CPSTs know that children on aircraft are better protected from injury when riding in an approved CR due to the potential of turbulence or crashes. Recently, a new study identified an additional reason: in-flight medical emergencies. In particular, the researchers (three doctors from U.S. universities and hospitals) looked at the in-flight injuries (IFIs, typically trauma or burns) that children sustained. They found such incidents to be infrequent relative to the number of such events to all passengers, but not negligible. Their takeaway: The protection CRs can provide with respect to potential IFIs can expand their in-flight benefits beyond during takeoff, landing, and turbulence.
A challenge for the researchers was that there is no published data regarding IFIs to children during commercial flights. They therefore had to review the electronic records of over 100,000 in-flight medical events reported from 2009 to 2013 to the world’s busiest ground-based medical support center (GBMS) in order to identify those involving children (ages 0–18). GBMS are staffed with medical personnel ready to remotely assist airplane crew members experiencing in-flight events. The GBMS used in the study is based in a level-1 U.S. trauma center, providing support for roughly 35 percent of all air traffic worldwide.
Out of all in-flight medical emergencies, researchers found over 12,000 that involved children, and 400 of these were injuries. Roughly 40 percent of these were scalding burns (such as from spilled coffee or food), 30 percent were contusions, 20 percent were cuts, and most of the remainder were closed-head injuries. The mechanism for traumatic injury included falls from the seat or bassinette, and a number were mishaps that occurred in various ways related to the fact that a child was free to move about the cabin (unrestrained). Over half of the injuries required further medical treatment after landing, and 115 were serious enough to require aircraft diversion.
The average age of injured children was 3 years. Of note, infants under 24 months were overrepresented in the injury incidents, making up 36 percent of the children who were hurt.
The research concludes that children could be better protected from in-flight medical emergencies if properly restrained in a CR for as much of the flight as possible, as this would keep them situated in a safer position. The study also notes that providing plenty of in-flight entertainment for the child is also key to keeping children from getting restless and moving about the cabin.
In addition, the study found that seating position matters. Being at or near the aisle carried an increased risk of injury, such as from burns due to passing hot liquids or trauma due to items falling from overhead bins. Coincidentally, it is already considered best practice to place children who ride in CRs on airplanes in a window seat or in the middle of a long center row to allow ease of movement in case of emergency evacuation.
Reference: Alves, Paulo M., MD, et al. “In-Flight Injuries Involving Children on Commercial Airline Flights.” Pediatric Emergency Care, December 9, 2016. Volume Publish Ahead of Print – Issue – p doi: 10.1097/PEC.0000000000000993.