More than a billion people travel by air each year, and just like the population in general, this massive group of travelers is aging. In addition, more and more seniors are flying than ever before, a trend that is worrying doctors about in-flight emergencies that they are increasingly being called upon to treat.
In a 2012 paper in Clinical Geriatrics, health policy professor Richard Stefanacci outlines the growing challenges for physicians – as travelers themselves – when they’re pressed into service to help a fellow passenger in distress, as well as the responsibilities that older people bear, to ensure they’re well enough to fly.
Stefanacci’s review adds to a growing body of research that suggests more consistency among airline procedures, reporting, training, and onboard equipment is necessary for the health and protection of all air travelers.
Fortunately, while the rate of onboard deaths doubled from 2002 to 2005, according to Stefanacci, they remain relatively rare. Onboard emergencies of all kinds are on the rise: a 2011 paper by Harvard Medical School professors Melissa Mattison and Mark Zeidel, published in the Journal of the American Medical Association, cites a survey of European airlines that revealed 10,000 medical emergency events over a period of five years.
Certain regulations, such as the move in 2001 by the US Federal Aviation Administration (FAA) to require airplanes with at least one flight attendant to carry an automatic external defibrillator, have improved outcomes significantly. But authors Mattison and Zeidel are critical of current practices, and write that there is substantial room for improvement in how onboard medical emergencies are handled.
Types of inflight emergencies: While several researchers lament the lack of standardized recording of such emergencies -- making a reliable tally difficult to find -- there are surveys and reports that give us information about which medical problems are most common.
The biggest cause of in-flight deaths: cardiac issues, including heart attacks. The most common onboard emergency, according to Stefanacci’s paper, is temporary loss of consciousness, or fainting. Other problems include hyperventilation, cardiac symptoms like shortness of breath and chest pain, gastrointestinal issues, and complications due to diabetes. While many older travelers are aware of the risk of deep-vein thrombosis, a potentially life-threatening blood-clotting disorder, only about 200 cases world-wide were reported from 1993-2003, according to the international Aerospace Medical Association (AsMA)in its Medical Guidelines for Airline Travel.
Is there a physician on board? If a medical emergency arises on a flight, the captain is likely to put out a call on the public address system to see if a doctor is available to help. Surprisingly – since whether a doctor is onboard is a matter of chance – a 1991 FAA study found physicians were available in 85% of the recorded emergencies.
Passenger physicians are typically protected by Good Samaritan laws, as long as they don’t overstep their area of expertise, and are not intoxicated. They are viewed as volunteers, complementing the efforts of the cabin crew, rather than overriding them.
Onboard emergency kits: Currently the FAA requires a number of elements to be carried in emergency kits on board US commercial aircraft. These include equipment like syringes, needles and stethoscopes, as well as medication like nitroglycerin for heart failure and angina, epinephrine, and antihistamines to combat allergic reactions. Many airlines augment their emergency kits with additional components.
Challenges for onboard physicians: Just taking a patient history in the cramped quarters of the cabin can be tough for a doctor, when called to help. The JAMA report cites several additional challenges faced by physicians treating fellow passengers.
- Limited space available to treat the ill passenger
- The onboard emergency kit not being readily available
- Unfamiliar layout and content of the emergency kit
- Flight attendants unavailable to help
In addition, Stefanacci lists the lack of availability of diagnostic and treatment tools, and supporting medical staff, as well as physiological changes that can occur with lower barometric pressure and relative humidity at 30,000 feet, as factors making a physician’s job more difficult.
Recommendations to improve passenger patient care: Harvard professors Mattison and Zeidel make a number of industry-wide suggestions to ensure improved outcomes in the event of an onboard emergency:
- A standardized system to record all in-flight emergencies, with mandatory reporting to an agency such as the US National Transportation Safety Board
- Follow-up debriefing of all staff and physicians involved in the emergency
- Design of a standardized emergency medical kit, with all components packed in standardized fashion so they’re identical on every plane and easy to navigate for a physician
- Improved training for flight attendants in how to assist medical personnel during an emergency
- Assignment of one flight attendant to a patient in distress
- Standardized access to land-based medical support for flight crews (currently many, but not all, airlines subcontract such services in the event a physician is not onboard)
- Ongoing revision of emergency procedures
What older travelers can do: While standardized protocol may help you survive an in-flight medical problem, the best approach is to try and avoid an emergency in the first place. Stefanacci and others recommend a pre-flight evaluation by your physician or health-care provider, to ensure you’re fit for travel. For advice on specific conditions, like heart disease and diabetes, as well as flight considerations for patients who’ve recently undergone surgery, consult AsMA's publication Medical Guidelines for Airline Travel: 2nd Edition by clicking here. Safe travels!
Keith J. Ruskin, Keith A. Hernandez, and Paul G. Barash. “Management of In-flight Medical Emergencies.” Anesthesiology 2008; 108:749 –55.
Melissa L. P. Mattison and Mark Zeidel. “Navigating the Challenges of In-flight Emergencies.” JAMA. 2011;305(19):2003-2004
Medical Guidelines for Airline Travel, 2nd Edition. Aerospace Medical Association (AsMA) Public Information Sheet. Accessed June 29, 2012.
Stefanacci RG. “Caring for older adults at 30,000 feet.” Clinical Geriatrics. 2012;20(5):24-28.
Tony Goodwin. “In-flight Medical Emergencies: An Overview.” BMJ 2000 November 25; 321(7272): 1338–1341.