Common In-Flight Medical Emergencies: What Doctors Should Know

Medical emergencies can happen anywhere, including during flights, where the unique challenges of being at 35,000 feet create an entirely different set of circumstances for both passengers and healthcare professionals. As healthcare providers, it's essential to understand what constitutes an in-flight medical emergency, how to respond appropriately, and the resources available to assist.

This guide is designed to help medical professionals understand when to intervene during an in-flight medical emergency, the most common emergencies encountered, and practical steps to take in these situations.

1. In-Flight Medical Emergencies: An Overview

An in-flight medical emergency refers to any health event that occurs on an aircraft during flight, requiring immediate or prompt medical attention. With more than 4 billion passengers flying annually, these emergencies are relatively common, occurring in approximately 1 in 600 commercial flights.

The confined and isolated environment of an airplane, coupled with limited medical supplies, poses significant challenges for healthcare providers. Understanding when to intervene and how to manage these emergencies can make a significant difference in patient outcomes.

2. Most Common Types of In-Flight Medical Emergencies

According to research and data from airline reports, the majority of in-flight medical emergencies are non-life-threatening. However, healthcare professionals should be prepared to handle a wide range of situations. The most frequently reported in-flight emergencies include:

a) Syncope and Pre-Syncope

• Syncope (fainting) or pre-syncope is the most common medical event in-flight, accounting for 30-37% of cases. Reduced cabin pressure, dehydration, and prolonged immobility contribute to a higher likelihood of fainting.

b) Respiratory Distress

• Breathing difficulties or exacerbation of chronic respiratory conditions (e.g., asthma, chronic obstructive pulmonary disease) are common, especially in a low-oxygen cabin environment.

c) Gastrointestinal Issues

• Nausea, vomiting, and abdominal pain are common, often triggered by turbulence or pre-existing conditions like gastroesophageal reflux disease (GERD).

d) Cardiac Events

• Cardiac emergencies, including chest pain or suspected heart attacks, are less frequent but among the most serious in-flight emergencies. An estimated 7% of in-flight emergencies involve cardiac events, including myocardial infarction (heart attack) and arrhythmias.

e) Seizures

• Approximately 6% of in-flight medical events involve seizures, particularly among passengers with a history of epilepsy. Seizures can also result from alcohol consumption, sleep deprivation, or hypoxia (low oxygen levels).

f) Allergic Reactions

• Allergic reactions, ranging from mild rashes to anaphylaxis, can occur during flights. Severe allergic reactions, although rare, are medical emergencies that require immediate intervention.

g) Trauma and Injuries

• Falls, burns from hot beverages, and other minor traumas often occur during turbulence or while moving around the cabin. More severe injuries may occur in extreme situations, such as emergency landings.

3. When to Intervene: The Role of Healthcare Professionals

As a doctor or healthcare professional on board, deciding when to intervene during an in-flight emergency is crucial. Airlines are required by international aviation regulations to seek volunteer assistance from trained medical personnel if needed. While there is no legal obligation for doctors to respond, ethical considerations often compel healthcare professionals to step in. Here are key factors to consider when determining whether to intervene:

a) Severity of the Situation

• Is the passenger’s life at risk? Are they in significant distress? If the situation appears life-threatening (e.g., cardiac arrest, anaphylaxis), immediate intervention is necessary.

b) Availability of Other Medical Personnel

• If another medical professional has already stepped forward, it may be appropriate to allow them to take charge. However, if the situation escalates or the initial responder requests help, multiple healthcare providers can collaborate.

c) Comfort with Available Equipment

• Airplanes are equipped with basic medical kits, but the contents vary by airline and country. Knowing what is available and being comfortable using the provided equipment is crucial.

