In-flight Emergencies: Is There a Doctor On Board?

At the AMA meeting this week in in Chicago, a vigorous debate regarding physician response to in flight emergencies ensued. Many of the physicians in the room recounted emergencies that occurred while they were passengers on a plane. I got the sense that outside of a few physicians that were members of the Aerospace Medical Association, a group that had recently been involved in standard setting for the response to an in-flight emergency, most physicians were frustrated by the lack of understanding, expectation, and available medical supplies and equipment to help a patient in distress.

I learned from my Aerospace Medical Association colleagues that there are uniform rules among domestic airlines that define a medical bag with certain supplies, but not an Epi-Pen, or a blood glucose meter. I also learned that the stethoscopes on airlines generally are not adequate, and that the airline crew responds to physicians volunteering to help with a degree of skepticism about their credentials.

I have been involved in a few in-flight emergencies, one several years ago on a transatlantic flight and another couple of occasions recently on domestic flights. These "emergencies" were minor but in all of these situations, I felt my ability to act as a physician was severely compromised by the lack of training, communication, experience of the crew, and the equipment on the airplane. Ironically and very sadly, as I returned home earlier this week, a passenger on a plane to Chicago died in flight.

The time has come to educate physicians and allied medical personnel about the most common in-flight emergencies, the expectations of the physicians and crew, and the availability of the diagnostic equipment and treatments. These guidelines for medical personnel involvement should be standardized and publicized across the airlines industry, both domestic and international. This will assure responses from physicians and flight crew are uniform and effective.

We will never be able to prevent every in-flight tragedy, but we can be better prepared to act within our training and recognized guidelines to deal with emergencies in an appropriate manner.