Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Management of inflight medical events on commercial airlines

Paulo M Alves, MD, MSc, FasMA
Section Editors
Daniel F Danzl, MD
Scott Manaker, MD, PhD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Inflight medical events are increasing due to the steadily rising number of air travelers, the aging of the United States and European populations, and the increasing mobility of people with acute and chronic illnesses [1,2]. Traveling physicians and other medical providers may suddenly find themselves in a difficult environment, in front of many onlookers, managing conditions they do not normally treat, with unfamiliar equipment. There are no universal guidelines for managing inflight medical events, but there are aspects of the aircraft environment and resources of which the treating clinician should be aware. This topic will review the following:

Epidemiology of inflight medical events and emergencies

Cabin environment and how this may affect passengers with medical complaints

Airline medical emergency protocols

Medical resources aboard aircraft (see 'Resources on board an aircraft' below)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 26, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Sirven JI, Claypool DW, Sahs KL, et al. Is there a neurologist on this flight? Neurology 2002; 58:1739.
  2. Medical Guidelines Task Force AMA: Medical guidelines for airline travel, 2nd ed, Aviat Space Environ Med 2003; 74:A1 www.asma.org (Accessed on November 13, 2005).
  3. Peterson DC, Martin-Gill C, Guyette FX, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med 2013; 368:2075.
  4. DeJohn CA, Wolbrink AM, Véronneau SJ, et al. An evaluation of in-flight medical care in the U.S. Aviat Space Environ Med 2002; 73:580.
  5. Delaune EF 3rd, Lucas RH, Illig P. In-flight medical events and aircraft diversions: one airline's experience. Aviat Space Environ Med 2003; 74:62.
  6. Cummins RO, Schubach JA. Frequency and types of medical emergencies among commercial air travelers. JAMA 1989; 261:1295.
  7. Lyznicki JM, Williams MA, Deitchman SD, et al. Inflight medical emergencies. Aviat Space Environ Med 2000; 71:832.
  8. Ruskin KJ. In-flight medical emergencies: time for a registry? Crit Care 2009; 13:121.
  9. Dowdall N. "Is there a doctor on the aircraft?" Top 10 in-flight medical emergencies. BMJ 2000; 321:1336.
  10. Szmajer M, Rodriguez P, Sauval P, et al. Medical assistance during commercial airline flights: analysis of 11 years experience of the Paris Emergency Medical Service (SAMU) between 1989 and 1999. Resuscitation 2001; 50:147.
  11. Weinlich M, Nieuwkamp N, Stueben U, et al. Telemedical assistance for in-flight emergencies on intercontinental commercial aircraft. J Telemed Telecare 2009; 15:409.
  12. Chan SB, Hogan TM, Silva JC. Medical emergencies at a major international airport: in-flight symptoms and ground-based follow-up. Aviat Space Environ Med 2002; 73:1021.
  13. Speizer C, Rennie CJ 3rd, Breton H. Prevalence of in-flight medical emergencies on commercial airlines. Ann Emerg Med 1989; 18:26.
  14. Silverman D, Gendreau M. Medical issues associated with commercial flights. Lancet 2009; 373:2067.
  15. DeJohn, C, Veronneau, SJ, Wolbrink, AM. The evaluation of inflight medical care aboard selected US air carriers: 1996-1997. Federal Aviation Administration, Technical report no. DOT/FAA/AM-0013, Office of Aviation Medicine, Washington DC 2000.
  16. Baltsezak S. Clinic in the air? A retrospective study of medical emergency calls from a major international airline. J Travel Med 2008; 15:391.
  17. Rayman RB. Inflight medical kits. Aviat Space Environ Med 1998; 69:1007.
  18. Ramírez de Arellano AB. Patients without borders: the emergence of medical tourism. Int J Health Serv 2007; 37:193.
  19. Possick SE, Barry M. Evaluation and management of the cardiovascular patient embarking on air travel. Ann Intern Med 2004; 141:148.
  20. Hung KK, Chan EY, Cocks RA, et al. Predictors of flight diversions and deaths for in-flight medical emergencies in commercial aviation. Arch Intern Med 2010; 170:1401.
  21. Valani R, Cornacchia M, Kube D. Flight diversions due to onboard medical emergencies on an international commercial airline. Aviat Space Environ Med 2010; 81:1037.
  22. Rotta AT, Alves PM, Mason KE, et al. Fatalities above 30,000 feet: characterizing pediatric deaths on commercial airline flights worldwide. Pediatr Crit Care Med 2014; 15:e360.
  23. Johnson AO. Chronic obstructive pulmonary disease * 11: fitness to fly with COPD. Thorax 2003; 58:729.
  24. Hampson NB, Kregenow DA, Mahoney AM, et al. Altitude exposures during commercial flight: a reappraisal. Aviat Space Environ Med 2013; 84:27.
  25. Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002; 346:1067.
  26. Matsumoto K, Goebert D. In-flight psychiatric emergencies. Aviat Space Environ Med 2001; 72:919.
  27. DeHart RL. Health issues of air travel. Annu Rev Public Health 2003; 24:133.
  28. Bettes TN, McKenas DK. Medical advice for commercial air travelers. Am Fam Physician 1999; 60:801.
  29. Wallace TW, Wong T, O'Bichere A, Ellis BW. Managing in flight emergencies. BMJ 1995; 311:374.
