E-Paper
Air Travel Safety
The circumstances in which GL Sanghi died on a flight has opened up a debate on the health related issues during long international flights, writes Dr KK Aggarwal.
The untimely, sudden and unusual circumstances in which the death of G L Sanghi, immediate Past President of Law Asia, Vice President of United Lawyers Association, Senior Vice Chairman of Heart Care Foundation of India and a noted lawyer of Supreme Court of India occurred has opened up a debate on the health related issues during long international flights.
Sanghi, 73, was not a known case of diabetes, high blood pressure or heart disease. He was a controlled asthmatic. He took an Lufthansa flight from SFO to Frankfurt on 5th January (Thursday) at 2:15 pm. Three hours after the flight took off, he had a large bout of vomiting and within minutes developed cardiac arrest from which he could not be revived. Fortunately, a US-based Cardiologist on board attended him to, now practicing in Sweden.
After Sanghi's death, his body, along with his luggage, was transferred to Winnipeg, Canada. Till then, no relatives in Delhi were informed of the unfortunate incidence by the airlines on which he was traveling. Only the point of departure in US was informed. As per the international regulations in Canada a post mortem was performed in Winnipeg Hospital.
Due to all these formalities, it took three days for the physical body to reach India, adding further to the emotional shock and trauma of the bereaved family members.
This incident raises certain serious questions. Firstly, about the safety of airlines passenger and secondly about the procedure if someone dies on the board. Let me discuss the second part first.
As per the International regulations, if a person dies on the board, it is the duty of the airlines to bring the passenger to the final destination, in this case Delhi (SFO to Frankfurt and Frankfurt to Delhi). However, the airlines decided to transfer the body at Winnipeg, which is entirely inexplicable.
Logically, Sanghi's body should have been brought to Frankfurt and then as a coffin passenger to Delhi. Post mortem could have been done either at Frankfurt or at New Delhi. There was no reason for them to have unloaded the body at Winnipeg. Medical certificate at Winnipeg clearly said that place of death was in the plane and the time of death as notified by the attending Cardiologist was 6:16 PM, California time, which was 30-40 minutes before the plane landed at Winnipeg. I feel that this is a matter, which the international travelers must take up collectively.
Regarding the safety of a passenger in the airlines, over 900-1000 people die each year in-flight. This number does not include deaths in medical patients being transported from one destination to the other. These 1000 deaths are unexpected deaths in people who otherwise are either healthy or a known-disease patient but fairly well controlled on medicines. The number one cause of death in the flight is cardiac arrest, which is death occurring within one hour of the onset of cardiac symptoms.
All airlines by law are required to have automatic electric defibrillators (AED) on the board, which has reduced the deaths rates in cardiac arrest by up to 40% (British airways). Every board personnel are required to get a training of atleast 40 hours in first aid.
Most cardiac arrests come after a few preliminary warning signs, which are often ignored by the passengers especially they think these symptoms might have been due to plane's take off. Warning signals may include a feeling of nausea, vomiting, uneasiness, chest discomfort, mild sweating, mild breathlessness or mild exhaustion.
Each airline must have tablets like nitrates, aspirin and Clopidogrel in their first aid kit. If a heart attack is suspected chewing 300 mg of Aspirin and 300 mg (four tablets) Clopidogrel taken orally with water can reduce the chances of death by almost 40%. All the airline staff must be trained in chest compression CPR which can be life saving if the cardiac arrest is due to ventricular tachycardia or ventricular fibrillation. During long flights, no symptoms should be ignored, no matter how innocuous they may appear.
In every flight, a medical doctor should preferably be on board, however, this rather may be difficult to implement practically. Instead, airlines could float a scheme whereby subsidized or free tickets could be offered to the first medical doctor boarding a particular flight.
It is very rare for a person to die in-flight due to reasons other than cardiac arrest. Hence, just like how first aid information is provided to every passenger regarding how to act during emergency landing in water etc, a pamphlet on first aid measures to be implemented during heart attack and some other conditions should be provided to every passenger.
In the current scenario most airlines are safe as all the airplanes are pressure compressurised. But still, air travels are contraindicated for patients with uncontrolled blood pressure, diabetes, and patients with unstable angina and with history of recent heart attack, angioplasty or bypass surgery. Just as there is a check list available for people who wish to donate blood, similarly, while buying a ticket, there should be a check list provided by the airlines giving details as to who should preferably avoid air travel on medical grounds.
(The writer is Senior Consultant, Moolchand Medcity; President, Heart Care Foundation of India; President, Delhi Medical Association; Member, Delhi Medical Council.)
