The Dose27:25What do I need to know about in-flight medical emergencies?
Emergency physician Dr. Scott Kapoor was on a recent flight to San Francisco when he took part in his most-recent mid-air consultation.
The flight crew called for a doctor, because of a patient complaining about chest pains.
About six or seven physicians stood up — including himself — Kapoor said, “because there was a medical conference.”
The patient’s chest pain eventually resolved on its own, and the plane ultimately didn’t need to be diverted to a nearby airport for additional care.
Kapoor’s experience might sound rare, but in-flight medical emergencies take place more often than airline passengers might think.
A study analyzing almost 78,000 cases between January 2022 and December 2023 suggested that medical emergencies happen once every 212 flights, with physicians most often volunteering to provide care, then nurses and paramedics.
Women experienced slightly more than half of the recorded emergencies, and long-haul flights, usually six or more hours, accounted for almost half of all recorded cases.
Nonetheless, experts say that airlines have clear protocols in place to respond to in-flight medical emergencies, with access to trained physicians who can provide ground support in the event that flight crew aren’t able to connect with a volunteer medical professional on board.
Here’s how airlines typically respond to an in-flight medical emergency.
First, identify the cause of medical distress
Major airlines usually have a clear order of operations when dealing with a passenger experiencing an in-flight medical emergency, according to Dr. Vincent Poirier, a senior medical advisor to Air Canada and Air Transat.
He says loss of consciousness, gastrointestinal issues like vomiting and diarrhea, and heart and lung problems are the most common in-flight emergencies.
After identifying a passenger in distress, flight crews will usually attempt basic first-aid, if they’re able.
“They are trained for CPR, basic life support and also they’re trained on the automatic external defibrillator,” Poirier told The Dose host Dr. Brian Goldman.
Flight crew have access to a first-aid kit that contains a number of over-the-counter remedies, including medication like Tylenol or Aspirin, as well as anti-nausea and anti-vomiting drugs, antihistamines, and supplies like bandages.
If the airline crew aren’t able to treat passengers using first-aid, they’ll escalate and call for a medical professional on board.
“It doesn’t need to be a doctor,” said Poirier, an associate professor at McGill University who co-founded the school’s onboard medical emergencies course.
“It can be a nurse; it can be a paramedic.”
Paging ground control
While every airline has a protocol for dealing with medical emergencies, cardiologist Dr. Paolo Alves, global medical director for MedAire, says those can vary from airline to airline.
MedAire provides ground medical support services for the airline and maritime industries, though Alves’s specialty is aviation.
“The good, old standard would be, in case of a medical situation, the flight attendants will page for the occasional medical volunteer on-board,” said Alves.
He added that some airlines call MedAire right away, whereas others only call as a backup if no volunteer offers help.
Once they’re contacted, MedAire connects callers with a trained emergency physician in a hospital.
Thanks to advanced medical monitoring devices carried on some planes, MedAire is able to receive information like blood pressure levels, blood oxygen saturation, and even heart rate through satellite links.
“Depending on the situation we might say ‘well, you can just go to the kit and provide this medication,'” said Alves.
Since flight attendants usually only have basic first-aid training, they can’t deliver injectable medications, nor can they administer medication requiring a prescription.
In that instance, services like MedAire will recommend paging for a medical volunteer, who can access a kit on board that’s reserved for use by medical professionals only.
Ground support services can also suggest whether the flight needs to be diverted, though the final decision rests with the pilot, who may choose to land if a patient has had a stroke or cardiac arrest, or if someone has given birth on board, among other reasons.
“This doesn’t mean that [the pilot] can land the plane immediately,” said Alves, explaining that the logistics of finding the nearest appropriate airport can pose issues, including geopolitical concerns.
Transport Canada and the Federal Aviation Administration have strict protocols for in-flight medical kits, though different airlines may choose to stock additional supplies, according to Poirier.
For flights that carry more than 100 passengers, Transport Canada requires medication like epinephrine, nitroglycerin, and atropine to treat issues like heart problems, severe allergic reactions, as well as to potentially sedate a patient in distress.
Air Canada and Air Transat also stock the antipsychotic haloperidol, the benzodiazepine lorazepam and even a naloxone kit, according to Poirier.
“Even if it’s not a regulation throughout Canada, it’s strongly recommended to carry naloxone, and our major carriers in Canada do carry naloxone,” he said.
Transport Canada also requires the emergency kit to contain tools like a blood pressure cuff, syringes to administer intravenous medication, a stethoscope, and a CPR mask with an oxygen port and valves.
Raise your hand if you can volunteer, experts recommend
Experts like Alves acknowledge that treating a patient on an airplane 9,000 metres in the air can be a nerve-wracking experience — especially if the medical professional in question isn’t a trained emergency medical provider.
“It’s a loud environment, it’s a cramped environment,” said emergency physician Dr. David Kodama, who is a transport medicine physician with Ornge Air Ambulance and a medical consultant for Air Canada.
“Not only that, but you’re dealing with equipment that is different … so trying to navigate some of those subtle pieces can be certainly challenging.”
Nonetheless, Kodama says medical professionals who volunteer can make a huge difference, even if they simply communicate with ground support.
A handful of passengers had their return tickets cancelled by Air Canada because the airline had no record of them taking earlier flights. The airline calls it a rare malfunction, but others say it’s a safety issue.
Additionally, doctors who step up to help are typically protected by Good Samaritan laws, meaning they’re less likely to face a potential malpractice suit if something goes wrong, says Kodama.
Passengers can minimize their risk of experiencing an in-flight emergency by consulting with a travel medicine physician if they’re concerned about their pre-flight health.
Poirier recommends people carry their medications with them on the flight, along with a list of those medications that can be consulted in the event of an emergency.
It’s also important for all passengers to stay well-hydrated, and regularly stand or stretch during long flights to avoid things like cramps and blood clots.
