February 2020 President’s Message

Resources available in case of an in-flight medical emergency

by Patricia Wyatt-Harris, MD —

Has this ever happened to you? You’ve settled into your seat on an airplane. You are either getting away for a much-needed vacation or you are returning from a wonderful trip. The flight attendant then makes an announcement that you don’t want to hear:

“Is there a doctor on the plane?”

This has happened to me twice, so I know it is fairly common.

In-flight medical emergencies are estimated to occur in about one in 604 flights. This data comes from emergencies that result in ground consultations, so they really happen more frequently than that. I attended a presentation on flight emergencies at the interim AMA meeting last fall. I found the information very helpful.

The in-flight environment has an effect on physiology. Commercial aircraft usually fly at 30,000 to 40,000 feet. The cabin is pressurized to about 12 psi, which is equivalent to being at about 5,000 to 8,000 feet.

This pressurization leads to expansion of closed gas-containing spaces in the body, such as sinuses and the middle ear. At 8,000 feet the gasses in these closed spaces expand about 30 percent, so if you ate Mexican food the night before your flight, you may experience 30 percent more bowel gas on the plane.

The aircraft cabin has a low partial pressure of oxygen, and air is drawn from an outside environment. It is then pressurized and dehumidified making dehydration more common.

Allergens may be more common. Most communicable diseases come from a preexisting exposure, not from exposure on the aircraft.

What should physicians do if they hear that dreaded announcement?

Although we are not obligated to respond, most physicians want to help their fellow passengers. Another question is whether or not there are legal consequences.

In the United States, the Aviation Medical Assistance Act (also referred to as a “Good Samaritan” shield) protects passengers who provide medical assistance from liability except in cases of gross negligence or willful misconduct. Flights outside the U.S. are governed by a complex combination of laws.

Because the emergencies may not be in your chosen specialty, there is now an app for your smartphone called airRx. This app includes algorithms for treatment of common emergencies, and suggestions for medications.

Most airlines now contract with companies that provide ground consultation. The crew can contact these entities, and they will talk you through treatment.

You may be asked if the flight needs to be diverted. This is a decision that is ultimately up to the captain, but your input is very valuable. The contents of medical kits vary, but they usually have some basic medications and equipment.

I wish that I had been aware of some of these tools when I was asked to help in medical emergencies. Fortunately, the patients had good outcomes both times.

I hope your future flights are uneventful. But if you are ever called upon to provide assistance, these resources can help you feel more comfortable being part of a medical team.