Mitigate Inflight Medical Emergencies With a Proactive Approach

Most pilots are formally trained for every type of routine and emergency situation. But an inflight medical emergency is usually not among them.

There currently are no federal requirements for any emergency medical training. After all, the chance of a passenger suffering a serious medical problem is minimal.

“From the studies we’ve done, there is a 1-in-604 chance that a commercial flight will have an inflight medical event,” explained Dr. TJ Doyle, M.D., MPH, medical director, communications and aviation consultation at University of Pittsburgh Medical Center/STAT-MD Services. “On the business aviation side, the frequency is orders of magnitude smaller, simply because the passenger count is so much lower.”

As one chief pilot for a Part 91 operator said, “An inflight medical emergency is so rare that our management doesn’t think it’s worth the added investment in specialized training for our crews. But, when we hire a contract cabin attendant, we prefer that they have some medical training like performing CPR.”

Related article: Inflight Connectivity for Remote Medical Treatment Is Evolving

Known Conditions Versus Medical Emergencies

While inflight medical issues are uncommon, it’s beneficial for flight crews to be aware of what types of problems are more likely to be encountered than others, said Doyle.

“The most common are syncopal events, which are those where someone feels like they are going to pass out,” he said. “There’s also a condition called vasodilation [dilation of blood vessels] where someone’s blood pressure goes down quickly, causing light-headedness or fainting.”

He also mentioned respiratory symptoms caused by lower oxygen levels in the aircraft’s cabin, followed by gastrointestinal issues like nausea and/or vomiting.

But how do you determine what is a reaction related to a known medical condition and what is an emergency? “A medical ‘condition’ refers to a health issue a passenger may already have, typically stable and managed through regular treatment or medication,” explained MedAire Global Medical Director Dr. Justin Devlin. “These conditions can range from chronic illnesses like diabetes or hypertension to temporary ailments such as a cold or minor injury.

“A medical ‘emergency’ is an acute situation that requires immediate attention due to its potential to be life-threatening or cause significant harm,” Devlin said. “Examples include heart attacks, severe allergic reactions or sudden loss of consciousness. Understanding this distinction is crucial for flight crews to assess and respond appropriately to passenger health needs during flights.”

Also, before each flight, awareness of any passenger’s known medical conditions will help prepare the crew for potential trouble. “Encouraging a culture of open communication regarding health issues is highly beneficial, especially in the context of business aviation, where passengers may include colleagues, executives and private individuals,” Devlin said. “A proactive approach allows flight crews to prepare to recognize signs and symptoms of potential medical issues.”

A condition that is “easily controlled on the ground” can worsen to an elevated state by just being in the air, Doyle said. “Some respiratory conditions, like COPD or pulmonary fibrosis, can become issues just because of the lower air pressure, so being at altitude can exacerbate a person’s situation.”

MedAire’s Fit-to-Fly service can help passengers and crew members understand any possible issues, Devlin said. “A member of our medical team assesses passengers’ fitness for travel, mainly if they present conditions that may deteriorate during the flight,” he said. “Additionally, our Trip Watch service combines flight and passenger information, enabling MedLink doctors to be prepared in advance should the flight require medical assistance.”

Related article: Training Your Passengers for Emergencies

Consider These Items for an Inflight First Aid Kit

Doyle also explained that because the many airborne medical issues are common, it’s a very good practice to complement your aircraft’s first aid kit with an array of over-the-counter (OTC) medications, including:

• Pain relievers
• Antihistamines
• Gastrointestinal medications
• Anti-nausea medications
• Portable oxygen

“Because these are OTC medication and not prescriptions, the cabin crew doesn’t require any medical training to administer them to passengers,” Doyle said. “Speaking of prescriptions, if a passenger has a specific need, like nitroglycerine or nausea medications, they should bring them on the aircraft and tell the crew so they can help in the event of an emergency.”

Medical Considerations for International Flights

For non-U.S. operations, rules and regulations about administering inflight medications may differ. “Preparing for international flights involves several key steps for flight departments,” said MedAire Vice President of Aviation Health Dr. Paulo Alves.

“Firstly, it is crucial to understand and comply with the specific regulations of each destination’s civil aviation authority, which may differ significantly from domestic requirements,” he continued. “This includes ensuring all necessary documentation, medical supplies and safety equipment are in place. Different destinations may have varying types of medications available, access to these medications, and rules governing their use, which must be carefully navigated.”

Having a Medical Professional On-Call

Having a trained, medical professional available on-call is optimal. According to Doyle, whether flying domestically or internationally, having a ground-based medical support service is something every operator should consider.

“They can provide a qualified medical professional who can not only provide instructions for the inflight situation but, more importantly, if you need to divert, they can aid in locating the best alternate destination based on where you are,” Doyle said. “Having that kind of professional support takes a lot of stress off the flight crew.”

Review the NBAA Buyers Guide: Medical Services