In-flight Medical Emergencies
Am Fam Physician. 2021 May 1;103(9):547-552.
Related letter: In-Flight Medical Emergencies and Medical Legal Issues
Author disclosure: No relevant financial affiliations.
In 2018, approximately 2.8 million passengers flew in and out of U.S. airports per day. Twenty-four to 130 in-flight medical emergencies are estimated to occur per 1 million passengers; however, there is no internationally agreed-upon recording or classification system. Up to 70% of in-flight emergencies are managed by the cabin crew without additional assistance. If a health care volunteer is requested, medical professionals should consider if they are in an appropriate condition to render aid, and then identify themselves to cabin crew, perform a history and physical examination, and inform the cabin crew of clinical impressions and recommendations. An aircraft in flight is a physically constrained and resource-limited environment. When needed, an emergency medical kit and automated external defibrillator are available on all U.S. aircraft with at least one flight attendant and a capacity for 30 or more passengers. Coordinated communication with the pilot, any available ground-based medical resources, and flight dispatch is needed if aircraft diversion is recommended. In the United States, medical volunteers are generally protected by the Aviation Medical Assistance Act of 1998. There is no equivalent law governing international travel, and legal jurisdiction depends on the patient's and medical professional's countries of citizenship and the country in which the aircraft is registered.
Approximately 2.8 million passengers flew in and out of U.S. airports per day in 2018.1 An overhead announcement requesting medical assistance at cruising altitude presents a unique situation for any health care professional given the physically constrained, resource-limited environment. The term “in-flight medical event” is often used interchangeably with “in-flight medical emergency” and includes a spectrum of conditions, ranging from minor to serious.2 There is no internationally agreed-upon recording and classification system for in-flight medical emergencies, and prevalence estimates vary between 24 and 130 emergencies per 1 million passengers.3–5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
|Clinical recommendation||Evidence rating||Comments|
Medical volunteers onboard the aircraft should consider ethical factors (e.g., appropriate physical and mental condition to render aid, practice within scope of expertise) in response to a request for medical assistance from a cabin crewmember.2,7,8
Expert opinion in the absence of clinical trials
Existing legislation and legal precedence in the absence of clinical trials
Referencesshow all references
1. Federal Aviation Administration. Air traffic by the numbers. June 2019. Accessed March 8, 2020. https://www.faa.gov/air_traffic/by_the_numbers/media/Air_Traffic_By_The_Numbers_2019.pdf...
2. Aerospace Medical Association Air Transport Medicine Committee. Medical emergencies: managing in-flight medical events. July 2016. Accessed November 8, 2019. https://www.asma.org/asma/media/AsMA/Travel-Publications/Medical%20Guidelines/In-flight-medical-events-guidance-document-revised-July-2016.pdf
3. Dowdall N. “Is there a doctor on the aircraft?” Top 10 in-flight medical emergencies. BMJ. 2000;321(7272):1336–1337.
4. Kim JH, Choi-Kwon S, Park YH. Comparison of inflight first aid performed by cabin crew members and medical volunteers. J Travel Med. 2017;24(2):1–6.
5. Kesapli M, Akyol C, Gungor F, et al. Inflight emergencies during Eurasian flights. J Travel Med. 2015;22(6):361–367.
6. Peterson DC, Martin-Gill C, Guyette FX, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013;368(22):2075–2083.
7. Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med. 2002;346(14):1067–1073.
8. Baltsezak S. Clinic in the air? A retrospective study of medical emergency calls from a major international airline. J Travel Med. 2008;15(6):391–394.
9. Aviation Medical Assistance Act of 1998, 49 USC §44701 (1998). Accessed March 8,2020.https://www.govinfo.gov/content/pkg/CRPT-105hrpt456/pdf/CRPT-105hrpt456.pdf
10. Wong M. Doctor in the sky: medico-legal issues during in-flight emergencies. Med Law Int. 2017;17(1–2):65–98.
11. Shepherd B, Macpherson D, Edwards CMB. In-flight emergencies: playing the good samaritan. J R Soc Med. 2006;99(12):628–631.
12. Hirano R. Convention on offences and certain other acts committed on board aircraft of 1963. Japanese Annual of International Law. 1964;8:44–59.
13. Dachs RJ, Elias JM. What you need to know when called upon to be a Good Samaritan. Fam Pract Manag. 2008;15(4):37–40.
14. Newson-Smith MS. Passenger doctors in civil airliners—obligations, duties and standards of care. Aviat Space Environ Med. 1997;68(12):1134–1138.
15. Kodama D, Yanagawa B, Chung J, et al. “Is there a doctor on board?”: Practical recommendations for managing in-flight medical emergencies. CMAJ. 2018;190(8):E217–E222.
16. International Air Transport Association. Medical Manual. 11th ed. June 2018. Accessed November 22, 2019. https://www.iata.org/publications/Documents/medical-manual.pdf
17. Nable JV, Tupe CL, Gehle BD, et al. In-flight medical emergencies during commercial travel. N Engl J Med. 2015;373(10):939–945.
18. Federal Aviation Administration. Advisory circular 121-33B: emergency medical equipment. January 12, 2006. Accessed October 11, 2019. https://www.faa.gov/documentlibrary/media/advisory_circular/ac121-33b.pdf
19. Graf J, Stüben U, Pump S. In-flight medical emergencies. Dtsch Arztebl Int. 2012;109(37):591–601.
20. International Civil Aviation Organization. ICAO health-related documents. Chapter 6. Aeroplane instruments, equipment and flight documents. Accessed November 13, 2019. https://www.icao.int/MID/Documents/2013/capsca-mid3/ICAOHealthRelatedSARPsandguidelines.pdf
21. Verjee MA, Crone R, Ostrovskiy G. Medical issues in flight and updating the emergency medical kit. Open Access Emerg Med. 2018;10:47–51.
22. Martin-Gill C, Doyle TJ, Yealy DM. In-flight medical emergencies: a review. JAMA. 2018;320(24):2580–2590.
23. Sand M, Gambichler T, Sand D, et al. Emergency medical kits on board commercial aircraft: a comparative study. Travel Med Infect Dis. 2010;8(6):388–394.
24. Badawy SM, Thompson AA, Sand M. In-flight emergencies: medical kits are not good enough for kids. J Paediatr Child Health. 2016;52(4):363–365.
25. Aerospace Medical Association. Medical guidelines for airline travel: stresses of flight. September 2014. Accessed November 3, 2019. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Stresses-of-Flight-Nov-2014.pdf
26. International Air Transport Association. Death on board. January 2018. Accessed November 28, 2019. https://www.iata.org/contentassets/ccbdc54681c24574bebf2db2b18197a5/death-on-board-guidelines.pdf
Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions