Associations between on board first aid and the outcomes of in-flight medical events in commercial passenger aviation: a scoping review

Background A clear understanding of associations between provided first aid and outcomes of medical events aboard commercial aircraft is crucial for informing quality-improvement initiatives and enhancing coordinated emergency responses. The objective of this scoping review was to map related research evidence. Methods English-language articles reporting studies that utilised inferential statistics to assess relationships between first-aid factors and outcomes of in-flight medical events (IFME) on commercial aircraft were sought in PubMed and Scopus. Results The review included 13 studies (two prospective and 11 retrospective), which collectively analysed 118,938 IFME reported for up to 84 domestic and international airline companies. The studies were highly heterogeneous in study samples, data sources, reported first-aid factors (e.g. on-board assistance by various providers, the use of a defibrillator, oxygen, a medical kit, or particular drugs), and outcomes (e.g. aircraft diversion, stable or improved victim's condition, additional care at destination, hospitalisation, survival, or death). Most studies ( n = 11, 84.6%) revealed a positive association between one or more first-aid factors and outcomes, three studies (23.1%) found a negative association, and nine studies (69.2%) did not identify an association. The identified associations do not confirm the presence of causal relationships between first-aid factors and outcomes. Conclusions The studies are sparse, methodologically heterogeneous, and do not confirm causation between on-board care and downstream outcomes of IFME, such as aircraft diversion or hospitalisation. Future research should investigate causal relationships between specific first-aid interventions and early, in-flight effects of care. The development of Utstein-style guidelines for uniform reporting of IFME is advisable.