Aviation Medicine and the Airline Passenger
Authors: Peter Trewby
Journal: Journal of the Royal Society of Medicine (2002)

If God meant us to fly, he would have given us feathers. Maybe he didn't because he cared about us and knew flying was dangerous. It's not as dangerous now as when Daedalus and Icarus tried out their wax wings or when the Montgolfier brothers' hot air balloon first rose into the air in 1783; but it is still dangerous. The first balloon flights tested man's ability to withstand a rare and hostile environment above the earth and it was fitting that one of the two people in the first balloon flight was a physician. We owe so much of our current understanding of the physiology of flight to these intrepid early physiologists and particularly to the 19th century French physiologist Paul Bert that it seems a pity that there is no chapter giving a historical perspective in Aviation Medicine and the Airline Passenger.

Dr. Cummin and Professor Nicholson have assembled a distinguished list of contributors to share the medical wisdom accumulated from 99 years of powered flight. Would-be travellers are reminded that it is only a thin metal envelope that separates us from an outside temperature of -50°C and an oxygen partial pressure well below that needed to sustain life. Not even the aeroplane's skin shields us from galactic cosmic radiation which carries a small but not totally insignificant cancer risk of 0.002% for each transatlantic crossing, so that regular flyers are exposed to doses of radiation above that of most classified radiation workers. The theoretical lifetime risk of a commercial pilot being killed by cosmic radiation is twice that of death from a flying accident. Inside the cabin we are exposed to the risks of leaking neurotoxic lubricants, infectious disease and air-rage from fellow passengers. The ever-present sick bag in our seat pocket reminds us of the effect of turbulent movement on the vestibular apparatus, and after a long easterly flight when we step safely onto the tarmac our bewildered brains take 4 days to regain their vigilance and sleep pattern. These and other aspects of flying are well described and make good reading. The bulk of the book, however, deals with more practical considerations on the management of medical conditions before and during flight. The simple messages stand out. Exhort your patients to stop smoking 48 hours before their flight. Tell them to put all medicines in their cabin luggage, not in the hold, and give them a written summary detailing their condition and treatment. If they are on warfarin they should carry ampoules of vitamin K, and if in a wheelchair a repair kit and pump. Make sure scuba divers do not fly for 48 hours after diving. If confronted with any medical condition on the plane, take a careful history. If necessary look through the patient's hand luggage for evidence of their disease and medication. Take heed of the excellent chapter by Geoffrey Chamberlain which tactfully reminds the well-meaning doctor that the less the amateur accoucheur does the better: mother, baby and well-trained stewardess know best. In case of pneumothorax this book tells all, including how to turn the finger of a rubber glove into a one-way valve. However, I shall worry much more about the person sleeping next to me who just could have had a silent cardiac arrest. The first chapter is on medicolegal aspects. Certainly it is relevant, but also depressing, dwelling as it does on such issues as the need to seek from the captain contractual indemnity for any ‘Good Samaritan’ act carried out before leaving the aircraft. No doubt good advice, but there is no mention of this in the original story of the Good Samaritan. Some of the chapters and particularly the chapter on immunization and infectious disease mix aviation medicine with travel medicine. This may be an asset—two books for the price of one (and some compensation for the £65 price tab). Each chapter is self-contained, which has the disadvantage that we are told frequently, for example, the relation between altitude and gas partial pressure but the advantage that only one chapter needs to be consulted to obtain the information needed for a particular patient.

For the general practitioner this is an authoritative source from which to guide the ageing but still travel-hungry and sun-seeking patient and the book will fit best here in the GP's practice library. For the occupational physician who advises frequent fliers it is a must, and it will be a very useful reference for hospital libraries and to all those professionally involved in aviation medicine both commercial and military. In the next edition it would be nice to have that enriching chapter on the history of aviation medicine and more didactic bullet points at the end of each chapter; and perhaps we might have a cheaper paperback version.