Medical emergencies on airline flights

In 2013, the New England Journal of Medicine published a study on the frequency and characteristics of in-flight medical emergencies involving large commercial airlines that not only provide an insight into what kind of medical emergencies happen during a flight, but that also provides guidance for medical professional who may be in a position to provide aid.

Below are key findings from the study, as well as information that would be of interest to medical professionals and emergency personnel who may be in a position someday to help someone during a flight.

Highlights of the study
The researchers collected data from about 7.2 million flights from the beginning of 2008 to the end of October 2010. These flights represented about 10% of all airline flights from the period. The most noteworthy findings from the study included the following:

• There were 11,920 in-flight medical emergencies, or about one emergency per 604 flights
• 36 cases resulted in a passenger death, with 31 of the 36 deaths due to cardiac arrest
• 31 of the 36 deaths involved cardiac arrest
• 875 of the fights with a medical emergency resulted in an aircraft diversion
• 24 cases involved women in labor, and three of those cases resulted in an aircraft diversion
• 2,804 passengers were transported to a hospital and 901 of them were admitted
• Findings suggest that about 44,000 in-flight medical emergencies occur each year worldwide

How often are medical professionals on board a flight?
The study implied that some kind of medical professional provided assistance over 75% of the time:

• Physicians - 48.1%
• Nurses - 20.1%
• EMS providers - 4.4%
• Other health care professionals - 3.7%

These figures appeared to include only the highest level medical provider. The study did not provide details about how often multiple providers were available. Also, the study did not estimate how often a health care professionals may have been on board the aircraft, but did not volunteer to help.

What kind of medical equipment is required on aircraft?
In the US, the FAA requires airliners to have on board both and Emergency Medical Kit (EMK), which has a variety of drugs and medical equipment, and an Automated External Defibrillator (AED) to deal with cardiac events.

The requirements, as well as a detailed list of the contents of the EMK, are contained in FAA Advisory Circular AC 121-33B. While all US airliners are required to have the minimum equipment, some may have additional medical equipment on board, and may also have a system allowing communication with ground-based medical professionals.

Are passengers who are medical professionals required to help during a medical emergency?
While the laws will depend on where an aircraft is operating, in the US, passengers, including medical professionals or first responders, are not legally required to help the cabin crew or flight crew during a medical emergency.

Can someone be sued because of their actions during a medical emergency?
The answer will again depend on where the event takes place, but in the US, the law protects passeners who offer medical assistance from any legal liability, so long as their actions don't involve gross negligence or willful misconduct. passengers, including medical professionals or first responders, are not legally required to help the cabin crew or flight crew during a medical emergency.

Suggestions for health care professionals and first responders
The authors of the study believe that health care professionals should be aware of their potential role as volunteer responders to in-flight medical emergencies.

AirSafe.com recommends that medical professionals, including physicians, physician assistants, nurses, paramedics, emergency medical technicians; as well as police officers, firefighters, and other first responders do the following:

• Be willing to volunteer if there is a need for your services
• Be aware that in the US, you have protection from legal liability so long as your actions don't involve gross negligence or willful misconduct
• Become familiar with the contents of a typical airline Emergency Medical Kit (EMK) and with the operation of an Automated External Defibrillator (AED)

Key points from the study

Source
Outcomes of Medical Emergencies on Commercial Airline Flights
Drew C. Peterson, Christian Martin-Gill, Francis X. Guyette,
N Engl J Med 2013; 368:2075-2083May 30, 2013