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Ground-based Medical Support (GBMS) for Airlines. An additional link in the system.

Michael Braida, MD, PhD

CAPSCA Middle-East MeetingCairo, 17 - 20 November 2014

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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

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Touching points in commercial aviation

DecisionPoint

Origin DestinationDiversion

EventPoint

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Decision

Operational factors

Technical assessment

Airline culture

Personal values

A CRM Perspective

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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:

(*) Excluding Chinese carriers and depending whether pax carried or RPKs is considered

Fully dedicated solutions Public services

Partially dedicated solutions In-house medical departments

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Historical Background

• Mayo Clinic

• Royal Flying Doctors

• Airline medical departments

• SAMU France

• MedAire – 1986

– Need for a structured approach to in-flight medical events

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How could GBMS help?

• Assisting airlines (crewmembers/gate agents)in identifying cases to be reported to healthauthorities

• Orienting crewmembers in handling suspectcases to minimize exposure/transmission risks

• Providing statistics to be matched with actualnotification figures received by system (ATC /local health authorities)

• Educating crewmembers and traveling public

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Experience with international public health concerns

• SARS – 2003• H1N1 – 2009

– Deep involvement coordinating with airlines aspects of crew and passenger health

– Worked closely with the CDC• MERS-CoV – 2013/2014• EVD - 2014

• GBMS have at least three touching points during pandemics– In-flight cases– Pre-flight pax fit-to-fly assessment– Crew support cases

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Opportunities for Intervention

Origin DestinationPassenger fit-to-fly assessments

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Percentage of CIDs in pre-flight assessments

6.2% 4.1% 4.8% 4.8%4.6%

3.67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013 2014

All other

Mental

Medical equip.

ENT (ear, nose and throat)

Infectious

Ob/Gyn

Respiratory

Cardiovascular

Neurological

Ortho/Trauma

Gastrointestinal

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Overall disposition – Pre-flight assessments

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

At Gate Onboard

No Recc.Not ClearClear

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Disposition of Pre-flight Screenings for Infectious / Communicable Diseases (Update 2014)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

At gate On board

No recc.ClearNot clear

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Dispositions and No-go rate per diagnostic category (2013)

41%

36%

33% 33%30%

29% 28%26%

23% 23% 22%20%

16%13%

8% 8% 7%

21%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

1000

2000

3000

4000

5000

6000

No ReccNot ClearClearNo-Go Rate

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Dispositions and No-go rate per diagnostic category (2014)

48%45%

43%40%

38%

32% 32%30% 29%

25% 24%23%

20%

15%14%

12% 10%

0%

10%

20%

30%

40%

50%

60%

0

500

1000

1500

2000

2500

3000

3500

4000

4500

No ReccNot ClearClearNo-Go Rate

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Infectious Diseases 2013/2014 Monthly Apr/Oct

0

50

100

150

200

250

Jan Feb Mar Apr May Jun Jul Aug Sep Oct

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Diagnostic impression

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013

All otherMeningitis - ViralTBHepatitisZosterMalariaVaricella (chicken pox)Acute febrile illness

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The determined traveler

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The “index” case: how it all startedhttp://who.int/mediacentre/news/ebola/20-october-2014/en/index1.html

• The Ebola virus entered Lagos on 20 July via an infectedLiberian air traveler, who died 5 days later.

• At the departure airport, he was visibly very ill, lying onthe floor of the waiting room while awaiting the flight.

• At the hospital, he told staff that he had malaria anddenied any contact with an Ebola patient.

• As was learned later, his sister was a confirmed casewho had died from the disease in Liberia.

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In-flight cases

Decision

Origin DestinationDiversion

Event

Contact GMBS

Onboard plan of care • Optimize medical volunteers • Continuation or diversion recommendations • Consistent data capture

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Nature of flight

International86%

Domestic14%

Short6%

Medium34%

Long55%

Ultra-long5%

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Diagnostic impression – In-flight

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013

All other

TB

Meningitis - Viral

Malaria

Varicella (chicken pox)

Acute febrile illness

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Time into flight

0

50

100

150

1 2 3 4 5 6 7 8 9 10

# C

ases

Hours of flightShort-haul Medium-haul Long-haul

In-flight case

Case evaluation•Confirm suspected communicable disease•Epidemiological assessment:

•Epidemics?•Case definition/Exposure Hx

•Public health concern?

•Contact airline operation agency•Recommend ATC notification•Recommend treatment as required•Document case

•Recommend treatment as required•Document case

Yes

No

GROUND SUPPORT

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Interactions during public health concern

Airline

Crews

Health authorities

GBMS

Passenger

Another Airline

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Ebola

• 19 cases mentioning Ebola in 2014– 15 in October– 12 In-flight / 7 Pre-flight

5

3

1

11 1

In-flight

United KingdomUnited StatesGhanaIrelandNigeriaQatar 5

1 1

FTF

United States

Ghana

United ArabEmirates

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Conclusions

• GBMS play a significant role in themanagement of Communicable Diseases

• GBMS data provides good monitoring ofdisease activity during epidemics

• Enhancing the system– Standardization

– Collaboration

– Technological advances

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Shukran! / Thank you!