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We thank Dr Grotewohl for pointing out the multitude of study data regarding the topic of travel-associated thrombosis and possible thromboembolic complications (VTE). The controversies regarding “air-travel associated thrombosis” or economy class syndrome follow us because the design of past studies did not allow us to draw any conclusions regarding causality. Undisputed risk factors include the association of the duration of immobilization with the development of VTE, as well as possibly additional, individual, predisposing factors (1). It is not known whether, immobilization remaining equal, the mild hypoxia during the flight constitutes an additional risk factor compared with traveling by car, bus, train, or ship (2). For this reason we pointed out in our article the need for individual, patient centered medicine while considering the general recommendations (3).

Drs Sand think that the medical equipment on board is inadequate and also point out the lacking standardization in the documentation of medical emergencies.

In the context of the medical equipment on board commercial aircraft, the recommendations from the ICAO (International Civil Aviation Organization) are obviously being confused with legal regulations. Owing to regular audit in all operative areas of aviation it can be assumed—at least in industrialized nations—that the valid legal standards with regard to medical equipment on board are adhered to (3). Whether these legal requirements are sufficient from a medical perspective is a whole other discussion.

The conclusion by Sand et al., that medical incidents on board are insufficiently documented, is based on data from 10 of the 1300 airlines in the study (4). Airlines that are present in the Medical Advisory Group of the IATA (International Air Transport Association) did not participate in this survey, although they represent more than 20% of global commercial air traffic. The IATA conducts a registry of medical emergencies based on standardized data from the airlines; this is updated annually. Currently, 26 airlines are participating in this registry. The results reported by Sand et al. (4) can therefore not be regarded as representative of the industry standard.

Professor Schmitz-Huebner reminds us of the medicolegal worries of traveling doctors regarding in-flight medical emergencies. As far as we are aware the declaration of assumption of liability on the airline’s part, as mentioned, is standard for the large European and extra-European airlines. If the form is not handed out by the cabin crew without prompting, please ask (in Lufthansa’s case, the form is on the back of the emergency protocol, in four languages).

DOI: 10.3238/arztebl.2013.0192

Prof. Dr. med. Jürgen Graf

Prof. Dr. med. Uwe Stüben

Dr. med. Stefan Pump

Medizinischer Dienst

Deutsche Lufthansa AG

juergen.graf@dlh.de

Conflict of interest statement
The authors are employees of Deutsche Lufthansa.

1.
Cannegieter SC: Travel-related thrombosis. Best Pract Res Clin Haematol 2012; 25: 345–50. Epub 2012 Aug 27. CrossRef MEDLINE
2.
Gupta N, Ashraf MZ: Exposure to high altitude: a risk factor for venous thromboembolism? Semin Thromb Hemost 2012; 38: 156–63. Epub 2012 Feb 17. CrossRef MEDLINE
3.
Graf J, Stüben U, Pump S: In-flight medical emergencies.
Dtsch Arztebl Int 2012; 109(37): 591–602. VOLLTEXT
4.
Sand M, Morrosch S, Sand D, Altmeyer P, Bechara FG: Medical emergencies on board commercial airlines: is documentation as expected? Crit Care 2012; 16: R42. CrossRef MEDLINE
1. Cannegieter SC: Travel-related thrombosis. Best Pract Res Clin Haematol 2012; 25: 345–50. Epub 2012 Aug 27. CrossRef MEDLINE
2. Gupta N, Ashraf MZ: Exposure to high altitude: a risk factor for venous thromboembolism? Semin Thromb Hemost 2012; 38: 156–63. Epub 2012 Feb 17. CrossRef MEDLINE
3.Graf J, Stüben U, Pump S: In-flight medical emergencies.
Dtsch Arztebl Int 2012; 109(37): 591–602. VOLLTEXT
4.Sand M, Morrosch S, Sand D, Altmeyer P, Bechara FG: Medical emergencies on board commercial airlines: is documentation as expected? Crit Care 2012; 16: R42. CrossRef MEDLINE

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