Say Goodbye to Airplane Nausea: A Strategy That Works
BLUF: If you are providing care to a commercial airline passenger with nausea and vomiting, consider having them “sniff” an alcohol prep pad as first line treatment.
In a review of 49,100 in-flight medical emergencies on commercial airlines, 6% included vomiting.1
33.9% of in-flight medical emergencies involving pediatric patients included nausea and vomiting, based on a study from a ground based medical support center involved with 35% of the worlds commercial airline travel.2
When an anti-emetic was given, aircraft diversion (unplanned landing at an airport, that wasn’t the intended destination) occurred only 0.9% of the time. If no anti-emetic was given, diversion occurred in 5.4% of cases. Aircraft diversion for an inflight medical emergency is inconvenient at best and very expensive at the least.3
Current US FAA guidelines require an emergency medical kit (doctor’s kit) on commercial airlines, but there is no requirement it contain anti-emetic medications. In 2019, the Aerospace Medical Association recommended the FAA update their emergency medical kit packing list to include anti-emetic medications, specifically ondansetron (trade name Zofran). This has not yet been adopted. 10 of 13 German airlines carry anti-emetic medications in a study from 2014.4
The FAA requires alcohol preparation pads or sponges in the kits. Post-Covid, many commercial airlines hand out alcohol wipes to passengers to disinfect the seating area.
Can alcohol prep pads / wipes be used to decrease nausea and vomiting? Yes, they can.
In a meta-analysis of four prospective randomized controlled trials, comprising 382 patients, comparing “sniffing” an alcohol prep pad to ondansetron for nausea and vomiting, the alcohol pad decreased nausea and vomiting at least as well as the medication.5
Specifically, sniffing the alcohol prep pad resulted in a 50% reduction in nausea twenty minutes faster than ondansetron. However, neither improved nausea or vomiting within the first ten minutes. By thirty minutes, there was more vomiting in the alcohol prep pad group (38 vs 6%, favoring ondansetron). Despite this, patient satisfaction with both treatments was the same; patients were equally happy given either treatment. No adverse effects were noted from use of the alcohol prep pad5
There is some limitation to this data. Most of the studies were on young (under 65 years old), female patients (two of four included studies were on females with post operative nausea and vomiting after elective laparoscopic surgery), and all patients were not felt to be “critically unwell.”5
Additionally, with the smell of the alcohol on the pad, there is no real way to “blind” the study participants. Obviously, the patient could tell which treatment they were getting. That certainly could lead to some bias belief regarding the efficacy of the the alcohol pad.5
Interestingly, one included study looked at 210 Emergency Department patients with mild traumatic brain injury (GCS ≧13) with nausea and vomiting. They found similar results and improvement with sniffing alcohol prep pads.6> This study was included in the above meta-analysis.
Ultimately, this treatment appears safe and effective, though with more vomiting ultimately compared to Ondansetron. So much so, that it is included in the National Model EMS Clinical Guidelines from the National Association of State EMS Officials.
References:
1Martin-Gill C, Doyle TJ, Yealy DM. In-Flight Medical Emergencies: A Review. JAMA. 2018 Dec 25;320(24):2580-2590. doi: 10.1001/jama.2018.19842. PMID: 30575886.
2Rotta AT, Alves PM, Nerwich N, Shein SL. Characterization of In-Flight Medical Events Involving Children on Commercial Airline Flights. Ann Emerg Med. 2020 Jan;75(1):66-74. doi: 10.1016/j.annemergmed.2019.06.004. Epub 2019 Jul 25. PMID: 31353055.
3Peterson DC, Martin-Gill C, Guyette FX, Tobias AZ, McCarthy CE, Harrington ST, Delbridge TR, Yealy DM. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013 May 30;368(22):2075-83. doi: 10.1056/NEJMoa1212052. PMID: 23718164; PMCID: PMC3740959.
4Hinkelbein J, Neuhaus C, Wetsch WA, Spelten O, Picker S, Böttiger BW, Gathof BS. Emergency medical equipment on board German airliners. J Travel Med. 2014 Sep-Oct;21(5):318-23. doi: 10.1111/jtm.12138. Epub 2014 Jun 6. PMID: 24903740.
5Kimber JS, Kovoor JG, Glynatsis JM, West SJ, Mai TTN, Jacobsen JHW, Ovenden CD, Bacchi S, Hewitt JN, Gupta AK, Edwards S, Taverner FJ, Watson DI. Isopropyl alcohol inhalation versus 5-HT3 antagonists for treatment of nausea: a meta-analysis of randomised controlled trials. Eur J Clin Pharmacol. 2023 Nov;79(11):1525-1535. doi: 10.1007/s00228-023-03560-x. Epub 2023 Sep 14. PMID: 37704796; PMCID: PMC10618376.
6Rezvani Kakhki B, Ghasemi T, Vafadar Moradi E, Abbasi Shaye Z, Mousavi SM. Aromatherapy with Isopropyl Alcohol versus Intravenous Ondansetron in Management of Mild Brain Trauma Nausea and Vomiting; a Randomized Clinical Trial. Arch Acad Emerg Med. 2022 Oct 31;10(1):e87. doi: 10.22037/aaem.v10i1.1792. PMID: 36426172; PMCID: PMC9676696.
