What happens when a passenger has a medical emergency onboard a flight?

Rudy De Kort / 22 June 2022

The cabin of an airliner, 40,000 feet up in the sky, is a pretty bad spot to suffer a medical emergency. Yet, I can tell you why the vast majority of cases have a happy ending!

30 daily in-flight medical emergencies

Consider that in general people are older and sicker today, compared to roughly ten years ago. So is the population of air travelers all over the world. People don’t stop flying because of their diabetes, asthma or cancer. At the same time, we have more long haul flights than ever before, and even ultra long haul flights that take you from Kuala Lumpur to New York or from London to Sydney, without making a stop.

Now, for as long as air travel is affected by travel restrictions and flight cancellations, it’s not the best time to pull statistics. But, to give you a general idea, I will tell you that pre-COVID, all airlines combined, dealt with an average of 30 medical events onboard commercial flights, anywhere in the world on any given day.

Anything can happen onboard

Most medical events are minor and have a good outcome. Some common occurrences are head injuries caused by carry on luggage falling out of the overhead bins, hot liquid burns, motion sickness, elbows that are struck by a trolley, panic attacks and abdominal pain due to gas expansion.

At the other side of the spectrum, there are the more serious cases like a seizure, a mental health crisis, or an allergic reaction. In extreme cases someone delivers a child onboard, and unfortunately some passengers also suffer life threatening events while they are flying, like a sudden cardiac arrest. In fact, once every five days someone dies onboard a commercial flight, somewhere in the world. Again, these numbers are pre-COVID, when airports where packed with passengers. As we speak, many airlines are cancelling flights again due to a variety of reasons.

Duty to care for passengers

So, if you ever experience or come across an in-flight medical emergency, the chances are very real that this is not the first time that the cabin crew have dealt with one.

In general, flight attendants of reputable airlines are very well trained to provide first aid and CPR in the flight environment and as a professional group, they’ve built up a lot of experience over the years.

That’s not a matter of luck. Airlines have a duty to care for their passengers, provided that medical expertise is not readily accessible in the air. They take this responsibility very serious. Major airlines will have procedures in place to respond to common medical problems in the air, and flight attendants re-train these procedures every year.

No, they are not medical professionals, but when it comes to how the human body responds to flying at altitude, an experienced flight attendant or a commercial pilot might very well be your best friend.

They do know a thing or two about dehydration, gas expansion, low oxygen levels and thrombosis in the legs.

Emergency equipment on an airplane

Also take into account that commercial airlines around the world are likely better equipped than you might think. Of course this will vary from airline to airline, but expect the world’s main carriers to be better prepared for medical emergencies than in the past, as they have their own medical departments that make sure that their aircraft are up to date with lifesaving medical supplies.

I know from first hand experience that major airlines in North America, Latin America, Europe, the Middle East, Asia and Australia not only carry first aid kits, but also oxygen, automated defibrillators and complete medical kits that are better equipped than most ambulances in the world. Emergency drugs and intravenous fluids can be started within minutes if there are trained medical professionals on the flight.

Is there a doctor onboard?

Contrary to popular believe, grabbing the PA-system and calling for a doctor is not necessarily the first line of action if something happens. In all cases, flight attendants will step up and provide first aid to a passenger who needs help. If you are flying on a smaller airline, the crew will be more likely to ask for help from any medical professional who happens to be onboard as a passenger. And in reality, it would be a lot of bad luck, to not have any passenger onboard who has had some degree of medical training. It’s more common to have multiple passengers step up. German airline Lufthansa goes a step further and keeps a list of medical professionals who voluntarily signed up to be called upon if they happen to be flying.

There are risks involved: the airline does not have knowledge of the level of training and experience of medical staff who volunteer to help. And understandably, not all doctors, nurses or paramedics will necessarily be helpful in an emergency, despite all good intentions. Relying on the skills of random passengers is a potential liability issue.

Therefore, larger airlines have continued to look for more options to respond to their passengers’ needs, under more controlled circumstances. And that is how telemedicine is increasingly becoming a widespread tool in commercial aviation.

Doctor on the ground

There are call centers on the ground, staffed by doctors who are trained in aviation medicine. And they can be contacted 24/7. No matter where in the world a plane is flying, the pilots can pick up a satellite phone and call an aviation doctor. The doctor will tell the crew in the air what questions to ask, and what to do. And that includes very specific instructions to administer lifesaving treatment or medication from the medical kit. That way, most medical events can be controlled safely and at the same time an unnecessary emergency landing can be prevented.

If the patient needs more complex interventions, that same doctor on the ground will instruct the cabin crew to find out if there is a trained medical professional onboard who can assist. One thing is for sure: every single thing that happens onboard will be carefully documented.

To land or not to land

Ultimately, it is the captain who will decide if the flight can continue, based on different factors.

One of the considerations is that even if there is a suitable airport close by, a diversion will take time.

For example: if a passenger went into cardiac arrest at cruising altitude and high quality CPR is being performed, the first few minutes are critical for survival. Let’s assume that medical professionals onboard are able to deliver shocks and inject medication, but nothing is helping. In the best case scenario, if the plane is flying over land, it can easily take up half an hour to come down from 40,000 feet all the way to touchdown at an airport. If the plane was crossing the ocean, reaching an airport could take much longer. The patient in cardiac arrest doesn’t have that much time. If he doesn’t respond to CPR in the next few minutes, he will not survive. The most reasonable option would then be to accept the death of the passenger and continue flying. Believe it or not, Singapore Airlines even keeps a special locker onboard their aircraft where the body of a deceased passenger can be discretely stored.

Over the years I have come across some very knowledgeable airline crews, and in combination with health care professionals onboard and medical consultation on the ground, a lot can be done in the event of a medical emergency. I can’t say the same thing for every airline I have flown with. But I can easily list multiple major airlines that are very well prepared for medical emergencies.

As a medically trained professional myself, I feel at ease, that if I became ill on a flight, I would be well taken care of.

Rudy de Kort is a flight paramedic and the founder of Jet Companion, a Canadian provider of medically trained travel companions.

EVERY MILE WE FLY IS FOR THE PURPOSE OF REUNITING PEOPLE OR BRINGING THEM TO SAFETY