November 15, 2018
In-Flight Medical Emergencies: What to Do

In-Flight Medical Emergencies: What to Do

by Keng Lam, MD

Earlier this year, I took a flight from Sacramento to Houston. Around mid-flight, I heard an announcement from a flight attendant requesting a health professional to assist a passenger. Even though I was only a medical student, I figured it would not hurt to volunteer.

When I arrived, a nursewas already there offering help. The passenger in distress was a young woman who had shortness of breath and a tingling feeling in her arms. I took some vitals using the provided equipment from the airline and gathered some history from her. Another gentleman who identified himself as an emergency medicine doctor also arrived to assist. In the end, the passenger’s condition was stable and the EMS arrived to take her to the hospital after we landed at our final destination.

If you fly frequently, you may have encountered an in-flight emergency like this one. In a 2013 study published in the New England Journal of Medicine, researchers reviewed records of medical emergencies from five large commercial airlines between January 2008 and October 2010—collectively accounting for about 10 percent of global passenger flight volume. They noted 11,920 emergencies that resulted in calls to a physician-directed medical communications center, or about one emergency per 604 flights.

The three most commonly reported problems were fainting, respiratory symptoms, and nausea/vomiting. In about half of cases there was at least one physician passenger who provided medical assistance in the air. About 7 percent of emergencies led to flight diversion, and fewer than 1 percent (0.3 percent) of distressed passengers died.

The Federal Aviation Administration (FAA) requires an emergency medical kit in every commercial airplane, which contains first-aid items ranging from CPR masks (used for protection in mouth-to-mouth resuscitation) to epinephrine pens (for severe allergic reactions). Most medications in the kit are required to be up to date and even replaced annually. The FAA also requires that all passenger planes have at least one automated external defibrillator on board.

Interestingly, the FAA does not have any specific guidelines about what type of medical emergencies should lead to aircraft diversion. That decision is left to the pilots and the airlines, usuallyin consultation with medical consultants on the ground. Obviously, flight diversion is costly to the airlines, so personnel must balance the potential expense of diverting the aircraft against the risk of completing the flight and delaying optimal medical care for the distressed passenger. When medical events arise, it is not unusual for volunteer health professionals on the plane to communicate with the airline’s medical consultants. The pilots do have the ultimate authority to make a decision, but they rely heavily on the professionals on board and on the ground for guidance.

What you can do

Fortunately, most of us will have a medically uneventful flight. Still, it’s worth taking steps to reduce the changes that you will experience a medical emergency in the air. Check out our article, Are You Fit to Fly?, for tips on determining when it’s safe to fly after surgery, during or after an illness, or if you are pregnant or have certain chronic medical conditions. Make sure you’re familiar with your medical history; in the event you need assistance while on board, the information will be useful to the professionals who are helping you.

Bring any medications you take on board in case the flight is unexpectedly delayed or you have unanticipated symptoms. And if you have a medical alert bracelet that denotes specific medication allergies or health conditions, be sure you are wearing it in case you have an emergency and are unable to answer questions.