The Clinician’s Guide to In-Flight Emergencies

Worldwide, over one billion people travel via commercial aircraft annually, and it is expected that this figure will double in the next 20 years.¹ Although it is difficult to estimate the frequency of in-flight medical events, since there is no mandatory reporting system,² it is estimated that medical emergencies occur in one out of every 604 flights.³ However, since uncomplicated issues are usually underreported, this figure is probably an underestimate because in the United States, only death or emergency diversion of the plane are required to be reported to the Federal Aviation Administration (FAA).⁴

Physicians are frequently called upon to assist fellow passengers who are ill during flight.  A recent article by Nable et al⁴ addresses the ethical and legal considerations for physicians who provide medical services to patients during commercial flights.

What Resources are Available On Board the Flight?

All US airlines are mandated by the FAA to carry first-aid kits (Table 1). At present, pediatric and obstetrical supplies are not included, although an Aerospace Medical Association Expert Panel has recommended expanding the current requirements to include these and other devices and equipment.⁴

Airlines cannot take for granted that a healthcare professional will be present on every flight in which a passenger becomes ill. For that reason, most airlines contract with ground-based medical consultation services.⁴ Clinicians at these centers provide treatment recommendations, which are available to on-board volunteer providers. Flight attendants are required to be trained in cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs).⁴