you with this kit. Please be noted that once the kit is provided to you, it is likely that ground-based

medical consulting services will have been notified to assist you in managing

your patient. First, remove these tabs. Next, unlatch and open the kit.

The first thing you'll notice when you open the kit is a bunch of documentation.

There's really only a couple things in here that you really should be aware of.

The first is a total list content of what is in the kit.

Take some time and familiarize yourself with what's available.

The second piece of documentation that is really important is an algorithm

of how to treat the most common causes of medical emergencies that you might encounter.

Ackery: I'm just gonna walk us through the top of the kit and some of the pertinent medications.

You can see at the very top here we have adrenaline or epinephrine, which is in a

concentration of one in a thousand. This should never be given through the

IV but should be given IM, unless there is a cardiac arrest, and there

instructions to on how to dilute that down.

The next thing over is we have some Ativan, some atropine, some Benadryl,

in fact there's even medications like Haldol and Valium. A couple things to

note here is that there is a powder form of Solu-Medrol which you need to

reconstitute with sterile water. There's Ventolin that can be

administered for people who have wheezing or some respiratory distress.

In our bottom left-hand corner is our pulse oximeter. It's important to note that

this pulse oximeter doesn't read normal values when we are flying at higher altitudes.

The cabin is usually pressurized at approximately seven to

ten thousand feet, and as a result of this, our oxygen saturations will appear

much lower, and a saturation of 88 to 93 percent is actually considered normal.

Kodama: So we'll talk a little bit about the equipment now, which is located starting

on the bottom tray. You'll notice that there's a blood pressure cuff,

a stethoscope, a sharps container, a burn dressing, a glucometer.

There are various sized oropharyngeal airways, and even umbilical cord clamps.

Something to note: at altitude, it is very difficult to hear breath sounds

and to estimate blood pressure with the stethoscope.

You may find it helpful when using the blood pressure cuff to

estimate the systolic blood pressure, either using the radial pulse

or the pulse oximeter. Continuing with the equipment, you'll notice that if you

remove the tray, there's more equipment located in the base. This is where you'll

find your IV administration kit, all of your syringes, needles and dressings, two

two bags of normal saline, IV tubing, some gloves to protect yourself,

and even a Foley catheter. Please note that every airline will have

a different kit with different contents. When called upon, please make sure

you take the time to familiarize yourself with what's available in each kit.

And that way, you can optimize patient care.

Ackery: So in addition to the kit, there's also a defibrillator on board.

Please look for these symbols for both the BVM and our defibrillator. They can be found in here.

So thanks for watching the video.

Kodama: We hope you find it helpful in the event of a medical emergency.

Ackery: We'd like to thank Air Canada, WestJet, and St. Michael's Hospital for helping put this together.