Advertisement

Seizure rescue medications are missing from in-flight medical emergency kits

Published:November 09, 2022DOI:https://doi.org/10.1016/j.yebeh.2022.108976

      Highlights

      • Seizure is a significant in-flight medical emergency event.
      • Seizures lasting longer than 5 minutes may progress to status epilepticus.
      • None of the major airlines were equipped with seizure rescue medications.
      • Easily applicable seizure rescue medications should be included in the in-flight medical emergency kits.

      Abstract

      Objective

      We aimed to inquire whether any seizure rescue medications are included in the in-flight medical emergency kits of the main airlines in the world. This data could help the airline authorities update their strategies in light of any shortcomings.

      Methods

      First, we identified ten major airlines in the world. Then, we searched the Google engine with the following keywords: “name of the airline” and “in-flight medical emergency” or “first aid kit” or “emergency kit”. In case there was no information on the web, we emailed the airlines and inquired about the contents of their in-flight medical emergency kits. We also investigated some of the major aviation organizations’ websites [i.e., Aerospace Medical Association (AsMA), International Civil Aviation Organization (ICAO), and International Air Transport Association (IATA)].

      Results

      None of the major airlines were equipped with easily applicable seizure rescue medications (i.e., buccal midazolam, a nasal spray of midazolam, or intranasal diazepam).
      The AsMA and ICAO recommend including injectable sedative anticonvulsant drugs in the in-flight medical emergency kits without any further specifications. The IATA does not provide specific recommendations for including seizure rescue medications in the in-flight medical emergency kits.

      Conclusion

      A seizure is a significant in-flight medical emergency event. The use of easily applicable seizure rescue medications during prolonged or repeated seizures is significantly associated with fewer sequelae for the affected person. Easily applicable seizure rescue medications should be included in the in-flight medical emergency kits, and the cabin crew should receive training on how and when to use them.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ceyhan M.A.
        • Menekşe İ.E.
        In-flight medical emergencies during commercial travel.
        J Travel Med. 2021; 28: taab094https://doi.org/10.1093/jtm/taab094
        • Asadi-Pooya A.A.
        • Nikseresht A.
        • Yaghoubi E.
        • Nei M.
        Physical injuries in patients with epilepsy and their associated risk factors.
        Seizure. 2012; 21: 165-168https://doi.org/10.1016/j.seizure.2011.10.009
        • Mesraoua B.
        • Abou-Khalil B.
        • Hosni Khodair R.
        • Melikyan G.
        • Al Hail H.
        • Asadi-Pooya A.A.
        Seizure clusters.
        J Drug Assess. 2021; 10: 86-90
        • Detyniecki K.
        • O'Bryan J.
        • Choezom T.
        • Rak G.
        • Ma C.
        • Zhang S.
        • et al.
        Prevalence and predictors of seizure clusters: a prospective observational study of adult patients with epilepsy.
        Epilepsy Behav. 2018; 88: 349-356
      1. https://www.ema.europa.eu/en/medicines/human/EPAR/buccolam/ accessed on 28 April 2022.

        • Cornett E.M.
        • Amarasinghe S.N.
        • Angelette A.
        • Abubakar T.
        • Kaye A.M.
        • Kaye A.D.
        • et al.
        VALTOCO® (Diazepam Nasal Spray) for the Acute Treatment of Intermittent Stereotypic Episodes of Frequent Seizure Activity.
        Neurol Int. 2021; 13: 64-78
      2. https://en.wikipedia.org/wiki/Largest_airlines_in_the_world/ accessed on 28 April 2022.

      3. https://www.britishairways.com/health/docs/during/Aircraft_Medical_Kit.pdf accessed on 27 April 2022.

      4. https://thepointsguy.com/news/whats-inside-an-airplanes-emergency-medical-kit/ accessed on 12 May 2022.

      5. https://www.asma.org/asma/media/AsMA/Travel-Publications/Medical%20Guidelines/In-flight-medical-events-guidance-document-revised-July-2016.pdf/ accessed on 13 May 2022.

      6. https://www.icao.int/publications/Documents/8984_cons_en.pdf/ accessed on 13 May 2022.