  30. Houston S, Graf J, Sharkey J. Commercial air travel after intraocular gas injection. Aviat Space Environ Med 2012; 83:809.
  31. Noble J, Kanchanaranya N, Devenyi RG, Lam WC. Evaluating the safety of air travel for patients with scleral buckles and small volumes of intraocular gas. Br J Ophthalmol 2014; 98:1226.
  32. King BR, Goss PW, Paterson MA, et al. Changes in altitude cause unintended insulin delivery from insulin pumps: mechanisms and implications. Diabetes Care 2011; 34:1932.
  33. Slater JP, Suplicki L, Wohlgemuth P, et al. Travel experience in patients actively supported by left ventricular assist device. J Am Coll Cardiol 2015; 65.
  34. Rayman RB. Passenger safety, health, and comfort: a review. Aviat Space Environ Med 1997; 68:432.
  35. Hsueh PR, Chen PJ, Hsiao CH, et al. Patient data, early SARS epidemic, Taiwan. Emerg Infect Dis 2004; 10:489.
  36. Kenyon TA, Valway SE, Ihle WW, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N Engl J Med 1996; 334:933.
  37. Olsen SJ, Chang HL, Cheung TY, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med 2003; 349:2416.
  38. WHO Research into Global Hazards of Travel (WRIGHT) Project:Ffinal report of phase 1 (2007). World Health Organization. Geneva. http://www.who.int/cardiovascular_diseases/wright_project/phase1_report/WRIGHT%20REPORT.pdf (Accessed on April 05, 2016).
  39. Johnston RV, Hudson MF, Aerospace Medical Association Air Transport Medicine Committe. Travelers' thrombosis. Aviat Space Environ Med 2014; 85:191.
  40. Toff WD, Jones CI, Ford I, et al. Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation. JAMA 2006; 295:2251.
  41. Hinkelbein J, Neuhaus C, Wetsch WA, et al. Emergency medical equipment on board German airliners. J Travel Med 2014; 21:318.
  42. Nable JV, Tupe CL, Gehle BD, Brady WJ. In-Flight Medical Emergencies during Commercial Travel. N Engl J Med 2015; 373:939.
  43. Thibeault C, Evans A, Air Transport Medicine Committee, Aerospace Medical Association. Emergency medical kit for commercial airlines: an update. Aviat Space Environ Med 2007; 78:1170.
  44. American Heart Association. Heart Disease and Stroke Statistics-2002 Update, Dallas, TX 2002.
  45. Brown AM, Rittenberger JC, Ammon CM, et al. In-flight automated external defibrillator use and consultation patterns. Prehosp Emerg Care 2010; 14:235.
  46. Page RL, Joglar JA, Kowal RC, et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med 2000; 343:1210.
  47. Alves PM, DeJohn CA, Ricaurte EM, Mills WD. Prognostic Factors for Outcomes of In-Flight Sudden Cardiac Arrest on Commercial Airlines. Aerosp Med Hum Perform 2016; 87:862.
  48. DeJohn, C, Veronneau, SJ, Hordinsky, JR. Inflight medical care: an update. Report number DOT/FAA/AM-97/2, FAA Office of Aerospace Medicine; Washingon, DC 1997.
  49. Hordinsky JR, George MH. Response capability during civil air carrier inflight medical emergencies. Aviat Space Environ Med 1989; 60:1211.
  50. Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004; 351:637.
  51. Shuvy M, Atar D, Gabriel Steg P, et al. Oxygen therapy in acute coronary syndrome: are the benefits worth the risk? Eur Heart J 2013; 34:1630.
  52. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med 2002; 347:1242.
  53. Alves PM, DeJohn CA, Ricaurte EM, Mills WD. Prognostic factors for outcomes of in-flight sudden cardiac arrest on commercial airlines. Aerosp Med 2016; 87:862.
  54. Hayashi Y, Iwami T, Kitamura T, et al. Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest. Circ J 2012; 76:1639.
  55. Harve H, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med 2009; 80:405.
  56. IATA Medical Manual. 8th ed. April 2016. https://www.iata.org/publications/Documents/medical-manual.pdf (Accessed on September 07, 2016).
  57. Wrenn K, Slovis CM, Gongaware J. Using the "GI cocktail": a descriptive study. Ann Emerg Med 1995; 26:687.
  58. Berman DA, Porter RS, Graber M. The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial. J Emerg Med 2003; 25:239.
  59. Piera A. ICAO's latest efforts to tackle legal issues arising from unruly/disruptive passengers: The Modernization of the Tokyo Convention 1963. Air and Space Law 2012; 37:231.
  60. Pierson K, Power Y, Marcus A, Dahlberg A. Airline passenger misconduct: management implications for physicians. Aviat Space Environ Med 2007; 78:361.
  61. Kovac C. Airline passenger dies after being sedated by doctor. BMJ 1999; 318:12.
  62. Gross CP, Reisman AB, Schwartz MD. The physician as ambivalent Samaritan: will internists resuscitate victims of out-of-hospital emergencies? J Gen Intern Med 1998; 13:491.
  63. Noel AA. Medical events during airline flights. N Engl J Med 2002; 347:535.
  64. Newson-Smith MS. Passenger doctors in civil airliners--obligations, duties and standards of care. Aviat Space Environ Med 1997; 68:1134.
  65. Dachs R. Responding to an in-flight emergency. Am Fam Physician 2003; 68:975.
  66. www.congress.gov/105/plaws/publ170/PLAW-105publ170.pdf (Accessed on September 07, 2016).
  67. Dedouit F, Tournel G, Barguin P, et al. Medical liabilities of the French physician passenger during a commercial air flight. Med Sci Law 2007; 47:45.