What Happens During A Medical Emergency On A Flight?

Medical emergencies on flights are relatively uncommon, but they do happen from time to time. With limited access to medical equipment and potentially longer times to reach professional care, airline crews have to be trained to deal with a whole host of eventualities. We take a look at what happens when someone needs medical help on their flight.

Emirates A380 with Ambulance
How for airlines manage medical emergencies? Photo: Getty Images

How often do medical emergencies happen?

Medical emergencies are not particularly common. According to a study in the New England Journal of Medicine, only around one in every 600 commercial flights will have some sort of medical encounter during the journey. Even so, that does mount up to some 44,000 flights per year worldwide, which means airlines need to be prepared for them to happen.

Some medical emergencies are heartbreaking, such as the case of the president of American Express, Ed Gilligan, who died from a sudden heart attack on a flight in 2015. Understandably, in the most severe of cases, access to rapid treatment on aircraft is limited. However, these are thankfully very rare.

According to the study, the most common types of emergency were nausea, fainting, and respiratory problems. The study concluded that among all passengers who had experienced a medical emergency in flight, less than 1% proved to be fatal.

What sort of emergency?

Broadly speaking, medical emergencies that occur during a flight can be placed into one of two categories – health-related or injury-related. Health issues can range from anxiety about the flight or feeling dizzy and faint to significant incidents like a heart attack or severe allergic reaction. Injuries, on the other hand, can include scalds from hot drinks through to injuries following severe turbulence and even onboard fights.

Cabin crew are trained to administer first aid and have some basic resources onboard such as bandages and cold packs. However, they are not paramedics and do not have the training or equipment to deal with the most severe incidents. As such, all airlines must have strict protocols in place so that the crew know exactly what to do in the event of a medical emergency.

Emirates cabin crew first aid
Cabin crew are extensively trained to administer first aid. Photo: Emirates

What happens when someone is in medical distress?

The first action that needs to happen is for the person to be identified by the cabin crew as being in medical distress. This can sometimes be something the cabin crew do themselves, but more frequently the passenger themselves, a traveling companion, or a nearby passenger will raise the alert.

At this point, all cabin crew will be made aware of the situation, as will the Captain. The first crewmember on scene will begin to assess the patient, and call for others to retrieve the appropriate items of first aid equipment.

The response from there on will depend on the severity of the situation. Cabin crew are trained to go through the typical A, B, C’s of first response (airway, breathing, circulation). The outcome of these checks will determine what actions need to happen next.

What medical assistance is onboard?

Airlines usually have a pretty comprehensive suite of first aid products, although it does vary between jurisdictions. For the United States, for example, the FAA publishes the following list of items that must be in the first aid kit before the plane is allowed to push back from the gate.

FAA First Aid equipment list
The minimum equipment list in the US. Image: FAA

While some of those items might sound confusing, they are designed to deal with the most common incidents. Antihistamines will help with allergic reactions, while analgesics will help with pain. Other items can begin stabilizing irregular heartbeats or assist with rescue breaths if the passenger stops breathing.

This is the most basic list of what airlines need to carry, but many go much further. Some may choose to carry anti-nausea medicine, glucose to treat low blood sugar, and EpiPen’s for the most severe allergic reactions. Some even carry Naloxone, a nasal spray to treat opioid overdoses.

Airline first aid kit
Aircraft carry well-stocked first aid kits. Photo: KLM

Down on the ground, Automated External Defibrillators (AED) are often found in local shops and public buildings. The FAA has required US airlines to carry AEDs since 2004. At present, there is no requirement for non-US airlines to carry these devices, but many do anyway. According to APH, airlines with AEDs onboard include Air France, Aer Lingus, British Airways, ANA, Etihad, and many more.

Is there a doctor onboard?

If you’re a frequent flyer, chances are you’ve heard the request for any doctor onboard to make themselves known to the cabin crew at least once. This doesn’t mean that it’s a life or death situation; it’s all just part of the process. Research has shown that there are doctors onboard as many as 70% of all commercial flights, so the chances of someone being present are pretty high.

For anything more than a very minor ailment, the in-charge flight attendant will call for a doctor over the PA. This will allow them to have a professional diagnosis made, and recommendations laid out for the next course of action. If there is no doctor onboard, many airlines have links with emergency medical service providers who can be reached via satellite phone or radio phone to advise on the situation.

British Airways CPR
Crew will request the help of any doctors onboard to diagnose the patient. Photo: Tom Boon | Simple Flying

With support from medical professionals, the crew should now be able to determine what to do next. The medical personnel will also be able to advise on whether it is safe to continue the flight with the passenger receiving onboard support, or whether a diversion should be considered.

Diverting the flight

Based on the information received from cabin crew and the doctor onboard or from the remote support agency, it will be the Captain’s final decision as to whether to divert the flight. Other factors will come into play here, such as the phase of the flight, the distance to destination, and the proximity of a suitable alternative airport.

Other issues can influence the decision to divert, such as what facilities are at the diversion airport, whether the aircraft will be overweight to land there, whether an appropriate medical response will be able to attend on landing, and much more. It’s a complex set of parameters that require some serious thought by the Captain.

France aircraft with ambulance
The Captain will have to ensure there is suitable assistance at the diversion airport. Photo: Getty Images

Diversions usually only take place in the most serious of situations. Diverting a flight causes delays and is costly to the airline. Emirates previously stated that a single flight diversion can cost it anything from $50,000 up to $600,000 or more, depending on the situation.

Whether or not a diversion is instigated, if the Captain considers that the flight should receive priority from air traffic control when it approaches its destination airport, the flight crew should immediately implement Emergency Communications protocol. This includes declaring MAYDAY or PAN PAN as appropriate.

Passengers can do their bit to facilitate a safe flight by ensuring they are fit to travel. They should carry necessary medication in their hand baggage, including inhalers and EpiPens, and should advise the airline of any severe allergies before traveling. In general, flying is very safe, and the vast majority of airline passengers enjoy their trips without incident. In the rare event of a medical emergency taking place, passengers should rest assured that their crew are perfectly positioned to take care of their needs.