      7. https://www.icao.int/Security/COVID-19/ReferenceMaterial/Annex%206.%20Part%201.%20Chapter%206.pdf#search=Attachment%20B%20medical%20emergency%20kit/ accessed on 13 May 2022.

      8. https://www.iata.org/en/programs/safety/health/ accessed on 13 May 2022.

        • Vigevano F.
        • Kirkham F.J.
        • Wilken B.
        • Raspall-Chaure M.
        • Grebla R.
        • Lee D.
        • et al.
        Effect of rescue medication on seizure duration in non-institutionalized children with epilepsy.
        Eur J Paediatr Neurol. 2018; 22: 56-63
        • Yoshinaga H.
        • Benitez A.
        • Takeda S.
        • Fournier M.
        • Kugler A.R.
        A Phase 3 open-label study of the efficacy, safety and pharmacokinetics of buccally administered midazolam hydrochloride for the treatment of status epilepticus in pediatric Japanese subjects.
        Epilepsy Res. 2021; 174106651https://doi.org/10.1016/j.eplepsyres.2021.106651
        • Shankar R.
        • Goodwin M.
        • Toland J.
        • Boyle A.
        • Grant A.
        • Pearson J.
        • et al.
        Oro-mucosal midazolam maleate: Use and effectiveness in adults with epilepsy in the UK.
        Epilepsy Behav. 2021; 123: 108242https://doi.org/10.1016/j.yebeh.2021.108242
      9. https://www.drugs.com/history/nayzilam.html/ accessed on 13 May 2022.

        • Wheless J.W.
        A critical evaluation of midazolam nasal spray for the treatment of patients with seizure clusters.
        Expert Rev Neurother. 2021; 21: 1195-1205https://doi.org/10.1080/14737175.2021.1890033
        • Chhabra R.
        • Gupta R.
        • Gupta L.K.
        Intranasal midazolam versus intravenous/rectal benzodiazepines for acute seizure control in children: a systematic review and meta-analysis.
        Epilepsy Behav. 2021; 125108390https://doi.org/10.1016/j.yebeh.2021.108390
        • von Blomberg A.
        • Kay L.
        • Knake S.
        • Fuest S.
        • Zöllner J.P.
        • Reif P.S.
        • et al.
        Efficacy, tolerability, and safety of concentrated intranasal midazolam spray as emergency medication in epilepsy patients during video-EEG monitoring.
        CNS Drugs. 2020; 34: 545-553
      10. https://www.drugs.com/history/valtoco.html/ accessed on 13 May 2022.

        • Higdon L.M.
        • Sperling M.R.
        A review of a diazepam nasal spray for the treatment of acute seizure clusters and prolonged seizures.
        Expert Rev Neurother. 2021; 21: 1207-1212https://doi.org/10.1080/14737175.2021.1965880
        • Wheless J.W.
        • Miller I.
        • Hogan R.E.
        • Dlugos D.
        • Biton V.
        • Cascino G.D.
        • et al.
        DIAZ.001.05 Study Group. Final results from a Phase 3, long-term, open-label, repeat-dose safety study of diazepam nasal spray for seizure clusters in patients with epilepsy.
        Epilepsia. 2021; 62: 2485-2495
        • Penovich P.
        • Wheless J.W.
        • Hogan R.E.
        • Guerra C.
        • Cook D.F.
        • Carrazana E.
        • et al.
        Examining the patient and caregiver experience with diazepam nasal spray for seizure clusters: Results from an exit survey of a phase 3, open-label, repeat-dose safety study.
        Epilepsy Behav. 2021; 121: 108013https://doi.org/10.1016/j.yebeh.2021.108013
        • Sharma S.
        • Detyniecki K.
        Rescue therapies in epilepsy.
        Curr Opin Neurol. 2022; 35: 155-160https://doi.org/10.1097/WCO.0000000000001038
        • Blond B.N.
        • Hirsch L.J.
        Updated review of rescue treatments for seizure clusters and prolonged seizures.
        Expert Rev Neurother. 2022; 22: 567-577https://doi.org/10.1080/14737175.2022.2105207