Medical Guidelines for Travelers

1
Medical Guidelines for Travelers
A. J. Parmet, MD, MPHMedical Director, Trans
World Airlines
ajparmet_at_cysource.com
2
The Environment of Flight

• Altitude
• 8000 ft cabin altitude/500 mmHg
• 21 Oxygen
• Humidity 5-20
• Air Quality
• Low biologic content
• ETS/dander
• Restricted Movement
• Motion
• Circadian Desynchron

3
The Disabled Traveler

• ADA/Airline Passenger Access Act
• 48 hour notification
• Special seating
• Oxygen

4
Medical Conditions Affected by Travel

• 650,000,000 US Airline Passengers/Year
• 1/350,000 Passengers has major medical event
• Not every event is due to travel.
• 1/3,500,000 Passengers dies

5
Cardiovascular I

• Use of O2 on the ground
• NYHA Class III-IV, PaO2lt70 mmHg
• Angina Class III-IV
• Cyanotic heart disease
• Pulmonary hypertension

6
Cardiovascular II

• Myocardial Infarction
• Uncomplicated10 to 20 days
• Complications6 weeks
• Unstable Angina
• Congestive Failure
• CABG2 weeks
• Uncontrolled dysrhthmias

7
Pulmonary

• Need for Oxygen?
• Practical test Can patient walk 50 yards or
  climb one flight of stairs without severe
  dyspnea?
• Consider a pulse oximeter
• Asthma is the most common medical emergency
• Deep Venous Thrombosis

8
Obstetrics

• Travel during pregnancy is safe, but
• Is this trip really necessary?
• 27-32-36 Weeks
• Bring shoelaces
• Passengers should get up
  
  and walk every hour
• Radiation

9
Obstetrics II - Crew Issues

• US Fly to 27th week
• Europe
• Pilots fly 2nd Trimester
• F/A ground on declaration

10
Pediatrics

• Newborns-safe at one week
• Small children should suck or drink on descent

11
Ear, Nose and Throat

• Any condition affecting the ability to
  equilibrate air pressure in the middle ear and
  sinuses
• Dont fly with a cold!
• Recent surgery of middle and
  inner ear
• Dental abscess

12
Surgical

• Intestinal gas expands by 25-50
• colostomies produce more fecal output
• Trapped gas- eye and brain
• Spinal anesthesia
• Pulmonary atelectasis

13
Neurologic

• CVA-delay 2 weeks
• Seizures are second most common events-usually
  due to failure to medicate
• Alzheimers/Sundowner Syndrome

14
Psychiatric

• Unpredictable behavior or threats to the health
  and safety of themselves and others
• Claustrophobia and Agoraphobia
• Drug and Alcohol abuse-detox first

15
Diabetes-Eastbound (6 Time Zones)

• Single dose
• Usual dose on morning of departure
• 1st morning at destination 2/3 usual dose
• 10 hours later, test glucose and give 1/3 of AM
  dose if glcgt
• 2nd morning, resume usual schedule
• Two dose
• Usual morning and evening doses
• Same procedure as for Single dose

16
Diabetes-Westbound (6 Time Zones)

• Single dose
• Usual dose on morning of departure
• 18 hours later, test glucose, give 1/3 AM dose
  and snack if glclt
• Next day, usual dose
• Two dose
• Usual morning and evening doses
• 18 hours later, test glucose, give 1/3 AM dose
  and snack if glclt
• Next day, resume usual schedule

17
Hyperglycemia

• Add Insulin to IV
• 0.1 U/g Dextrose
• 5U to 1 L D5W

18
Economy Class Syndrome or Vehicular DVT

• Preexisting DVT, usually two weeks prior to
  travel
• Clot propagation occurs with prolonged inactivity
  (not just in tourist seats, any vehicle)
• Embolism occurs with debarkation
• Prevention by hydration and hourly in seat
  exercises or get up and walk

19
Miscellaneous

• HIV
• Tuberculosis
• Other Infectious Diseases
• Carry Your Medications with You!
• Prescription Lables on Bottles, particularly for
  controlled substances
• Dont Import Medications to the US

20
Airsickness

• Diphenhydramine
• Meclizine
• Transdermal scopalamine

21
Decompression Sickness

• Wait 12 hours after a single scuba dive
• Wait 24 hours or longer after multiple dives,
  multiple days

22
Vaccinations

• Yellow Fever is the only mandatory vaccine
• Basic MMR, Td, Hep A, TBtine
• Consider Cpx, Hep B, Typhoid, Flu, Pneumonia
• Poor Cholera, Plague
• Consult http//www.cdc.gov

23
Emergency Treatment

• Aircraft
• Land at nearest airport
• Oxygen
• Minimal Medical Kit
• Advanced Medical Kit
• AED
• Cruise Ships
• Ships doctor
• Larger medical kit
• Ship inspections available at www.cdc.gov

24
Reference

• Medical Guidelines for Airline Travel, Air
  Transport Committee of the Aerospace Medical
  Association, Alexandria VA, 1997

25
Pack for your Trip?

• You return from vacation with the local rum.
  Which of the following is not allowed on the
  aircraft?
• A. Spiced Rum (65 Alcohol)
• B. Dark and Hot Rum (70 Alcohol)
• C. 151 Rum (75 Alcohol)

26
You are going hunting and plan to carry your own
weapons and ammunition. Which is allowed?

• A. Check 11 pounds net weight of ammo and weapon,
  complete NOTICE TO ARMED INDIVIDUAL FORM
• B. Check 21 pounds of ammunition in original
  manufactures cartons.
• C. Check 11 pounds gross weight of ammunition in
  a sturdy carton.

27
Can you carry mace or pepper spray as long as it
is on your person?

• A. True
• B. False

28
Which of the following can be carried as checked
luggage?

• A. Full Scuba Tanks
• B. Propane and CO2 Cartridges
• C. Fireworks
• D. Self-inflating life rafts
• E. Dry ice up to 4.4 pounds