Transport Research International Documentation (TRID)

In-Flight Medical Events on Commercial Airline Flights

Wed, 18 Feb 2026 13:22:00 GMT

In-flight medical events are an inevitable challenge in commercial aviation. Managing these events is complicated by constrained medical resources and delayed access to definitive care. To characterize the epidemiology of in-flight medical events and identify factors associated with aircraft diversion, hospital transport, and in-flight mortality. This cohort study included 77790 in-flight medical events reported to a global ground-based medical support center from January 1, 2022, through December 31, 2023. All passengers experiencing an in-flight medical event across 84 participating airlines during the study period were included. Data were collected from consultations initiated by flight crew via radio or satellite communication with a dedicated ground-based physician. No demographic or clinical exclusions were applied. Medical conditions occurring during commercial flights that prompted contact with the ground-based support center. Data included clinical presentation, in-flight management, passenger demographics, involvement of volunteer medical professionals, and disposition. Primary outcome was aircraft diversion, and secondary outcomes were hospital transport and in-flight mortality. Descriptive statistics, univariate analyses, and multivariable analyses were used to identify clinical and operational variables associated with these outcomes. Among 77790 in-flight medical events, the overall incidence was 39 events per 1 million enplanements, with 1 event per 212 flights, or 17 events per billion revenue passenger kilometers. The median (IQR) age of affected passengers (42316 females [54.4%]) was 43 (27-61) years. Aircraft diversion occurred in 1.7% of cases, most frequently due to neurologic (41%) and cardiovascular (27%) conditions. Suspected stroke (adjusted OR [AOR], 20.35; 95% CI, 12.98-31.91) and acute cardiac emergencies (AOR, 8.16; 95% CI, 6.38-10.42) were the factors associated with the highest odds of diversion. The involvement of a physician volunteer was also associated with increased odds of diversion (AOR, 7.86; 95% CI, 4.49-13.78). In this cohort study of 77790 in-flight medical events, these events occur more frequently than previously reported. Serious neurologic conditions, cardiac events, and physician volunteer involvement are each associated with higher odds of diversion. These findings contribute to the understanding of in-flight medical event frequency and outcomes and may inform policy, flight crew training, and diversion protocols.

Attractive accessibility: Exploring disparities in attributes of primary care physicians in New Jersey

Mon, 13 Oct 2025 13:52:13 GMT

This study examines the spatial accessibility of primary care physicians (PCPs) in New Jersey and neighboring areas. The authors compare the general accessibility of all PCPs with 'attractive accessibility'—the accessibility of PCPs with desirable attributes, such as being board-certified, receiving high online ratings (score ≥4), or speaking a language other than English, including Spanish. Accessibility indices were computed using the 2-Step Floating Catchment Area method with a 30-min travel time from census tracts in New Jersey. On average, the authors identify a weighted number of 26.0 PCPs per 10,000 residents accessible by car, 1.1 by transit, and 7.9 by e-bike. Transit accessibility is high in tracts near Philadelphia but moderate near New York City due to intense competition for doctors. E-bikes improve accessibility but modestly benefit tracts near New York City due to limited cycling infrastructure. Census tracts with higher proportions of socially disadvantaged populations generally have greater accessibility to PCPs, including those with attractive attributes. However, when examining the ratio of attractive accessibility to overall accessibility, these areas tend to access lower proportions of highly rated PCPs, yet higher proportions of Spanish-speaking PCPs.

The assessment of cognitive function and medical fitness to drive in older adults: A qualitative study with general practitioners

Mon, 14 Apr 2025 17:08:45 GMT

The increasing ageing population has led to a pressing need to develop standardized measures and guidelines for assessing cognitive fitness to drive. With the onus of annual medical assessments for driving falling on general medical practitioners (GPs) in Australia, there is a need to explore their experiences and opinions regarding such assessments. This qualitative study explored the perceptions, opinions and experiences of GPs regarding the assessment of older drivers, with a particular emphasis on the assessment of cognitive function. Six registered GPs within Australia participated in an anonymous telephone interview. Following a constructivist grounded theory approach, themes were generated using gerunds. A total of 5 themes were developed from the data: (1) pre-empting: planting the seed and softening the blow, (2) maintaining the doctor-patient relationship and deflecting pressure, (3) satisficing: doing the best possible with imperfect knowledge whilst balancing competing demands, (4) learning from experience versus formal training and (5) seeking standardized procedures and policy guidance. The findings highlight that medical assessments for driving are complex and challenging for GPs, particularly in terms of screening for cognitive fitness to drive. The need for evidence-based approaches for assessing cognitive fitness to drive, standardized procedures and formal training for cognitive assessments, were emphasized.

Medications and traffic accidents involving older drivers: Do Spanish primary healthcare physicians know enough?

Tue, 16 Jan 2024 09:03:28 GMT

The aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics. A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample. On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants. Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis

Thu, 28 Dec 2023 13:26:30 GMT

ObjectiveTo investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model.BackgroundCognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered.MethodWe built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario.ResultsThe EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase.ConclusionWe demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase.ApplicationThe SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.

