Symptom-Based Categorization of In-Flight Passenger Medical Incidents

Mahony PH, Myers JA, Larsen PD, Powell DMC, Griffiths RF. Symptom-based categorization of in-flight passenger medical incidents. Aviat Space Environ Med 2011; 82:1131–7.

Introduction: The majority of in-flight passenger medical events are managed by cabin crew. Our study aimed to evaluate the reliability of cabin crew reports of in-flight medical events and to develop a symptom-based categorization system. Methods: All cabin crew in-flight passenger medical incident reports for an airline over a 9-yr period were examined retrospectively. Validation of incident descriptions were undertaken on a sample of 162 cabin crew reports where medically trained persons’ reports were available for comparison using a three Round Delphi technique and testing concordance using Cohen's Kappa. A hierarchical symptom-based categorization system was designed and validated. Results: The rate was 159 incidents per 10⁶ passengers carried, or 70.4/113.3 incidents per 10⁶ revenue passenger kilometres/miles, respectively. Concordance between cabin crew and medical reports was 96%, with a high validity rating (mean 4.6 on a 1-5 scale) and high Cohen's Kappa (0.94). The most common in-flight medical events were transient loss of consciousness (41%), nausea/vomiting/diarrhea (19.5%), and breathing difficulty (16%). Discussion: Cabin crew records provide reliable data regarding in-flight passenger medical incidents, complementary to diagnosis-based systems, and allow the use of currently underutilized data. The categorization system provides a means for tracking passenger medical incidents internationally and an evidence base for cabin crew first aid training.