High-altitude health care: Navigating in-flight medical emergencies - The DO (2024)

Editor’s note: This article is a follow-up to Dr. Dillard’s first piece on emergency medical care during air travel, which covered the ethical and legal considerations for in-flight emergency medical care.

As our world becomes more connected through airplane travel, in-flight medical emergencies are becoming a more common occurrence. For physicians, it is helpful to know the capabilities and equipment of the flight crew and the aircraft in advance of being asked to provide assistance. Knowing the common conditions associated with flying can also prepare a physician for an emergency should it occur.

The Federal Aviation Administration (FAA) has a list of medical equipment that is required to be on every aircraft, which is listed in a table below. While it may be helpful to be familiar with these supplies, it is important to note what is not present in the medical kits as well.

Filling in the gaps

Noticeably absent is easy-to-use EpiPens for anaphylaxis. The epinephrine in the medical kit must be diluted in saline to be administered. There are no antiemetics present either. However, there are alcohol pads, which can be sniffed to assist with nausea.

Some of the provided equipment may not be ideal for use by some physicians. A critical piece of equipment that is missing is a glucometer. However, diabetic patients often bring their testing supplies with them in their carry-on. Also, the stethoscopes are typically disposable and not as high-quality as what one may use in their primary clinic. Loud airplane noise and the low quality of the stethoscopes can make it difficult to auscultate for cardiac sounds and breath sounds.

Aside from the FAA-required medical supplies, many aircrafts also carry oxygen, which can be administered to hypoxic patients. Importantly, in cases of cardiac arrest, all aircrafts are equipped with AEDs. Individual airlines have also started adding additional equipment in addition to the standard equipment. For example, Delta Air Lines has added automated blood pressure cuffs, digital thermometers and pulse oximeters to their medical bags.

Medications and management

Some medicines that physicians can consider bringing on an aircraft include anti-diarrheal drugs such as Imodium, pain relievers such as ibuprofen, cough drops and nasal decongestants. Patients often carry their own EpiPens, meclizine and prescription antiemetics; if helping a patient with an allergic reaction, nausea or dizziness, physicians can check to see if they brought their own medication on the plane.

It is also important to understand how the flight crew responds to an in-flight medical emergency. Most medical problems that arise on an aircraft are minor in nature and are usually handled by the flight crew without relying on medically trained passengers. The flight crew is trained in basic first aid and CPR and receives re-education periodically. However, they are not required to obtain a formal CPR certification.

Leading in-flight emergencies

One of the most common triggers for a call for help in an in-flight medical emergency is syncope. Although the differential for syncope is broad, in most cases it tends to be harmless and can usually be attributed to vasovagal syncope or volume depletion. After obtaining vitals and performing a comprehensive physical exam, patients can be given oral fluids. Sometimes, it may be of benefit to administer a drink with sugar in case the patient is hypoglycemic.

The next big category is GI upset. This is usually caused by motion sickness. Patients can be administered an oral antihistamine from the FAA medical kit or sniff the medical kit’s alcohol pads to assist with nausea and vomiting.

Allergic reactions, while common, are typically minor in nature and rarely require diversion of the aircraft. Common triggers on planes include pets (dogs and cats) and nuts. Patients can be administered antihistamines from the emergency kit. For more severe allergic reactions that lead to anaphylaxis, epinephrine would be indicated.

More rare events include complaints like chest pain. Due to the lack of medical and diagnostic equipment, patients may need to be administered aspirin if acute coronary syndrome is suspected and the plane must be diverted to the nearest airport for further stabilization in a hospital. Cardiac arrests during flights are extremely rare, but if one occurs, the standard CPR/ACLS protocols should be followed.

Know before you go

In summary, in the event of an in-flight medical emergency, it is helpful to have an understanding of the aircraft’s medical supplies and the capabilities of the flight crew. It may be wise to bring additional medications with you on a flight to be better prepared for an emergency. While rare, most medical events on an aircraft are typically benign in nature.

FAA-required emergency kit supplies for U.S. aircrafts

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