Child Pedestrian Safety

Mon, 21 Aug 2023 09:08:09 GMT

This statement is a revision of the 2009 American Academy of Pediatrics policy statement "Pedestrian Safety" and is accompanied by a technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2023-062508) providing additional detail to support the recommendations in the policy. The policy statement is updated in the areas of pediatric pedestrian education, the risks of distracted walking, the benefits of design and programming in safe routes to school, and the emergence of the "Vision Zero" strategy. This goal of the statement is to assist practicing pediatricians as they counsel families about both the benefits of active transportation and the risks and safety precautions for child pedestrians at different ages. Specific recommendations are offered in three sections: legislative advocacy, pediatricians providing advocacy, and anticipatory guidance. The statement also briefly identifies trends in public health and urban design relevant to pedestrian safety.

Epidemiology and Prevention of Child Pedestrian Injury

Mon, 21 Aug 2023 09:08:09 GMT

This report supports policy recommendations in an accompanying 2023 policy statement "Child Pedestrian Safety" (available at www.pediatrics.org/cgi/doi/10.1542/peds.2023-62506). The authors of this report review trends in public health and urban design that are relevant to pedestrian safety and then provide practical information to assist pediatricians. Pediatricians are encouraged to discuss with their patients the benefits of active transportation and the specific risks and safety strategies for child pedestrians at different ages. Specific topics covered include vehicle design, driver support systems that increase pedestrian safety, learning pedestrian skills, the role of adult supervision, reducing pedestrian and driver distraction, and interventions with drivers. The authors note that, since the previous policy statement was published in 2009, the field of safety for child pedestrians has evolved, with new information on educating children on traffic safety, the risks of distracted walking, safe routes to school, and initiatives to support “Vision Zero.”

Changes in Pediatricians' Child Passenger Safety Counseling With Initiation of a Booster Seat Program

Mon, 21 Aug 2023 09:08:08 GMT

This article reports on a study undertaken to evaluate how a booster seat distribution program affected the documentation of restraint usage and anticipatory guidance at well-child visits at a pediatric primary care practice. The authors conducted a retrospective chart review of patients aged 4 to 12 years from June to December in 2019 and 2020, representing before and after a booster seat program. The booster seat program enabled physicians to give a booster seat free of charge to any child seen in the clinic who fit the requirements of needing a booster seat. The authors found the most frequently documented restraints in 2019 and 2020 were seat belts (51% vs 30%), booster seats (25% vs 27%), and not documented/unclear (17% vs 25%). They conclude that the program significantly increased referrals for booster seats. The authors also note that, despite significant differences in the proportion of children in each restraint category, overall booster seat use was similar between years. The authors stress the importance of primary care providers in offering education and intervention in the sometimes-complex arena of car safety seat usage.

Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019

Thu, 27 Jul 2023 16:55:29 GMT

Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society’s (AGS’s) Clinician’s Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. The authors also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.

Driving safety among Israeli military physicians in combat units

Fri, 21 Jul 2023 09:18:42 GMT

The objective of this study was to characterize driving safety and the factors affecting it among physicians in combat units in the Israel Defense Forces (IDF), who have high workloads and substantial sleep deprivation, which could influence driving safety. This cross-sectional study included physicians in combat units who had a personal vehicle equipped with an advanced driver assistance system (ADAS). The study outcomes included events such as drowsy driving or falling asleep while driving, as well as motor vehicle accidents (MVAs), obtained from self-reports from digital questionnaires, and objective ADAS driving safety scores. Sleep hours, burnout scores (Maslach Burnout Inventory), combat activity levels, and demographic characteristics were obtained through digital questionnaires, and their effects on the outcomes were analyzed. Sixty-four military combat unit physicians were included in the study. No differences in drowsy driving, MVAs, or ADAS scores were found between the 2 combat activity level groups. The results showed that 82% of participants reported dozing off while driving, and this was positively correlated with accelerations (β = 0.19; P = .004) and negatively correlated (adjusted R2 = 21%) with hours of sleep (β = −0.28; P = .001). Eleven percent reported experiencing MVAs, none of whom required hospitalization. The mean ADAS safety score was 87.17 ± 7.54, and this was positively correlated with the cynicism score (β = 1.45; P = .04; adjusted R2 = 4.7%). No association between dozing off/falling asleep while driving and the reported MVAs was found (P = .10 and P = .27, respectively). Physicians in combat units have a low incidence of MVAs and high ADAS scores. This may be attributed to the high safety climate enforced in military units. However, the high rate of dozing off while driving highlights the importance of addressing driving safety in this population.

