Ground-based Medical Support (GBMS) for Airlines. An additional link in the system. Michael Braida, MD, PhD

Transcription

1 CAPSCA Middle-East Meeting Cairo, November 2014 Ground-based Medical Support (GBMS) for Airlines. An additional link in the system. Michael Braida, MD, PhD

2 Disclosure Michael Braida is a full-time MedAire/International SOS employee MedAire is a medical solution provider for commercial airlines and business aviation Ground-based medical advice, training and medical equipment International SOS is a global health and security assistance company Opinions expressed are personal, not necessarily reflecting MedAire / International SOS positions

3 Touching points in commercial aviation Event Point Decision Point Origin Diversion Destination

4 A CRM Perspective Technical assessment Operational factors Decision Personal values Airline culture

5 Current scenario Ground-based medical support (GBMS): 30+ years 58%-68% of top 50 airlines in the world (*) utilize GBMS GBMS is a recommended practice by ICAO - IATA Four types of GBMS: Fully dedicated solutions Partially dedicated solutions Public services In-house medical departments (*) Excluding Chinese carriers and depending whether pax carried or RPKs is considered

6 Historical Background Mayo Clinic Royal Flying Doctors Airline medical departments SAMU France MedAire 1986 Need for a structured approach to in-flight medical events

7 How could GBMS help? Assisting airlines (crewmembers/gate agents) in identifying cases to be reported to health authorities Orienting crewmembers in handling suspect cases to minimize exposure/transmission risks Providing statistics to be matched with actual notification figures received by system (ATC / local health authorities) Educating crewmembers and traveling public

8 Experience with international public health concerns SARS 2003 H1N Deep involvement coordinating with airlines aspects of crew and passenger health Worked closely with the CDC MERS-CoV 2013/2014 EVD GBMS have at least three touching points during pandemics In-flight cases Pre-flight pax fit-to-fly assessment Crew support cases

9 Opportunities for Intervention Origin Passenger fit-to-fly assessments Destination

10 Percentage of CIDs in pre-flight assessments 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 6.2% 4.1% 4.8% 4.8% 4.6% 3.67% All other Mental Medical equip. ENT (ear, nose and throat) Infectious Ob/Gyn Respiratory Cardiovascular Neurological Ortho/Trauma Gastrointestinal

11 Overall disposition Pre-flight assessments 100% 90% 80% 70% 60% 50% 40% 30% No Recc. Not Clear Clear 20% 10% 0% At Gate Onboard

12 Disposition of Pre-flight Screenings for Infectious / Communicable Diseases (Update 2014) 100% 90% 80% 70% 60% 50% 40% 30% No recc. Clear Not clear 20% 10% 0% At gate On board

13 Dispositions and No-go rate per diagnostic category (2013) % 45% % 40% 33% 33% 35% 30% 29% 28% % 30% % 23% 22% 20% 21% 25% No Recc % 13% 20% 15% Not Clear Clear 8% 8% 7% 10% No-Go Rate % 0 0%

14 Dispositions and No-go rate per diagnostic category (2014) % % 50% % 43% % 38% 40% % 32% 30% 29% % 24% 23% 20% 15% 14% 12% 10% 30% 20% 10% No Recc Not Clear Clear No-Go Rate 0 0%

15 Infectious Diseases 2013/2014 Monthly Apr/Oct Jan Feb Mar Apr May Jun Jul Aug Sep Oct

16 Diagnostic impression 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% All other Meningitis - Viral TB Hepatitis Zoster Malaria Varicella (chicken pox) Acute febrile illness 0%

17 The determined traveler

18 The index case: how it all started The Ebola virus entered Lagos on 20 July via an infected Liberian air traveler, who died 5 days later. At the departure airport, he was visibly very ill, lying on the floor of the waiting room while awaiting the flight. At the hospital, he told staff that he had malaria and denied any contact with an Ebola patient. As was learned later, his sister was a confirmed case who had died from the disease in Liberia.

19 In-flight cases Decision Event Contact GMBS Origin Diversion Onboard plan of care Optimize medical volunteers Continuation or diversion recommendations Consistent data capture Destination

20 Nature of flight Ultra-long 5% Short 6% Long 55% Medium 34% Domestic 14% International 86%

21 Diagnostic impression In-flight 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% All other TB Meningitis - Viral Malaria Varicella (chicken pox) Acute febrile illness 0%

22 Time into flight 150 # Cases Hours of flight Short-haul Medium-haul Long-haul

23 In-flight case Yes Case evaluation Confirm suspected communicable disease Epidemiological assessment: Epidemics? Case definition/exposure Hx Public health concern? No Contact airline operation agency Recommend ATC notification Recommend treatment as required Document case Recommend treatment as required Document case

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25 GROUND SUPPORT

26 Interactions during public health concern Airline Passenger Health authorities Another Airline GBMS Crews

27 Ebola 19 cases mentioning Ebola in in October 12 In-flight / 7 Pre-flight In-flight United Kingdom United States Ghana Ireland Nigeria Qatar 1 1 FTF 5 United States Ghana United Arab Emirates

28 Conclusions GBMS play a significant role in the management of Communicable Diseases GBMS data provides good monitoring of disease activity during epidemics Enhancing the system Standardization Collaboration Technological advances

29 Shukran! / Thank you!