For travelers and aircraft crews alike, experiencing a medical emergency in a foreign country is a major fear, but for corporate pilot Mark Zakula, that nightmare played out when he suffered a life-threatening issue while on a mission to Israel five years ago.
While dining with his fellow crewmembers in a Tel Aviv hotel, he suddenly felt chest pains and began sweating. He returned to his hotel room to call his company’s medical provider. “That was my first mistake,” he told the audience during a panel discussion on managing surprise medical issues at NBAA’s Schedulers & Dispatchers Conference, held in April in San Diego. “Never ever go somewhere by yourself when you think you are having a heart attack because I could have ended up dead in my room and nobody would have known.”
Zakula called Aircare International, which his company had recently contracted as its medical provider. “In less than a minute the ER physician was on the phone with me,” he said. After hearing Zakula’s symptoms, the on-call doctor advised which hospital he should go to.
He then informed his copilot that he was going to the hospital, went downstairs, and summoned a taxi for another mistake. “Don’t take a taxi to go to the hospital when you are having a heart attack, call for an ambulance just in case,” he explained, adding that his co-pilot and flight attendant insisted on accompanying him.
After a battery of tests, Zakula was informed he did indeed suffer a heart attack and would require two procedures. Since payment was required at the time, Aircare guaranteed payment as part of Zakula’s employer’s plan. That worked out to approximately $35,000 for six nights in the hospital, two medical procedures, and the emergency room visit. After that, Zakula returned back to the U.S., only this time he rode in the back of the airplane watching movies, rather than occupying his seat in the flight deck.
Having previous experience as a trauma center volunteer, Zakula advised crew members to get training to spot the signs of serious illness. “It’s not expected, but when it happens you’re ready, it’s just instinct.” He also stressed that medical care systems around the world may be completely different than what is expected in the United States.
Aircare v-p of operations Karl Kamps noted that in Zakula’s situation, it was important for him not to have to worry about how to immediately pay for his care “because most international countries that you go to, they are not going to accept your medical insurance.” He said that crews should know what benefits and services their providers offer international travelers.
A primary concern for his company is determining the level of care that is available in that country and whether the patient requires medevac to a more suitable location. In cases of inflight illness, diversion options based on the quality of care should be baked into every flight plan, and crews must be aware of how to contact their medical providers in flight.
Onboard Medical Kits
As well, on those aircraft that carry medical kits, Kamps stated that the crew should be familiar with their contents and their use. “When you have department meetings, pull out that medical kit so everyone can get their hands on it,” he said and suggested operators request a demo kit from their provider for that purpose. “If you don’t know what you have, how are you going to use it?” Some providers will help coordinate training days with possible scenarios that crews will have to face requiring the use of the medical kit.
Zakula added that when his company traveled to remote destinations in Africa, the medical kit would be enhanced to include IVs, sterile sutures, and even operating equipment because while a doctor might be found, they might not have the necessary supplies. Depending on the destination, medicines such as antimalarials should be preloaded and most providers will pre-fill prescriptions of specific medications that might be required of individual passengers. As well, medications have expiration dates and should be periodically replaced, along with the batteries on some equipment. While keeping track of those expirations is typically another task for the flight crew, according to Zakula, some providers will keep track of such things and automatically send alerts and replenishments.
Denise Gouvin, passenger services manager with Travelers Indemnity, explained that her department relies heavily on preflight situational planning, with medical awareness a prime consideration, particularly in the Covid era. Vaccination status and testing protocols will vary from country to country, and understanding what quarantine and transport regulations are in effect is vital should a team member contract the disease.
At each destination, the department evaluates the available care providers and in cases of international trips, will actually scout out the ground routes to the hospital from the airport and hotel. Part of the preparation against the unexpected is determining how to contact emergency medical services in each country because “911” is not universally recognized.
During the Covid-induced lull in flying, Gouvin’s department took the initiative to have all of its flight attendants become emergency medical technicians (EMT) through a program at a local college. “It has really opened up options for us when there is an unexpected medical emergency,” Gouvin said, adding that would now permit them to act as medical escorts to help transport ill passengers. It also allowed additional medical equipment to be carried onboard the aircraft becaue the flight attendants are now trained in its use.
As part of the preflight planning, Kamps suggested that passengers should file any preexisting health conditions and medications with the medical provider. Understanding the level of privacy involved, and bound by federal law to protect sensitive patient health information, Aircare offers a secure app that passengers can access to upload their information directly to its operations center, bypassing the company flight department or aircraft operator entirely. In case they are incapacitated that information will be accessible to help guide their care until they reach suitable medical assistance. In such instances, Zakula noted having dependable internet connectivity aboard the aircraft is invaluable, allowing communication of symptoms. His company even carries a device as part of its medical kit that can monitor a patient, automatically transmitting their vital signs through the internet to an emergency room physician. “If you don’t have it, think about getting it,” he said.
In cases where the crew believes a passenger may have difficulty boarding the aircraft, Kamps noted that there are services that will meet the aircraft on arrival or departure and assist them.