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Flashcards in Air Travel Deck (41):

Which of the following statements is true regarding health measures specified by the International Health Regulations (IHR):
a) Health measures stipulated by the IHR are the minimum any state may apply for protection against diseases of significance in international travel.
b) International diplomats are exempt from the provisions of the IHR.
c) Except in case of extreme emergency constituting a grave danger to public health, free pratique cannot be refused for diseases other than plague, cholera, and yellow fever.
d) Bodies in sealed coffins are subject to the IHR
e) A person under surveillance is restricted to the quarantine area of a sanitary airport.

c) Health measures stipulated by the IHR are the maximum measures that may be applied to Signatory states to control diseases of significance in international travel. A traveler with plague, yellow fever, or cholera should not be permitted to depart. A traveler under surveillance may depart with notification of the destination health authority. Sealed coffins are not subject to IHR's. An international diplomat is only exempt from IHR provisions if he travels in a sealed coffin.


All of the following statements concerning air travel during pregnancy are true EXCEPT:
A) At a cabin altitude of 8,000 feet, fetal PaO2 is essentially the same as sea level.
B) Evolved gas (decompression sickness) does not post a risk to the fetus.
C) Pregnancy related emergencies are most common in the first and third trimesters.
D) Selected pregnant patients may safely fly as passengers up to 36 weeks of gestational age.

B) Because of the relatively low venous pressure in the uterine environment, the fetus is at greater risk than the mother of DCS.


The following statements concerning the cabin environment in pressurized commercial aircraft are true EXCEPT:
A) At a barometric pressure of 8,000 feet within the cabin, normal adult hemoglobin is approximately 90% saturated.
B) Cabin humidity is commercial aircraft ranges from 10-20%.
C) Ozone levels within a pressurized aircraft are approximately equal to outside ambient concentration.
D) The risk of ionizing radiation exposure generally increases with increasing altitude and latitude.

C) On average ozone levels increase by 70 ppb per km increase in flight altitude, although the relationship between ozone and altitude is highly variable. In US domestic air space, ozone levels greater than 100 ppb are routinely encountered outside the aircraft cabin.


Which of the following statements concerning inflight medical emergencies onboard commercial transport aircraft is/are true.
A) Most cases had a preexisting condition.
B) The most common etiology of inflight deaths is cardiac.
C) Physician travelers were available to respond to approximately 85% of inflight emergencies.
D) In accordance with FAA regulations, the contents of inflight medical kits on all passenger transport aircraft with gross weight of >7500 Ibs and one or more flight attendants must include an onboard defibrillator.
E) All of the above are correct.

E) All of the above are correct.


Passengers are protected from contracting disease in flight mainly because of:
A) high efficiency particulate air filters
B) 100% turnover of cabin air every few minutes
C) laminar air flow throughout the cabin
D) the use of disinfectants
E) ultraviolet light exposure of recirculated cabin air

A) HEPA filters are found in most commercial aircraft. They will filter any particulates or micro-organisms that are >0.3 microns in diameter. Hence practically all airboure particles including bacteria, fungi, and viral clumps will be stopped.
Most newer aircraft afford a 50% aircraft circulation of cabin air. Although they do provide laminar air flow, this does not provide protection from contaminants. Neither recirculated or engine bleed air is exposed to ultraviolet light.


A common cause of foodborne illness inflight is due to:
A) Delays in serving meals
B) infected food handlers
C) contaminated gravies
D) nonpotable water
E) improperly cleaned utensils

B) Infected food handlers and improper holding temperatures are the two most common causes of foodborne illness inflight.


The single best way to determine suitability for flight of a patient with COPD is by
A) respiratory rate at rest
B) overall clinical assessment
C) PaCO2
D) PaO2
E) heart rate at rest

D) PaO2. Although overall clinical assessment, including exercise tolerance, is essential in evaluating a patient with COPD, the single best parameter is the PaO2. In general, a patient with a value above 70 mmHg should be safe to fly even with cabin altitudes of 8,000 feet. However, if there is any doubt, medical oxygen could be ordered. For patients with a PaO2 less than 70 mmHg, medical oxygen must be available or given.


Which of the following is true regarding aeromedical evacuation of patients with decompression sickness?
a) Only pressurized aircraft are suitable for this purpose.
b) Helicopters (non-pressurized) are suitable provided they do not fly above 3,000 feet SL.
c) Helicopters are never suitable for this purpose.
d) When helicopters are used, worsening of DCS symptoms may occur if flight above 200 feet AGL of the take-off point is attempted.

d) When helicopters are used, worsening of DCS symptoms may occur if flight above 200 ft AGL of the take off point is attempted. The patient should be on 100% oxygen.


