Review Article

Healthcare Professionals and In-Flight Medical Emergencies: Resources, Responsibilities, Goals, and Legalities as a Good Samaritan

Authors: Pascal Joseph de Caprariis, MD, Angela de Caprariis-Salerno, RPh, MS, Claudia Lyon, DO


Common in-flight emergencies include syncope, respiratory symptoms, nausea/vomiting, cardiac symptoms, and seizures. Flight conditions, such as changes in air pressure and humidity, can exacerbate existing chronic medical conditions. In 2017, US airlines carried 849.3 million passengers. Undoubtedly, there were many requests for in-flight medical assistance. Whenever a medical event occurs, it is standard procedure that an announcement be made by a flight attendant, requesting medical personnel to identify themselves. The 1998 Aviation Medical Assistance Act provides liability protection for a healthcare professional (HCP) acting as a good Samaritan. Nevertheless, HCPs may initially experience trepidation providing care in an aircraft. They may be unaware that a first aid kit, a emergency medical kit, and an automatic external defibrillator are on every plane. Flight crews have been trained in cardiopulmonary resuscitation, and a support system, including a ground-based consultation service, is available to provide radio assistance from an on-call physician. When multiple HCPs volunteer, the most experienced should assume leadership of care. After evaluating the ill passenger, the HCP communicates the assessment to the crew and, when necessary, to the ground-based physician. The goal of in-flight care is to medically stabilize the ill passenger and facilitate the individual’s arrival at the scheduled destination for continued medical care. When unable to stabilize the passenger’s condition, the decision to divert the plane rests with the flight’s captain. Our article helps HCPs to best understand their resources, structured support, liability, and role during an in-flight medical event. With this knowledge of resources, a good Samaritan can confidently attend to an ill airline passenger in flight.

