Airlines are not obligated to report in-flight medical emergencies, as such published statistics may differ from actual occurrences. Nevertheless, a 2013 study published by the New England Journal of Medicine (NEJM) found 12,000 in-flight medical emergencies among 744 million airline passengers of large commercial airlines.

A similar study by the University of Pittsburgh Medical Centre (UPMC) found that almost half the time a medical doctor responded. Among a total of 12,000 in-flight medical emergencies, 36 resulted in deaths. The NEJM study reported that only 7% of these emergencies required emergency flight diversion.

Is there a doctor on board?

Dr Keith Van Meter stepped up to help an unresponsive man with two colleagues while on flight. Their efforts to administer CPR and epinephrine were unable to sustain a pulse. Under the stares of fellow passengers, Meter and his colleagues administered CPR for a half hour before the plane landed. Miraculously, the patient survived.

Not all in-flight medical emergencies end well, as was the case for Dr John Knight, who was paralysed by the lack of equipment to help an unresponsive patient. Without a defibrillator, he could not stop the patient’s arrhythmia, and was traumatised by the death of the patient.

“Immediately after the incident, I lobbied Congress, the National Transportation Safety Board, and the FAA to ask that airlines expand their medical kits and change their protocol.”

What doctors should know

Flight attendants are trained to administer CPR, and may be experienced in such situations, so a doctor should offer assistance rather than immediately taking charge.

A review article published in the NEJM recommends getting patient permission, requesting flight diversion if the patient’s condition is critical, and keeping a written medical record of the encounter.

Common emergencies encountered in-flight are syncope, respiratory and cardiac symptoms, nausea, and vomiting.

Although there are no international regulations for in-flight medical kits, a standard emergency medical kit usually includes a stethoscope, syringes, intravenous catheters and commonly used medications.

Furthermore, increasing numbers of airlines now utilise the services of remote emergency response centres like MedAire, providing further help to physicians encountering in-flight medical emergencies. The company provides round-the-clock medical help to airlines via call centres staffed by emergency physicians.

When a passenger dies mid-flight, it becomes an operational decision, according to Dr. Paulo Alves, the global medical director of aviation health for MedAire. The decision to proceed with the flight will depend on level of disruption to other passengers. "As much as possible, they’ll try to put the body back on a seat," he said. Placing the body in a restroom is not recommended, as rigor mortis may complicate removal.

Should doctors answer the call?

According to flight attendant Heather Poole: “There have been times I've had a medical emergency, called for a doctor and no one rang their call light,” Poole said. “Not everyone wants to volunteer. They'll sit and pray someone else answers our calls. That's why I keep trying.”

With little equipment or knowledge of the patient’s medical history, doctors are hesitant to help. “But what if I was the only doctor on the plane? The patient may be much worse off if he or she did not receive any medical attention,” said Dr Clement Lau.

There are also major concerns regarding legal liability. Fortunately, many airlines including those in the UK, Australia and Malaysia will indemnify medical volunteers against legal liability. There are also no documented cases of physicians being sued for providing medical assistance in-flight. MIMS

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