A 44 year old male truck driver developed chest pain while driving and was seen in a valley community which is at 1200 ft altitude. The diagnosis, made in a small community hospital, was myocardial infarction with second degree heart block and multifocal PVC's. An IV with D5W was started utilizing a typical hospital IV set up with a glass container. Lidocaine was administered and an IV infusion of lidocaine was started and stabilized at a rate of 2mg/min. The patient was evacuated by helicopter to the CCU of a major medical center 109 miles away. The helicopter had to fly to 8,000 feet to clear the mountains and then descend to 900 feet ft at the medical center. Which of the following best describes the hazards of the flight and the need for special precautions?
a) The glass bottle is a potential missile There is a hazard of decreased and therefore insufficient lidocaine on ascent and increased and potentially excessive amounts of lidocaine and fluids on descent.
b) The glass bottle constitutes a potential inflight missile. There is a hazard of increased and therefore excessive lidocaine on ascent and decreased lidocaine on descent.
c) The glass bottle constitutes a potential inflight missile. There is a hazard of decreased or stoppage of lidocaine and therefore insufficient lidocaine on ascent and increased lidocaine on decent.
d) The glass bottle constitutes a potential inflight missile. There is a hazard of increased and therefore excessive lidocaine on ascent and decreased or cessation of lidocaine and therefore insufficient lidocaine on descent.

d) The gas expand above the fluid increasing the pressure in the bottle hence it could be a missile, but also it pushes more fluid into the line. Therefore it increases on ascent. On descent the pressure decreases and the fluid decreases. However, it may even stop at such a low altitude or the original altitude, and the quantity of the fluid has changed. So "D" is the right answer.


Almost any patient can be transported by air if proper consideration is given to the relationship of that particular flight environment and the patient's condition. With the rapid growth of the civilian component to meet the increasing demands for patient transportation by air, there are a number of providers who do not possess all of the recommended services and equipment that have characterized the extremely fine service which has been characteristic of military air evacuation. The most consistently vital component to adequate air transportation is:
a) oxygen availability for patient and crew.
b) adequate suction equipment.
c) pressurization.
d) A physician knowledgeable in aerospace medicine.

d) A physician knowledgeable in aerospace medicine.


A patient is to be transported following treatment of mandibular, maxillary, and facial fractures which has required fixation of the jaw. The most critical need for the patient's well-being during transport is:
a) that the pilot avoid turbulence
b) an attendant knowledgeable in the patient's condition
c) oxygen and anti-motion sickness medication
d) suction availability for nasal and/or oropharyngeal suction
e) rubber band retention devices or similar devices which can be removed by the patient or attendant.

e) If the patient starts vomiting, you want to be able to quickly remove the retention devices so the patient can clear his/her own airway or so the attendant can clear the airway.


In the evacuation of a patient with maxillofacial trauma, which of the following is NOT a major consideration?
a) motion sickness
b) aircraft type
c) airway compromise
d) flight altitude
e) b and d

e) b and d. Motion sickness, nausea, and the potential for airway compromise are major considerations.


Which of the following statements is FALSE with respect to the air transportation of patient who have recently suffered ocular trauma.
a) supplement O2 must be provided
b) patients with recently traumatized eyes or who have had recent surgery must be transported in pressurized aircraft with near sea-level capability, or at less than 1500 ft absolute altitude.
c) Patients in this category should be heavily sedated, but morphine should be avoided (pupil constriction).
d) Antibacterial eye ointment, such as neosporin ointment should be placed in the would and the eye patched lightly prior to evacuation.
e) Vibration of air transportation will probably not cause any increased ocular problems as a result of aeromedical evacuation.

D) Do not place ointments in the eye if there is concern for globe rupture. Neosporin especially can be irritating.


All small aircraft and helicopters used for air evacuation have a significant problem with high noise levels (often approaching 100db). For which of the following groups of patients will these noise levels pose the greatest problems?
a) Newborns
b) Geriatrics
c) patients with middle ear disease
d) Pregnant females
e) hypertensives

a) newborns. They have very delicate hair cells.


Which of the following categories of pulmonary patients travels by air most poorly?
a) bronchial asthma
b) oat cell carcinoma
c) pulmonary abscess (without cavitation)
d) pneumonia
e) patients with atelectasis of mild to moderate degree

d) pneumonia. Patients with pneumonia have a greater chance of decompensation during flight.


