Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Management of inflight medical emergencies on commercial airlines

INTRODUCTION

Inflight medical emergencies are increasing due to the steadily rising number of air travelers, the aging of the US and European populations, and the increasing mobility of people with acute and chronic illnesses [1,2]. Physician passengers 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 emergencies, but there are unique considerations. This topic will review the following:

  • Epidemiology
  • Cabin environment
  • Airline medical emergency protocols
  • Resources aboard an aircraft
  • Management of common emergencies
  • Liability and legal protection for Good Samaritans

Screening of patients for air travel is discussed elsewhere. (See "Preflight patient assessment".)

EPIDEMIOLOGY

There are nearly two billion US and overseas air travelers each year [2]. Inflight medical emergencies occur at a rate of 20 to 100 per million passengers, with a death rate of 0.1 to 1 per million [3-6]. The precise incidence of inflight medical emergencies is unknown because there is no uniform or required reporting system, and flight crews do not routinely report minor inflight medical incidents that do not require ground medical support [1].

A few studies have looked at the number of activations of ground-based emergency medical services for passengers arriving at a given airport. The combined data suggest an incidence of 21 to 25 emergencies per million passengers with 0.1 to 0.3 deaths per million passengers [4-8]. Other studies examined all inflight emergencies that occurred on all flights of a specific airline, or that generated a call from the airplane to ground-based medical advisors. As an example, from 1998 to 1999 British Airways had 92 emergencies per million passengers [9]. Seventy percent of these were handled by the flight crew, leaving about 28 incidents per million passengers that would have generated a call for ground-based medical advice. Air France flights made 1.9 calls to ground-based physicians per million passengers [10]. These data suggest most inflight medical events are not serious and are handled adequately by airline crews.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

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 (click here) ©2010 UpToDate, Inc.
References Top
  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. Available at www.asma.org (Accessed on October 13, 2005).
  3. DeJohn, CA, Wolbrink, AM, Veronneau, SJ, et al. An evaluation of in-flight medical care in the U.S. Aviat Space Environ Med 2002; 73:580.
  4. 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.
  5. Cummins, RO, Schubach, JA. Frequency and types of medical emergencies among commercial air travelers. JAMA 1989; 261:1295.
  6. Lyznicki, JM, Williams, MA, Deitchman, SD, Howe, JP, 3rd. Inflight medical emergencies. Aviat Space Environ Med 2000; 71:832.
  7. 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.
  8. Speizer, C, Rennie, CJ, 3rd, Breton, H. Prevalence of in-flight medical emergencies on commercial airlines. Ann Emerg Med 1989; 18:26.
  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. Nordenberg, L. Dealing with the depths of depression. FDA Consum 1998; 32:26.
  12. Possick, SE, Barry, M. Evaluation and management of the cardiovascular patient embarking on air travel. Ann Intern Med 2004; 141:148.
  13. 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.
  14. Rayman, RB. Inflight medical kits. Aviat Space Environ Med 1998; 69:1007.
  15. Johnson, AO. Chronic obstructive pulmonary disease * 11: fitness to fly with COPD. Thorax 2003; 58:729.
  16. Gendreau, MA, DeJohn, C. Responding to medical events during commercial airline flights. N Engl J Med 2002; 346:1067.
  17. Matsumoto, K, Goebert, D. In-Flight Psychiatric Emergencies. Aviat Space Environ Med 2001; 72:919.
  18. DeHart, RL. Health issues of air travel. Annu Rev Public Health 2003; 24:133.
  19. Bettes, TN, McKenas, DK. Medical advice for commercial air travelers. Am Fam Physician 1999; 60:801.
  20. Wallace, TW, Wong, T, O'Bichere, A, Ellis, BW. Managing in flight emergencies. BMJ 1995; 311:374.
  21. Rayman, RB. Passenger safety, health, and comfort: a review. Aviat Space Environ Med 1997; 68:432.
  22. Hsueh, PR, Chen, PJ, Hsiao, CH, et al. Patient Data, Early SARS Epidemic, Taiwan. Emerg Infect Dis 2004; 10:489.
  23. 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.
  24. Olsen, SJ, Chang, HL, Cheung, TY, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med 2003; 349:2416.
  25. Thibeault, C, Evans, A. Emergency medical kit for commercial airlines: An update. Aviat Space Environ Med 2007; 78:1170.
  26. American Heart Association. Heart Disease and Stroke Statistics-2002 Update, Dallas, TX 2002.
  27. 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.
  28. 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.
  29. DeJohn, C, Veronneau, SJ, Hordinsky, JR. Inflight medical care: an update. Report number DOT/FAA/AM-97/2, FAA Office of Aerospace Medicine, Washington DC 1997.
  30. Hordinsky, JR, George, MH. Response capability during civil air carrier inflight medical emergencies. Aviat Space Environ Med 1989; 60:1211.
  31. Wrenn, K, Slovis, CM, Gongaware, J. Using the "GI cocktail": a descriptive study. Ann Emerg Med 1995; 26:687.
  32. 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.
  33. 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.
  34. Newson-Smith, MS. Passenger doctors in civil airliners--obligations, duties and standards of care. Aviat Space Environ Med 1997; 68:1134.
  35. Dachs, R. Responding to an in-flight emergency. Am Fam Physician 2003; 68:975.
white circle LOG IN
white circle DEMO