Army doctors warn that long flights pose blood clot risk
Lt. Col. Joseph Mack, a radiologist at the 325th Combat Support Hospital in Camp Arifjan, Kuwait, reviews an X-ray showing a blood clot in the heart.
CAMP ARIFJAN, Kuwait — Servicemembers face all kinds of risks deploying, but might not realize that the dangers can start on the flight itself: Sitting for hours can result in potentially deadly blood clots forming in the legs and traveling to the lungs or heart.
The problem: doing nothing.
“Our average flights are 21 to 24 hours, and that’s not including the time in between flights,” said Col. Colleen Kloehn, deputy commander of clinical services for the 325th Combat Support Hospital. “You’re stationary for all that time.”
Her hospital sees about three blood clot patients per month.
“That’s a fairly high number,” said Kloehn. “It can happen to young and old.”
The risk of blood clots during air travel is not a new phenomenon. In 2007, the World Health Organization released findings that the risk of blood clots doubles when sitting still while traveling more than four hours. Many airlines now have pamphlets in the seat pockets advising passengers to stretch and move around.
But the trend among soldiers was only recently recognized.
Col. Bernard Geiser is an Army Reserve battalion surgeon. In civilian life, he is an emergency room doctor at a Pittsburgh hospital.
“I worked at a pretty busy [hospital], I would see maybe one blood clot a month, and then when I was in Kuwait, I was seeing one every maybe 10 days,” said Geiser.
He found this curious since Pittsburgh has a population of about 300,000, and there are about 13,000 U.S. military personnel in Kuwait.
“That’s what made me start thinking there is something going on.” All of Geiser’s blood clot cases were related to air travel.
Then Geiser had three blood clot cases in a two-week period. Two of the patients had potentially fatal massive blood clots. This was Geiser’s call to action. He didn’t formally review records; instead he talked to fellow doctors who had also treated military air travelers, verifying his suspicion.
“There are a lot more blood clots than we would expect,” he said.
Later he learned from the U.S. Army Public Health Command that there are 250 blood clot cases each year in the Army. “It was an unrecognized problem,” said Geiser.
“Everybody on this side of the pond had to get here by airplane, so we’re all at risk,” Geiser explained. Despite forming in the legs, a blood clot can break off and travel to the heart or lungs. “The problem with blood clots in the lung is that you can just drop over dead unexpectedly.”
And it’s not always an easy problem to recognize.
“When people pass out, not everybody thinks of a blood clot,” said Geiser. However, he said it’s standard procedure to look for a blood clot when someone passes out. He recommends that anyone with a swollen leg, shortness of breath or chest pain in the days after a long flight get checked by a heath care provider.
For the military, blood clots pose an additional problem.
“They’re not treated all the same, that’s the thing,” Kloehn said. “You have to give certain medications that can help break up a clot. And in this environment it gets tricky to give those medications.” Treatment can be complicated and take six months. Hospitals in a deployed environment are not geared for that kind of care; Kloehn said most blood clot patients are evacuated out of the theater for treatment.
Geiser hopes to raise awareness about blood clots, saying, “Prevention is cheap; it’s free.” He encourages people to simply get up, stretch and move around when flying.
Kloehn takes extra precautions.
“Personally I wear compression stockings when I do those long flights. Those are really tight socks,” she explains. “It really helps. Your legs don’t get swollen ... the blood can’t collect down there.”
Geiser made posters and is trying to get them placed at military air terminals and United Service Organizations facilities. He wants people to understand the risks and to be proactive in preventing blood clots. The ultimate goal is for the aircrew to make a 10-second informational announcement on every flight, said Geiser.
“People think ‘it’s not going to happen to me,’ ” said Kloehn. “It can be detrimental to your health if you get one of these. And prevention is fairly easy.”