In-flight medical emergencies occur with surprising frequency — about 44,000 times a year, or once in every 604 flights, according to an article published last week in the New England Journal of Medicine (NEJM).
Just as surprising is the fact that in three-fourths of those emergencies, a medical professional is on board to help. Indeed, in half the cases, that traveling professional is a doctor.
Passengers should be grateful that doctors and other medical professionals are willing to volunteer their help. For, as the article explains, U.S. health-care providers are not legally obligated to step forward and assist during an in-flight medical emergency, as they are in Australia and some European countries.
They are encouraged to do so, however. In 1998, Congress passed the Aviation Medical Assistance Act, which protects health-care providers from liability in such situations — unless those providers act with “gross negligence,” such as providing care while intoxicated.
A challenging environment
The NEJM article, written by four emergency medicine physicians, is designed to help health-care providers understand what to expect if they decide to press the call button when a flight attendant asks, “Is there a doctor on board?”
The information provided in the article is also helpful for passengers. It underscores the challenge — and limitations — of receiving medical care at 35,000 feet.
Passengers need to be aware that air travel can exacerbate underlying diseases, such as heart problems, diabetes and epilepsy, as well as trigger a new condition.
Planes are required to carry a first-aid kit stocked with basic supplies, including equipment for delivering intravenous saline solutions, a bronchodilator inhaler and nitroglycerin tablets. They must also have an automated external defibrillator on board.
Flight attendants are, of course, trained in cardiopulmonary resuscitation (CPR) and in how to use the defibrillators. The airlines also contract with ground-based medical consultation services to give treatment recommendations to flight attendants during an emergency.
Flights are not, however, automatically diverted to the nearest airport during an in-flight medical emergency.
“The decision to divert lies solely with the captain of the aircraft,” write the authors of the NEJM article. “Diversion is a complicated decision that must take into consideration factors such as fuel, costs, the ability of the aircraft to land at the closest airport, and the medical resources available at that airport.”
Here are some of the medical conditions that are most likely to result in a flight being diverted. (Most of the statistics come from a 2013 article also published in NEJM.)
- Heart attacks. These medical events are quite rare on airplanes, accounting for only 0.3 percent of all in-flight emergencies. They are responsible, however, for 86 percent of in-flight medical events that result in a death.
- Fainting (syncope). Some 37 percent of in-flight medical emergencies involve passengers fainting. Dizziness and fainting can be the result of dehydration, caused by the dry, pressurized air in the aircraft cabin. But it can also be caused by an underlying and potentially fatal medical condition, including a heart attack.
- Difficulty breathing (dyspnea). About 12 percent of in-flight medical emergencies involve passengers having difficulty breathing. Again, these problems are usually the result of an underlying medical condition, such as a form of high blood pressure known as pulmonary hypertension. High altitudes can exacerbate such conditions.
- Stroke. About 2 percent of in-flight medical emergencies are suspected strokes. Low blood sugar (hypoglycemia) can sometimes mimic the symptoms of a stroke. Not all in-flight emergency medical kits contain a glucometer, which measures blood sugar. In such cases, a flight attendant or volunteer passenger-physician may ask other passengers if they have a glucometer that can be borrowed. (Given the high prevalence of type 2 diabetes in the U.S., chances are good that one or more passengers will have this piece of medical equipment.)
- Seizures. About 6 percent of in-flight medical emergencies involve seizures. These seizures can be related to many different medical conditions, including epilepsy, infections, head injuries, or complications from diabetes. Low oxygen levels in the aircraft cabin and travel-related disruptions in the passenger’s circadian rhythms can exacerbate such conditions — and trigger a seizure.
- Psychiatric issues. About 3.5 percent of in-flight medical emergencies are psychiatric in nature. “Potential stressors,” write the article’s authors, “include a lengthy check-in process, enhanced security measures, delayed flights, cramped cabins, and alcohol consumptions.” Aircraft medical kits do not contain sedatives, so volunteer physician-passengers are advised to use “improvised physical restraints … to ensure the safety of other passengers if attempts at deescalating the situation and calming the passenger are unsuccessful.”
The NEJM article is, unfortunately, behind a paywall, but you will find an abstract on the journal’s website.