What we are reading
In this heading we intend to give news of recent articles or that deserve to be reread and commented . It will be an open page to all colleagues who wish to collaborate by describing or commenting on topics of sports medicine .
Revista Medicina Desportiva informa , 2018 ; 9 ( 3 ): 3-5 .
Dr . Inês Pádua Nutritionist and researcher at the Faculty of Nutrition and Food Sciences of the University of Porto
Comment to the scientific article
In-Flight Medical Emergencies during Commercial Travel Reasonable , J . V et al . N Engl J Med . 2015 ; 373 ( 10 ): 939-45 .
Summary
This work aimed at a reflection on the position of a doctor before emergencies on board of an airplane , which occur with relative frequency and which often results from a worsening of the diseases already existing in passengers , although new conditions can be arise . It is made clear that , even if this medical support is not compulsory , it is part of an ethical commitment , which is assumed and that there should be positions on the legal framework of this Act and on the limits of it , due to the austere and uncontrolled environment , which councils the prudence of clinical practice . Thus , the mandatory resources on board ( dictated by the Federal Aviation Administration and valid for American commercial airlines ) were revised and the procedures for acting through some of the most frequent emergencies , notably acute myocardial infarction , cardiorespiratory symptoms , mental disorders , trauma , syncope , dyspnea and acute and potentially contagious infections . The work also addressed the position of the crew in the face of medical emergencies , the need for their training ( particularly in basic life support and the use of defibrillators and the crew-medical cooperation itself , notably in the making of extreme decisions , such as diversion of the airplane route and emergency landing ( these of the commander ’ s strict responsibility for decision ).
Comment
With the increase in globalization and the consequent use of the aircraft as a means of transport , the emergencies on board and the need for action constitute a concern and a reality that is ever present to the doctor . The creation of recommendations and the delineation of strategies supported and marked by the legal framework and the instruction of the airlines / crews is of the utmost importance . This work has led to a pertinent reflection and revision in this area , but it will be important to consider a gap in terms of the mention of emergencies related to food allergy and anaphylaxis . Food allergy is a growing problem 1 of public Health and Food Safety , having emerged as the ‘ second wave ’ in the epidemic of allergic diseases . 2 Food allergy may manifest at any age , including adulthood , and there is no available treatment , implemented by routine , in addition to the total eviction of the allergen ( s ) and , consequently , the food ( s ) involved . 1 Failure to fulfill the eviction diet can lead to the situation of anaphylaxis , and food is effectively one of the main causes of anaphylactic reactions 3 , 4 and the first in pediatric age in Portugal . 5-7 A anaphylactic reaction may endanger the patient ’ s life if there is no adequate and timely response , notably through the administration of adrenaline , which constitutes first-line treatment . 8 The problem also gains a larger dimension if we consider that accidental exposure to allergens is not uncommon 9 , mainly due to the ubiquitous nature of some of the most prevalent allergens ( such as milk or egg ) and a widespread lack of information and education in this area . 10 . 11 Airline travel is a particular cause of anxiety for patients and families 12 . 13 , and they often restrict the number of vacations or who report even if they have never travelled . 14 . 15 Still , both the urgency of inclusion of these passengers , the aforementioned globalization and the need to use the aircraft in contexts beyond the recreational ( notably professionals ) make it more and more important to reflect on the measures to promote their safety . Data on frequency of allergic reactions in airplanes are limited . However , it is known that about 10 % of the passengers with peanut food allergy have already experienced a reaction on board 12 and have already been responsible for emergency landings . 16 Additionally , in the media , social networks , patient pages and clinical contact , reports of onboard reactions and lack / failure of assistance are added . In recent years , many american airlines have implemented some preventive measures , such as eliminating the distribution of peanuts during the flight due to the high prevalence of this food allergy in the anglo-saxon countries . However , and taking into account the possibility for passengers to carry their own snacks on board , the risk of exposure will always be present . 12 , 17 , 18 This risk will also remain in the “ buffer zone ” or “ free area ”, another measure that provides for a zone reserved for
Revista de Medicina Desportiva informa may 2018 · 3