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1. Ros M. 17 hours in the air? World’ longest airline routes. Published September 18, 2017. Accessed November 19, 2017.
2. Bureau of Transportation Statistics. Annual passengers on all U.S. scheduled airline flights (domestic & international) and foreign airline flights to and from the United States, 2003-2017. Accessed May 11, 2018.
3. 14 CFR 121.805. Crewmember training for in-flight medical events. Accessed November 18, 2017.
4. Federal Aviation Administration. Emergency medical equipment training advisory circular AC121-34B. Accessed October 28, 2018.
5. International Air Transport Association. Medical manual, 11th ed. Accessed October 28, 2018.
6. Büehrle E, Gabler A. Notfallmedizin im Flugzeug: Erste Hilfe über den Wolken. Dtsch Arztebl 2005;102:A-338-A-342.
7. Ruskin KJ. In-flight medical emergencies: time for a registry? Crit Care 2009;13:121.
8. Peterson DC, Martin-Gill C, Guyette F, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med 2013;368:2075-2083.
9. Chandra A, Conry S. In-flight medical emergencies. West J Emerg Med 2013;14:499-504.
10. Cocks R, Liew M. Commercial aviation in-flight emergencies and the physician. Emerg Med Australas 2007;19:1-8.
11. Delaune EF, 3rd Lucas RH, Illig P. In-flight medical events and aircraft diversions: one airline’ experience. Aviat Space Environ Med 2001;74:62-68.
12. Moss AJ, Longstreth WT. In-flight neurologic emergencies. Neurology 2002;58:1717.
13. Baltsezak S. Clinic in the air? A retrospective study of medical emergency calls from a major airline. J Travel Med 2008;15:391-394.
14. Szmajer M, Rodriguez P, Sauval P, et al. Medical assistance during commercial airline flights: analysis of 11 years experience of the Paris Emergency Medical Service (SAMU) between 1989 and 1999. Resuscitation 2001;50:147-151.
15. Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002;346:1067-1073.
16. Donner HJ. Is there a doctor onboard? Medical emergencies at 40,000 feet. Emerg Med Clin North Am 2017;35:443-463.
17. Lippold SA, Objio T, Kozarsky PE. Air travel. Accessed November 19, 2017.
18. Department of Transportation, Federal Aviation Administration. 14 CFR Parts 121 and 135: emergency medical equipment final rule. Published April 12, 2001. Accessed November 18, 2017.
19. Moore BR, Ping JM, Claypool DW. Pediatric emergencies on a US-based commercial airline. Pediatr Emerg Care 2005;21:725-729.
20. International Civil Aviation Organization. Operation of aircraft. Part I: international commercial air transport-aeroplanes. Published July 2010. Accessed November 19,2017.
21. 14 CFR Appendix A to part 121, first aid kits and emergency medical kits. Accessed November 18, 2017.
22. Alves PM, Evans AD, Pettyjohn FS, et al. Medical guidelines for airline travel. In-flight medical care. Accessed November 19, 2017.
23. Ruskin KJ, Hernandez K, Barash PG. Management of in-flight medical emergencies. Anesthesiology 2008;108:749-755.
24. Bukowski J, Richards JR. Commercial airline in-flight emergency: medical student response and review of medicolegal issues. J Emerg Med 2015;50:74-78.
25. Thompson CA. Pharmacists respond to inflight medical event, perhaps prevent flight diversion. Am J Health Syst Pharm 2015;72:1166-1167.
26. Sand M, Morrosch S, Sand D, et al. Medical emergencies on board commercial airlines: is documentation as expected? Crit Care 2012;16:R42.
27. Nable JV, Tupe CL, Gehle BD, et al. In-flight medical emergencies during commercial travel. N Engl J Med 2015;373:939-945.
28. Silverman D, Gendreau M. Medical issues associated with commercial flights. Lancet 2009;373:2067-2077.
29. Sánchez-Borges M, Cardona V, Worm M, et al. In-flight allergic emergencies. World Allergy Org J 2017;10:15.
30. Lovell M. In-flight medical emergencies-a difficult medical and legal environment. Accessed November 20, 2017.
31. Aerospace Medical Association Air Transport Medicine Committee. Guidance document. Medical emergencies: managing in-flight medical events. Accessed November 20, 2017.
32. Macleod S. “If there is a doctor aboard this flight…”: issues and advice for the passenger-psychiatrist. Australas Psychiatry 2008;16:233-237.
33. Federal Aviation Administration. Advisory circular: emergency medical equipment. Accessed November 19, 2017.
34. 14 CFR 25.1447. Equipment standards for oxygen dispensing units. Accessed October 28, 2018.
35. Thibeault C, Evans A, et al, Air Transport Medicine Committee. Emergency medical kit for commercial airlines: an update. Aviat Space Environ Med 2007;78:1170-1171.
36. Chatfield E, Bond WF, Thibeault C, et al. Cross-sectional survey of physicians on providing volunteer care for in-flight medical events. Aerosp Med Hum Perform 2017;88:876-879.
37. Shepherd B, Macpherson D, Edwards CMB. In-flight emergencies: playing the good Samaritan. J R Soc Med 2006;99:628-631.
38. Reyes NL, Beckman MG, Abe K. The Pretravel Consultation Counseling & Advice for Travelers: Deep Vein Thrombosis & Pulmonary Embolism. CDC.
39. Aviation Medical Assistance Act of 1998. Public Law 105-170. Accessed November 19, 2017.
40. Stewart PH, Agin WS, Douglas SP. What does the law say to good Samaritans? A review of Good Samaritan statutes in 50 states and on US airlines. Chest 2013;143:1774-1783.
41. Noel AA. Medical events during airline flights. N Engl J Med 2002;347:535-537.
42. Graf J, Stüben W, Pump S. In-flight medical emergencies. Dtsch Arztebl Int 2012;109:591-602.
43. Kovac C. Airline passenger dies after being sedated by doctor. BMJ 1999;318:12.
44. Baldwin D. Emirates diverted 60 of 194,000 flights over medical emergencies in 2016. Published February 7, 2017. Accessed November 19, 2017.
45. Mattison MLP, Zeidel ML. Navigating the challenges of in-flight emergencies. JAMA 2011;305:2003-2004.
46. Katzer RJ, Frumin E, Silverman D, et al. In-flight medical emergencies: creation of a novel simulation based medical student curriculum. Published April 22, 2013. Accessed October 28, 2018.
47. Katzer RJ, Duong D, Weber M, et al. Management of in-flight medical emergencies: are senior medical students prepared to respond to this community need? West J Emerg Med 2014;15:925-929.
48. Chandra A, Conry S. Be prepared for in-flight medical emergencies. Published August 1, 2010. Accessed February 20, 2018.
49. Ludmir J. The challenge of in-flight emergencies. Published August 4, 2011. Accessed February 18, 2018.