4. Airline Medical Kits: What’s Available?

The contents of an airplane's medical kit can differ between airlines, but regulations generally ensure that certain equipment and medications are on board. According to the Federal Aviation Administration (FAA) and the European Aviation Safety Agency (EASA), a standard in-flight medical kit may include:

• Basic diagnostic tools: Stethoscope, blood pressure cuff, thermometer
• Emergency medications: Aspirin, epinephrine (for anaphylaxis), nitroglycerin (for chest pain), antihistamines, bronchodilators (for asthma attacks), and glucose (for hypoglycemia)
• IV fluids and saline: For dehydration or emergencies requiring intravenous access
• Defibrillator: Automated external defibrillators (AEDs) are required on all commercial flights to manage cardiac arrests
• Oxygen supply: Supplemental oxygen is available in case of respiratory distress or hypoxia

Being aware of these tools can help healthcare professionals assess their ability to manage different emergencies while in-flight.

5. Managing Common In-Flight Medical Emergencies

a) Syncope

• Management: Have the passenger lie flat and elevate their legs to increase blood flow to the brain. Ensure they are hydrated by offering water once they regain consciousness. Monitor for any recurrent symptoms.

b) Respiratory Distress

• Management: Administer supplemental oxygen and, if necessary, bronchodilators for passengers with asthma. Ask if the passenger has any personal medications, such as an inhaler. In severe cases, consider diverting the flight.

c) chest pain

• Management: Administer aspirin if available, and use nitroglycerin if the passenger has a known history of heart disease. Apply AED if cardiac arrest occurs. Immediate diversion for emergency medical care is recommended if the situation is life-threatening.

d) Seizures

• Management: Ensure the passenger is safe and prevent injury during the seizure. Once the seizure subsides, monitor airway and breathing, as post-seizure confusion (postictal state) is common. Use oxygen if necessary.

e) Anaphylaxis

• Management: Administer epinephrine as soon as possible if signs of anaphylaxis are present (e.g., difficulty breathing, swelling, rash). Follow up with antihistamines. Emergency diversion should be considered if the reaction is severe.

6. Legal and Ethical Considerations for Healthcare Professionals

Healthcare providers often worry about the legal implications of intervening in a medical emergency, especially in unfamiliar settings like an aircraft. However, various laws offer protection:

a) Good Samaritan Laws

• Many countries have Good Samaritan laws, including the U.S., which protect healthcare providers who offer assistance during emergencies. In the airline setting, these laws typically shield doctors from liability as long as they act in good faith and within the scope of their expertise.

b) Ethical Obligation

• While there is no legal mandate for a doctor to intervene in an in-flight emergency, the ethical responsibility to provide aid is often a compelling factor. As healthcare professionals, the Hippocratic Oath or equivalent medical ethics guide decisions in these scenarios.

7. Flight Crew Role and Communication

Flight crews are trained to handle basic first aid and CPR, but they rely on the expertise of healthcare providers during medical emergencies. Clear communication between the medical professional and crew is critical.

• Delegation: The healthcare provider should delegate tasks to flight attendants, such as administering oxygen or providing medical kits.
• Communication with Ground Medical Support: Many airlines have ground-based medical support services that can offer guidance. Collaboration between the healthcare professional and these services can assist in making decisions about flight diversion.

8. When to Divert the Flight: A Critical Decision

One of the most challenging aspects of managing in-flight emergencies is deciding whether the plane should be diverted. A medical professional’s input is critical in this decision, but the final call rests with the captain. Situations that may warrant a flight diversion include:

• Suspected cardiac events requiring immediate attention
• Seizures that cannot be controlled
• Unrelieved chest pain or respiratory distress
• Severe trauma or life-threatening bleeding

Factors to Consider:

• Flight duration to the next destination
• Availability of emergency medical services upon landing
• Stability of the patient during the flight

Conclusion

Managing in-flight medical emergencies requires a combination of clinical skill, quick thinking, and the ability to work with limited resources. While many in-flight emergencies are minor, healthcare professionals must be prepared to handle more serious situations like cardiac events, anaphylaxis, or respiratory distress. Awareness of airline medical kits, good communication with the flight crew, and understanding legal protections are essential when providing care at 35,000 feet.