title: Improving pilot response to in-flight strokes: a randomized controlled trial.
abstract: BACKGROUND
  When a passenger suffers an in-flight stroke (IFS), the pilot decides when to expedite access to ground care. Pilot pro-activeness towards IFS could improve outcome and should be promoted. Unfortunately, little is known about a pilot's stroke pro-activeness or limiting factors.
  
  
  METHODS
  Randomized controlled trial of an educational intervention (American Stroke Association, 30-slide stroke awareness lecture) through an internet-based computer system using pilot students and instructors as subjects. Pilots completed pre-intervention and post-intervention tests of 25 simulated in-flight scenarios that describe strokes and other neurological and medical symptoms. Outcomes chosen were the percentage of pilots that would use a medical radio service, declare an emergency on board, or divert to the nearest airport for each scenario.
  
  
  RESULTS
  Participant pilots (n = 104) were less likely to respond to IFS than to myocardial infarction (p < 0.001). Fear of retaliation by an employer was the most important modifiable limitation. The educational program increased the simulated rate of emergency declarations for in-flight vertebrobasilar strokes (p < 0.001) and subarachnoid hemorrhage (p < 0.001).
  
  
  CONCLUSIONS
  Pilot-simulated response to certain IFS improves immediately after this educational intervention, which should be disseminated in schools and airlines. Further studies are needed to determine the long-term benefits of this intervention and the impact on actual diversion rates. Companies should also review their policies to shield pilots from retaliation when altering the flight plan for patients.
authors.affiliation: Department of Neurology, School of Medicine, Saint Louis University, Missouri, USA. enrique-leira@uiowa.edu
authors.forename: Enrique C
authors.initials: EC
authors.lastname: Leira
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.forename: Kathleen W
authors.initials: KW
authors.lastname: Wyrwich
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Northam
authors.forename: Aninda B
authors.initials: AB
authors.lastname: Acharya
authors.forename: Yi
authors.initials: Y
authors.lastname: Pan
authors.forename: Eve M
authors.initials: EM
authors.lastname: Holzemer
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Womack
mesh_terms: D001359:Aviation; D003194:Computer-Assisted Instruction; D004630:Emergencies; D006801:Humans; D007318:Inservice Training; D009203:Myocardial Infarction; D020521:Stroke; D013345:Subarachnoid Hemorrhage; D014195:Travel