Traveler’s Deep Vein Thrombosis: How to Stay Safe
Last week I read the tragic story of a young man in Britain who died from deep vein thrombosis (DVT). DVT is a clot that forms in the legs and, in this man’s case, breaks off, moves through the bloodstream, and ends up blocking blood flow to the lungs (pulmonary embolism). It is most often caused by prolonged periods of inactivity. In this man’s case, every day he played Xbox for 12 hours or more without getting up.
The story got me thinking about an FAA bulletin I ran across a while ago that offered advice on ways to prevent what it calls Traveler’s Thrombosis, which is caused by sitting for extended periods of time. It’s advice we can all use, no matter our health, but is particularly critical for MedFlight911’s health-compromised patients.
In an air ambulance the patient is on a stretcher, which can be positioned in a number of different ways (and re-positioned periodically). Like a hospital bed, the stretcher promotes positions that minimize the chances of deep vein thrombosis. In addition, the in-flight physician, critical care nurse or paramedic can do many of the things a hospital nurse would do to help reduce the chances of DVT (including leg massage and compression stockings).
But when we’ve arranged a medical escort on a commercial airline, the patient flies in the same First Class seat as everyone else. So the medical escort takes a number of precautions to prevent a DVT – which is more common in patients who have had a DVT before; patients who have certain heart diseases, cancer, or a blood clotting disorder; patients who are pregnant; patients who smoke; patients who are obese; patients on birth control; and older patients. Patients who have recently had major surgery or trauma are also at a higher risk for DVT.
So what can the air medical escort do? There are a number of things the medical escort will do to help prevent a DVT on a commercial flight. (Most of these are tips are also useful for airplane passengers in general.)
- Deep vein thrombosis socks. Special support stockings or socks are designed to promote blood flow to the legs and feet; our medical escorts provide them for patients when it’s appropriate.
- Leg massage. Massage can also promote blood flow to the legs, which helps reduce the chances of a thrombosis. Our medical escorts will massage the patient’s legs to promote blood flow (and maximize comfort).
- Positioning. Deep vein thrombosis occurs most often when a person is sitting (with his or her legs bent at the knee) in the same position for an extended period of time. So changing sitting positions can help get the blood flowing and minimize the chances of a DVT. (To note, when we do an air medical escort on a commercial airline, we always fly First Class, where shifting positions is easier than in Economy Class.)
- Movement (to whatever extent possible). On commercial flights our air medical escorts will help the patient move around to whatever extent possible. For patients who are fairly mobile, that may mean short trips up and down the aisle. Even for patients who are not mobile, the medical escort can help shift positions and do leg stretches and ankle rotations to keep the patient comfortable and reduce the chances of DVT.
- Staying hydrated. This is a good tip for life in general – travelling or no. But especially when travelling on a long flight, staying hydrated (with water, not alcohol or soda) is important. The medical escort will help the patient to stay hydrated throughout the flight.
- Low molecular weight heparin injection. When MedFlight911 is doing an air medical transport with a patient at higher risk for DVT, the medical escort will consider (in consultation with the patient’s health care providers, of course) an injection of low molecular weight heparin (Lovenox), which lessens the risk of a DVT clot.
Deep vein thrombosis is not a common occurrence, and it typically happens to people who have been sedentary for an extended period of time and have some other risk factor. That said, at MedFlight911 the health and wellbeing of our patients is our primary concern, and our medical escorts do everything possible to keep patients comfortable and safe while in transit.