What Happens When Someone On Your Flight Has A Medical Emergency

If there's a medical emergency on a flight, some planes will make an emergency landing so the passenger can get treatment. But on others, sick passengers are treated on board by flight attendants or medical personnel who happen to be on the same flight and volunteer to help.

Here & Now's Jeremy Hobson talks with Dr. Jose Victor Nable (@ERDocJV), a physician at MedStar Georgetown University Hospital, about how in-flight medical emergencies are treated.

On how often there are medical emergencies on airplanes

"Unfortunately, there isn't very much hard data on this, because there's no centralized reporting system to which all airlines need to report these issues to. Pretty much every airline in the United States has to contract with a ground-based consultation service and that's because there isn't necessarily going to be a health care provider or aboard every single flight. And in 2013, a group of researchers published a study in the New England Journal in which they queried the database of one of these ground-based consultation services that provides its service to approximately 10 percent of global airline traffic. And over about a 2 1/2 year period, there were about 12,000 in-flight medical events."

On what kinds of things cause a medical emergency on an airplane

"It varies. People experience medical issues pretty much as frequently as they do on the ground. In that study in the New England Journal, on those 12,000 events, the significant chunk of those were related to passengers who were passing out or nearly passing out. That was the most common. The second-most common were breathing issues and then the third-most common were GI or gastrointestinal-related issues, such as nausea and vomiting."

“These aircraft are not meant to be flying clinics. They're not meant to necessarily respond to every single type of medical emergency.”

Dr. Jose Victor Nable

On whether those medical emergencies were related to flying

"The fact that you are flying at altitude does, potentially, place patients at increased risk for in-flight medical events, and that's because although airlines pressurize their cabins, they're not necessarily pressurized to sea level. And for a variety of reasons, they're actually pressurized to 6,000 to 8,000 feet. So you're basically in a flying tube breathing in air that's equivalent to an altitude of 8,000 feet. It's also fairly dry. And so, as a result of that high altitude that passengers are experiencing, passengers who have underlying issues, such as respiratory issues, cardiovascular issues, are at an increased risk for developing an in-flight medical event."

On flight attendants' training for dealing with medical problems

"So, interestingly, in the 1930s, as the airline industry was starting to take off, pretty much every single flight attendant in the United States was a nurse. And that was primarily for one major reason. And it was because in the 1930s, aircraft were crashing all the time. It was a very new industry. We were not very experienced. And, as a result, they needed to have people aboard their aircraft that could calm an understandably anxious flying public. And so, as a result, they place nurses aboard all their airlines. Now, World War II happens, and this requirement, that all flight attendants be nurses was dropped, so that they could be diverted towards the war effort. Flight attendants today do receive some amount of medical training, specifically in the United States. All flight attendants are trained to do CPR, and they're also, probably more importantly, trained to recognize serious medical issues and solicit help either from the cabin, from other passengers who are flying or to contact medical professionals on the ground to say, 'Hey, we've got this guy having chest pain. What do you think we should do?' "

On whether it's common for medical equipment failures to occur

"The medical equipment that has to be on board, at least U.S.-based airlines, is set by the FAA. The FAA was mandated in 1998, the Aviation Medical Assistance Act. And that required the FAA to basically update the set of equipment that was aboard aircraft. This was around the time that automated external defibrillators were actually becoming more commonplace and cheaper. So, basically, if somebody was having a cardiac arrest or their heart stopped aboard an aircraft prior to this, it was not necessarily going to be common that these AEDs, or automated external defibrillators, would be aboard. But in 1998, this list was updated to require this. Now, it's hard to say specifically, in terms of how often these types of equipment fail. But I would say that these aircraft are not meant to be flying clinics. They're not meant to necessarily respond to every single type of medical emergency. There is very limited amount of medications and types of equipment aboard U.S.-based airlines. For example, the FAA doesn't require obstetrical supplies aboard U.S.-based airlines. And so if someone were to have an obstetrical emergency or someone were to go into active labor, there wouldn't necessarily be an obstetrical kit to help with that situation. The point of the in-flight medical kit is really to help stabilize someone such that that person can get to more definitive care in the event that aircraft needs to make an expedited landing."

“Interestingly, in the 1930s, as the airline industry was starting to take off, pretty much every single flight attendant in the United States was a nurse.”

Dr. Jose Victor Nable

On emergency landings, and who gets to make that decision

"Ultimately that is the captain's decision. It's a very complicated decision to land an airplane in an expedited fashion, or to divert that aircraft, meaning having to land in an airport other than its intended destination. Now they can take into account several factors. Since all U.S.-based airlines contract with ground-based consultation services, they can basically contact somebody on the ground, their in-house physician, who can help make that decision for them. And it's complex for a number of reasons. For example, the closest airport might not necessarily be an appropriate airport for them to land at. It's also extremely expensive to divert aircraft from its intended destination. And then, also, the patient's condition might not necessarily benefit from an expedited landing. If the situation is able to be handled aboard without having to land the aircraft earlier, then the captain might decide to keep on going."

On whether health care providers on planes are mandated to respond to events

"There's no requirement that health care providers respond. That's not necessarily true all over the world. For example, if you're a licensed health care provider traveling in the European Union, you do have a mandated responsibility to respond to these events. In the United States, that's not necessarily the case. In fact, there is no legal requirement that you do so. I would probably argue you probably do have an ethical or moral obligation to act. But this 1998 Aviation Medical Assistance Act was meant to encourage health care providers to respond by providing them with liability protection, as long as they're acting in good faith without gross negligence."

On how you should fly, with all of this in mind

"First off, our skies, for the most part, are extremely safe, both from a safety standpoint and from a medical standpoint. Even though there might not necessarily be a health care provider aboard your flight, every airline in the United States is able to pull up a health care provider at the push of a button through these ground-based consultation services. So, I wouldn't necessarily be hesitant to fly just because there's a medical emergency that's reported in the news. I would, however, caution that if you do have underlying health issues, particularly if you have respiratory issues or cardiovascular issues, it's probably a good idea to touch base with your primary care health care provider to determine if there are any sort of strategies that can help mitigate any sort of in-flight medical events. For example, passengers were patients who need supplemental oxygen while they're on the ground may need to increase that oxygen while they're in flight."