In the aeromedical evacuation of a patient with multiple injuries, including a basilar skull fracture, which of the following is most likely needed in flight? Assume there is no respiratory embarrassment, minimal blood loss, or no evidence of continuing internal bleeding, and the patient has been unconscious, but is now waking and apparently improving.
a) endotracheal tube or tracheostomy
b) supplemental respiration with a Byrd respirator or IPPB
c) Supplemental oxygen
d) Prone, head down position
e) None of the above

c) Supplemental oxygen


For a rescue air ambulance, such as a helicopter, responding directly to automobile accidents, which of the following characteristics has been demonstrated to be of least importance?
a) a physician on board
b) Oxygen available for the patient
c) IV fluids (preferably in plastic bags)
d) Splints or backboard
e) Interior size of aircraft

a) physician on board. The scoop and run and get to a trauma center as fast as possible is the more critical nature than having a physician on board.


In handling the air evacuation of patients with orthopedic problems, which of the following actions is NOT necessary prior to evacuating the patient?
a) Hanging weight traction must be removed and replace with constant tension (Collins) spring traction.
b) Recently applied casts should be bivalved and taped in place.
c) Casts should be removed and replaced with firmly inflated air splints to prevent the vibration of the aircraft from causing abrasions and chafing and to aid in emergency evacuation of the aircraft, if necessary.
d) Patients with mandibular immobilization must have provision for rapidly removing the fixation, either with a ripcord device or with wire cutters at the bedside.
e) Patients soon after the vascular repair should have their casts windowed over the site of the repair.

C. Do not remove the casts, but rather bivalve them. Do not place air splints that are firmly inflated. The expansion at altitude will cut off the circulation.


Which of the following problems is an absolute contraindication to flight as a passenger/patient on a commercial airliner? (Assume special arrangements can be made with the airline, eg- oxygen or suction.
a) Myocardial infarction within six weeks
b) Chronic Obstructive Pulmonary Disease
c) Anemia (Hbg less than 7 G%, HCT less than 30%).
d) Recent pneumothorax
e) None of the above

e) Although all have risks, none are an absolute contraindication to flight in a commerical aircraft.


The aeromedical evacuation of an anemic patient can present serious hazards in regard to O2 delivery to tissues at altitude. When transporting a patient with an anemia of unknown etiology whose hemoglobin is approximately 7.5 grams, the flight surgeon should:
a) transfuse the patient with whole blood, then evacuate by aircraft.
b) not transport the patient by aircraft but should utilize surface transportation as expeditiously as possible.
c) transport by air if most feasible and administer O2 in flight
d) None of the above.

c) Transport by air if most feasible and administer O2 inflight. Transfusion prior to flight may not be a bad idea also, but whole blood is not necessarily necessary.


Which of the following is an absolute contraindication to flight as a passenger?
a) Upper respiratory infection
b) Glaucoma
c) Presence of an untreated pneumothorax
d) Presence of a colostomy
e) Uncomplicated pregnancy in the beginning of the second trimester

c) Untreated pneumothorax


Most modern aircraft have laminar flow moving air from ______ to ______ with air turnover and exchange rates of close to 20 volumes per hour.

Ceiling to floor


The highest risk with infected passengers is how far from patient zero?

1-2 rows.


True or False, the use of oxygen in flight is covered under Medicare Part B for beneficiaries with a certificate of necessity. The FAA recently authorized use of oxygen concentrators in flight for patients.



When may the healthy newborn fly?

1 week postpartum


An uncomplicated MI may safely fly when?

After 2 weeks


A complicated MI may safely fly when?

After 6 weeks


When can a person who has just had a CABG safely fly?

After 10-14 days


When can a person fly after having a stroke?

After 2 weeks.


What is the single most helpful test to determine if a COPD patient can fly?

Arterial Blood Gas. A PaO2 of greater than 70 can fly without in-flight medical oxygen.


A hypoxic challenge test a 15% inspired FaO2 may help determine if a patient can tolerate air travel. True or False.



When can a patient with known TB fly after starting medication?

Two weeks.


A patient with a hemoglobin below _______ should not fly.

8.5 g/dl


The single most important factor that significantly improve cabin air quality on commercial aircraft was ___________.

Smoking bans


The air in an aircraft is completely exchanged every ______ minutes.

3 to 4 minutes. 20 times per hour.


How much of the air is recirculated?



All air if filtered via HEPA filters. What is the particle size that most airline HEPA filters capture?

0.3 microns and larger.


What are the number one medical complaints that cause diversions?
What are the number one medical complaints overall?

Weak and dizzy.


When a physician is called upon to assist, he/she is covered by ________, part of the 1998 Aviation Medical Assistance Act.

Good Samaritan immunity


The ICAO is part of what organization?

United Nations


True or false, all states must comply with ICAO standards.

False. ICAO standards are the minimum standards for all contracting states unless they elect not to comply, in which case ICAO publishes the differences, with possible negative impacts on the noncompliant states (restrictions on flights etc).