title: Symptom-based categorization of in-flight passenger medical incidents.
abstract: BACKGROUND
  The majority of in-flight passenger medical events are managed by cabin crew. Our study aimed to evaluate the reliability of cabin crew reports of in-flight medical events and to develop a symptom-based categorization system.
  
  
  METHODS
  All cabin crew in-flight passenger medical incident reports for an airline over a 9-yr period were examined retrospectively. Validation of incident descriptions were undertaken on a sample of 162 cabin crew reports where medically trained persons' reports were available for comparison using a three Round Delphi technique and testing concordance using Cohen's Kappa. A hierarchical symptom-based categorization system was designed and validated.
  
  
  RESULTS
  The rate was 159 incidents per 106 passengers carried, or 70.4/113.3 incidents per 106 revenue passenger kilometres/miles, respectively. Concordance between cabin crew and medical reports was 96%, with a high validity rating (mean 4.6 on a 1-5 scale) and high Cohen's Kappa (0.94). The most common in-flight medical events were transient loss of consciousness (41%), nausea/vomiting/diarrhea (19.5%), and breathing difficulty (16%).
  
  
  CONCLUSIONS
  Cabin crew records provide reliable data regarding in-flight passenger medical incidents, complementary to diagnosis-based systems, and allow the use of currently underutilized data. The categorization system provides a means for tracking passenger medical incidents internationally and an evidence base for cabin crew first aid training.
authors.affiliation: Occupational and Aviation Medicine Unit, Department of Medicine, University of Otago Wellington, Wellington South, New Zealand.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Mahony
authors.forename: Julia A
authors.initials: JA
authors.lastname: Myers
authors.forename: Peter D
authors.initials: PD
authors.lastname: Larsen
authors.forename: David M C
authors.initials: DM
authors.lastname: Powell
authors.forename: Robin F
authors.initials: RF
authors.lastname: Griffiths
mesh_terms: D000401:Aircraft; D003697:Delphi Technique; D004282:Documentation / Q000592:standards*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005392:First Aid / Q000706:statistics & numerical data; D006801:Humans; D008499:Medical Records / Q000592:standards; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D014195:Travel