In-Flight Medical Emergencies

Posted by • September 4th, 2015

In-Flight Medical Emergencies -When a medical emergency occurs during a commercial flight, health care providers should be prepared to respond. A new review article offers guidance on how to respond to the more common emergencies and on roles and liabilities in offering medical assistance aboard an airplane.

Estimating the frequency of in-flight medical events is challenging because no mandatory reporting system exists. A study of a ground-based communications center that provides medical consultative service to airlines estimated that medical emergencies occur in 1 of every 604 flights. This is likely to be an underestimate, however, because uncomplicated issues are probably underreported.

Clinical Pearls

• Is cardiac arrest one of the more common in-flight emergencies?

Among in-flight medical emergencies, cardiac arrest is quite rare, accounting for only 0.3% of such emergencies, yet it is responsible for 86% of in-flight events resulting in death. Syncope and presyncope are relatively common medical events; in one study, these conditions accounted for 37.4% of all aircraft medical emergencies. Seizures and postictal states account for 5.8% of aircraft emergencies, and complications from diabetes account for 1.6%. Psychiatric issues constitute 3.5% of in-flight medical emergencies. Suspected strokes account for approximately 2% of in-flight medical emergencies.

• What resources are available for managing an in-flight medical emergency?

The Federal Aviation Administration (FAA) mandates that United States-based airlines carry first-aid kits that are stocked with basic supplies such as bandages and splints. At least one kit must contain the additional items listed in Table 1 (see below). At least one automated external defibrillator (AED) must be available. These supplies are not comprehensive (e.g., there are no pediatric or obstetrical supplies). Because health professionals are not aboard every flight, most airlines contract with ground-based medical consultation services. The clinicians at these centers can provide treatment recommendations. On-board volunteer providers can also consult these services during an emergency. The FAA also mandates that flight attendants receive training every other year in cardiopulmonary resuscitation and the use of AEDs.

Table 1. Contents of In-Flight Emergency Medical Kits.

Table 3. Suggested Response to In-Flight Medical Emergencies.

Morning Report Questions

Q: What option may be considered, in addition to supplemental oxygen, to improve oxygenation in patients who develop respiratory compromise during a commercial flight?

A: Supplemental oxygen should be provided if the clinician suspects respiratory compromise, and the clinician might request a descent to a lower altitude to improve oxygenation. Because of Dalton’s law and because commercial airliners are usually pressurized to the equivalent altitude of 6000 to 8000 ft, passengers typically have a partial pressure of arterial oxygen of 60 mm Hg (at sea level, it is normally 75 to 100 mm Hg). A descent in altitude may permit higher pressures of oxygen, though at a risk of the use of more fuel, because fuel consumption is greater at lower altitudes.

Q: Do physicians have a legal obligation to provide assistance for an in-flight medical emergency, and what legal protections are in place for doing so?

A: Liability is generally determined under the law of the country in which the aircraft is registered, but the law of the country in which the incident occurs or in which the parties are citizens could arguably apply. Although U.S. health care providers traveling on registered U.S. airlines have no legal obligation to assist in the event of a medical emergency, ethical obligations may prevail. In addition, many other countries, such as Australia and many in Europe, do impose a legal obligation to assist. In 1998, Congress passed the Aviation Medical Assistance Act (AMAA), which protects providers who respond to in-flight medical emergencies from liability and thus encourages medical professionals to assist in emergencies. This law applies to claims arising from domestic flights and most claims arising from international flights involving U.S. carriers or residents. The AMAA does allow for liability of providers if the patient can establish that the provider was “grossly negligent” or intentionally caused the alleged harm. With respect to “gross negligence,” providers are liable only if they exhibit flagrant disregard for the patient’s health and safety.

Table 2. Features of the Aviation Medical Assistance Act (AMAA) of 1998.

2 Responses to “In-Flight Medical Emergencies”

  1. Daniel Livio MD says:

    Thank you for illuminating us.
    Ethical obligations should always prevail when a doctor faces an emergency.
    Even if prevalence of emergencies is underestimated, having a doctor aboard in each and every flight doesn’t sound logic and may be unaffordable for any airline.
    However, companies save billions having no doctors aboard.
    Is there any rule, regulation or recommendation describing how much the doctor managing an emergency should be paid?
    On the other hand, how many flights facing a medical emergency don’t have a doctor aboard?
    How many flights have a doctor aboard?
    Best Regards,
    Daniel Livio; MD.

  2. Gaetano Santulli says:

    Very interesting report.
    What do you think about limiting the consumption of alcohol in-flight?

    Best Regards,
    Gaetano Santulli, MD, PhD