In-Flight Medical Emergencies Management by Anesthetist-Intensivists and Emergency Physicians

Mon, 26 Sep 2022 09:10:06 GMT

In-flight medical emergencies (IME) are challenging situations: aircraft cabins are noisy and narrow, medical supplies are scarce, and high-altitude related physiological changes may worsen chronic respiratory or cardiac conditions. The aim of this study was to assess the extent to which anesthetist-intensivists and emergency physicians are aware of IME specificities. A questionnaire containing 21 items was distributed to French anesthetist-intensivists and emergency physicians between January and May 2020 using the mailing list of the French Society of Anesthesia and Intensive Care Medicine and the French Society of Emergency Medicine. The following topics were evaluated: high-altitude related physiological changes, medical and human resources available inside commercial aircraft, common medical incidents likely to happen on board, and previous personal experiences. The questionnaire was completed by 1064 physicians. The items corresponding to alterations in the arterial oxygen saturation, respiratory rate, and heart rate at cruising altitude were answered correctly by less than half of the participants (respectively, 3%, 42%, and 44% of the participants). Most responders (83%) were interested in a complementary training on IME management. The present study illustrates the poor knowledge in the medical community of the physiological changes induced by altitude and their consequences. In addition to offering specific theoretical courses to the medical community, placing sheets in commercial aircraft summarizing the optimal management of the main emergencies likely to happen on board might be an interesting tool.

Travel distance to cancer-diagnostic facilities and tumour stage

Thu, 24 Feb 2022 17:16:13 GMT

Specialization and centralization in healthcare systems increase patients' travel distance to cancer-diagnostic facilities but the impact of distance on tumor stage remains unclear. This study aimed to study the travel distance to cancer patient's GP and to the hospital of diagnosis and the association with tumor stage for 12 cancer types. A cohort study was conducted including cancer patients in Denmark diagnosed between 2005 and 2016 with rectum, malignant melanoma, breast, testis, esophageal, colon, cervix, prostate, stomach, pancreatic, lung and ovary cancer (n = 256,663). Distance to each patient's GP and to the hospital of diagnosis were calculated using ArcGIS, Network Analyst. The results showed that for most easy-to-diagnose cancer types (rectum cancer, malignant melanoma, testis cancer) and cervix cancer, increasing travel distance to the hospital of diagnosis increased the odds of advanced disease at diagnosis. Contrary, increasing travel distance to the hospital was associated with decreased odds of being diagnosed with advanced disease stage among hard-to-diagnose cancer types (stomach, pancreatic, lung and ovarian cancer), and prostate cancer. Distance to the GP was overall not associated with tumor stage. The underlying mechanisms for these findings are multifaceted and might reflect differences in presentation, symptomologies and investigations used for diagnosis across cancer types.

Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving

Tue, 22 Feb 2022 10:28:27 GMT

Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals’ ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts.Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting.Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania’s mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p?

Prevention of road crashes in older adults: Perspectives on facilitators, barriers and the role of the family doctor

Wed, 29 Dec 2021 10:52:16 GMT

People over 64 years have a high fatality rate when they are involved in traffic accidents. Besides, older victims of road crashes are expected to rise in the future due to population aging. The purpose of the study was to document their perception on the role of the family doctor, the main facilitating factors, and the perceived barriers to the temporary or permanent restriction of their driving. This qualitative study used focus group methodology. A sample of 16 people over 65 years old was obtained through a series of segmentation criteria at an active participation center for older adults in a small town in Jaen province (Spain). All were invited to participate in a discussion during which they were asked to express their opinions and subjective experiences concerning the role of their family doctor. The group conversation was taped, fully transcribed and analyzed, and codes were generated with both deductive and inductive methods. After merging the codes to generate themes, the authors identified 9 relevant categories: perception of age-related risk, road safety, role of public authorities, driver assessment center, role of the family doctor, role of the family, proposals for addressing traffic accidents in older adults, consequences of the driving prohibition, and public transport. All categories help to explain the subjective driving and traffic safety experiences of older road users. Although family doctors do not usually ask their older patients about road driving, they are highly valued by these patients. Thus, family doctors have a great potential to act, along with the family members, for the benefit of older patients' traffic safety, in ways that can prevent their involvement in road crashes and reduce the negative consequences of having to stop driving if necessary.

Prevalence and predictors of road crash involvement among medical doctors in Malaysia: A cross-sectional study protocol

Mon, 22 Nov 2021 09:07:21 GMT

Medical doctors are often subjected to long working hours with minimal rest in between the shifts. This has led to many fatal and non-fatal road crash involvement (RCI). This study aims to determine the prevalence and predictors of RCI among medical doctors in Malaysia. This is a cross-sectional study among 375 Malaysian medical doctors who met the inclusion criteria. A predetermined self-administered questionnaires will be used to collect information regarding the sociodemographic, health status, workplace information, work commuting information, driving behavior, history of RCI, fatigue, sleep quality, mental health status and work engagement. The questionnaires consist of the following instruments: (1) sociodemographic, health status, workplace information, work commuting information, driving behavior and history of RCI; (2) Checklist of Individual Strength Questionnaire; (3) Pittsburgh Sleep Quality Index; (4) 21-item Depression Anxiety and Stress Scale; and (5) Utrecht's Work Engagement Scale. The data will be analyzed using SPSS program V.24. Descriptive and inferential statistics will be used to determine the prevalence and predictors of RCI. This study protocol has received ethics approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR-18-3983-40609) and the Ethics Committee for Research Involving Human Subject, University Putra Malaysia (JKEUPM). Online written informed consent will be obtained from each study participant by the researchers. Results of the study will be disseminated through relevant journals and conferences.