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
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.
acting through some of the most
frequent emergencies, notably acute
myocardial infarction, cardiorespira-
tory symptoms, mental disorders,
trauma, syncope, dyspnea and acute
and potentially contagious infec-
tions. 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 defibrilla-
tors and the crew-medical coopera-
tion 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).
Summary Comment
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 frame-
work of this Act and on the limits
of it, due to the austere and uncon-
trolled 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 With the increase in globaliza-
tion 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 recommen-
dations and the delineation of strat-
egies 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 pub-
lic 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 evic-
tion of the allergen(s) and, conse-
quently, 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 Por-
tugal. 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 aller-
gens (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 anxi-
ety 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 Addition-
ally, in the media, social netw ܚ]Y[ Y\[[X[X \ܝ وۘ\ XX[ۜ[X٘Z[ \Hو\\[H\HYY [ X[ YX\X[H[Y\X[Z\[\]H[\[Y[Y YB ][]HYX\\\ X\[[ZKB][ H\ X][ۈو X[] \[ HY YH HY ][[Hو \[\H[ B[\^ۈ[ Y\ˈ]\[Z[[X[ H X[] B܈ \[\ \H Z\ۂۘXۈ\ H \و^ \B[[ ^\H \[ L M N\ \[[ [XZ[[ H8'Y\ ۙx'B܈8'YH\Xx'K[\YX\\H ] ݚY\܈H ۙH \\Y܂]\HHYYX[H\ܝ]H[ܛXHX^H N0