Perspectives: Responding to Medical Emergencies When Flying

Introduction

You find your seat, buckle up, and the plane takes off. An hour or so into the flight, you hear the flight attendant's request over the public address system, "If there are any medical personnel on the flight, please press your flight attendant call button." As medical personnel on the flight, you ask yourself, "Can I respond? Should I respond?"

Per the Federal Aviation Administration (FAA), 2.9 million airline passengers travel on an average of 45,000 flights daily in the United States. Globally, >3.5 billion passengers traveled on commercial aircraft in 2022, nearly returning to pre-COVID-19 pandemic levels.

Medical emergencies occur on approximately 1 of every 604 commercial flights. The most common emergencies include syncope or presyncope, respiratory symptoms, or nausea and vomiting. For 90% of these emergencies, aircraft continue to their destination. For the remaining 10%, however, aircraft divert to an alternative landing site, most frequently for cardiac arrest, cardiac symptoms (e.g., chest pain), obstetric or gynecologic issues, or possible stroke. The death rate for medical emergencies on commercial flights is approximately 0.3%.

Medical supplies on aircraft

U.S. carriers

The FAA mandates which medical supplies U.S. carrier aircraft flying domestically or internationally must have available onboard. Required medical supplies on U.S. carrier aircraft are listed in the Code of Federal Regulations (14 CFR, Part 121; subpart X, 121.803 and Appendix A). U.S. carrier aircrafts with ≥1 flight attendant are required to have a U.S. Food and Drug Administration–approved automated external defibrillator, ≥1 first aid kit, and an emergency medical kit (EMK) in the passenger cabin. The number of first aid kits available on an aircraft corresponds to the number of seats: 1 kit for 0–50 seats; 2 for 51–150 seats; 3 for 151–250 seats; 4 for >250 seats. Travelers should be aware that supplemental oxygen may not be available on board.

A first aid kit must contain the items listed in Box 7.2.1.

Box 7.2.1

A list of medications required in the EMK and equipment for administration can be found in Box 7.2.2. A blood pressure cuff, stethoscope, cardiopulmonary resuscitation masks, oropharyngeal airways, and a manual resuscitator for ventilation are included for use in the event of a cardiac or pulmonary event.

Box 7.2.2

International carriers

EMK contents may vary among international carriers, despite guidance from the International Civil Aviation Organization (ICAO).

Infection control supplies on aircraft

ICAO provides guidance for commercial aircraft to carry one or more "Universal Precaution Kits" containing standard personal protective equipment and supplies to clean contaminated surfaces. As these kits are not regulated by the FAA, their presence or completeness on any given aircraft cannot be guaranteed.

Legal considerations

U.S. domestic flights

The 1998 Aviation Medical Assistance Act (AMAA) of the United States protects medical personnel from damages in federal or state court for providing good-faith medical care in the event of a medical emergency. The AMAA does not cover gross negligence or willful misconduct.

International flights

Air carriers flagged in some countries (e.g., Canada, the United Kingdom, the United States) do not require medical personnel to respond to in-flight medical emergencies. Other countries state that healthcare professionals have an obligation to respond.

When responding to a medical emergency on an international flight, the AMAA might not apply. Furthermore, it is unclear what entity has jurisdiction over liability for care rendered; the country where the aircraft is registered might have jurisdiction, or jurisdiction could be based on the aircraft's geographic location at the time an incident occurs. In other cases, the medical responder's licensure country is the jurisdiction for liability. Jurisdiction might also depend on whether the aircraft was in the air or on the ground when the incident occurred. Although most airlines and countries offer protection for Good Samaritans, medical personnel responding to an emergency, even if an act of goodwill, might be at risk of litigation.

Things to consider before responding

Am I eligible to respond? For U.S. domestic flights, the 1998 AMAA defines a medically qualified individual as "any person who is licensed, certified, or otherwise qualified to provide medical care in a state, including a physician, nurse, physician assistant, paramedic, and emergency medical technician." You may be asked to provide documentation of your level of training and licensure. For international flights, which medical personnel are accepted as medically qualified may vary by country and airline.

Should I respond if I consumed alcohol (or any other substance or medication that may affect judgment) on the flight or before boarding? If you have, reconsider responding—you might be at risk for misconduct.

What is my personal level of comfort and clinical competence in evaluating a person with a medical issue? Most commercial aircraft use ground-based medical services to assist with clinical assessment and make decisions regarding severity and flight diversion. If multiple medical personnel volunteer to assist, determine who has the most relevant experience to assist the person efficiently and competently. Because responding to a mid-flight medical event may be stress-inducing for the responder, anxiety level may also impact a responder's willingness and degree of involvement.

Should I respond if I am flying on an international carrier whose flag is not the United States? The legal ramifications of delivering care to a fellow passenger or a crew member are not always clear.

Box 7.2.3 provides a checklist for medical personnel responding to in-flight medical emergencies.

Box 7.2.3

Additional considerations

Deciding to respond

For U.S.-licensed medical personnel, the decision to respond is a personal one, grounded in ethical obligation. Although the United States offers protections for medical personnel who aid ill persons in good faith, the nature of the medical issue and the possibility that the optimal medications or equipment may not be included in the first aid kit or EMK could create a difficult situation. Always be honest with the flight attendants and the pilot regarding your assessment of the ill person's condition and your degree of comfort with assisting; if needed supplies are not available aboard the aircraft, communicate this immediately. If traveling on an international carrier's flight, consider both ethics and the flight's legal jurisdiction. Also consider that if the medical event occurs at the start of a long-haul flight, volunteering may result in hours of ongoing clinical monitoring.

Do not resuscitate

If a traveler has a "Do Not Resuscitate" order, you may choose to heed this. Be aware that individual airline policies might require flight attendants to attempt resuscitation despite this documentation.

For the traveler

Travelers play a role in the prevention of in-flight emergencies. Box 7.2.4 provides recommendations for travelers to help ensure they are fit to fly.

Box 7.2.4

Disclaimer

Perspectives chapters supplement the clinical guidance in this book with additional content, context, and expert opin­ion. The views expressed do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).