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by Amanda Castleman, AARP, April 27, 2022
Konstantin Labunskiy / Alamy Stock Photo
A 52-year-old Boeing executive from Washington state experienced a traveler’s nightmare in 2012: He had a heart attack while flying home from Dubai to Seattle on United Arab Emirates. The crew had a beyond-bare-bones medical kit with an electrocardiogram machine on board, but too weak a Wi-Fi signal to transmit the files to the MedAire health consultants on the ground. Fortunately, an American EMT on board could read and relay the information to the doctors, who then determined the patient needed immediate attention at a hospital.
The captain had two options on where to divert the plane based on the flight’s path: Baku, Azerbaijan, or Tehran, Iran. He settled on Tehran, since that route allowed him to dump fuel over the Caspian Sea and then land safely — plus, MedAire’s database showed the city had top-notch hospitals for dealing with this sort of emergency. An ambulance met the plane on the runway and took the passenger to the hospital, where doctors treated him with drugs to prevent arterial blockages and performed an angioplasty. They then cleared him to fly home and recuperate in Washington state.
At any time, roughly 1 million airline passengers are airborne, and some experience medical crises. While it’s not likely — there’s an average of one such incident per 604 flights, according to the Journal of the American Medical Association — many fliers are nervous about the possibility that they’ll have some sort of health issue while stuck 32,000 feet in the air. That’s a long way from an emergency room.
“This is a virtual city suspended in the sky. You’re going to see things,” says Paulo M. Alves, M.D., global medical director of aviation health for Phoenix-based MedAire. But when medical issues occur, Alves stresses that airlines have several resources at hand, including the type of ground-to-air consultations his company’s highly trained teams provide cabin crews.
As a result, deaths are rare: Only 1 in 8 million travelers pass away in midair.
“The severe events that we deal with most often are cardiac arrest and stroke,” says Taylor Garland, a spokesperson for the Association of Flight Attendants-CWA in Washington, D.C. “Mental illness and addiction [overdoses] are also becoming more common.”
Other emergencies often occur because the in-flight environment can exacerbate health issues. Planes are pressurized and conditions resemble the effects of being at 5,000 to 8,000 feet in altitude, which means slightly less oxygen than sea-level dwellers may be accustomed to. This most commonly can cause fainting, gastrointestinal issues and wooziness, but it can also aggravate respiratory and cardiovascular symptoms. “These things happen in regular people’s lives. There’s nothing magical about the airplane, except it just stresses the system a little bit,” says Lewis S. Nelson, M.D., chair of the department of emergency medicine at Rutgers New Jersey Medical School in Newark.
To ensure that members of their in-flight teams can handle the unexpected, all major carriers teach them basic first aid, which includes administering CPR and supplementary oxygen. “[Our] crew members are also trained to administer automated external defibrillators,” adds a Singapore Airlines spokesperson.
The U.S. Federal Aviation Administration doesn’t require extensive medical kits on board, but it does mandate certain supplies to help crew members handle health emergencies. The must-haves include assessment tools such as stethoscopes, as well as adhesive tape, analgesics, antihistamines, bronchodilators, lidocaine, nitroglycerin, saline and tourniquets. It also requires IV lines (used when hypotension sets in from dehydration, hemorrhaging or other causes), but they can only be administered by qualified medical professionals. Pilots or flight attendants will sometimes make an announcement asking if anyone on board has medical training and is willing to help.
When even more professional assistance is required, cabin crews turn to companies like MedAire, a leading provider of (among other services) medical training and in-flight emergency assistance to the airlines, for their expertise. “It’s helpful to have live advice from medical personnel who understand the effects of altitude on human physiology, the constraints of the aircraft environment and the types of training we receive — and who have intimate knowledge of the equipment we have to work with,” Garland says.
MedAire even has an app that walks crew members and volunteers through diagnostic steps and collects key data for its specialists on the ground.
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Whenever someone faces a life-threatening emergency in flight, the captain decides whether to divert the plane, explains Kevin Karpé, a principal at Diverse Vector Aviation Consulting in San Marcos, California. Diversions happen in only about 7 percent of incidents, according to experts at the University of Pittsburgh School of Medicine.
When a diversion is deemed necessary, the captain suggests a route and the best time to begin a descent to air traffic controllers. “They will literally move other aircraft out of the way in order to accommodate the emergency and provide a direct path to the airport, and will coordinate emergency personnel to access the aircraft as soon as possible after landing,” Karpé says. From there, about a quarter of patients are transferred to a hospital by ambulance, where only 9 percent are admitted.
Worried about possibly suffering an in-flight emergency? Alves says the best defense is a good offense: When in doubt, consult a doctor before traveling. Lots of factors — like being stuck in traffic, carrying luggage, rushing at the airport and fear of flying — can stress your body. Aircraft pressurization adds to that, with effects similar to what lower-altitude residents might feel when arriving at the mile-high city of Denver or even loftier destinations.
Other tips from medical experts: Get cleared by your doctor for take-off if you’ve recently had abdominal, brain, chest or eye surgery. Then stay alert and notify a flight attendant should anything seem amiss. Likewise, be cautious if you have a condition — even a borderline one — that is oxygen-dependent, such as COPD, severe anemia or cardiovascular or respiratory diseases. Also be mindful when sitting still for four hours or longer because immobility can cause blood clots (deep vein thrombosis) or a pulmonary embolism. The Centers for Disease Control and Prevention recommends compression socks and frequent leg movements if you have risk factors such as being older than 40, overweight or on hormone replacement therapy.
“Long story short, if you’re unsure of your health status, don’t fly,” Alves says. “Please don’t do it, because you’re exposing yourself to the effects of altitude, and now you’re in a remote situation with scarce medical resources.”
Seattle-based freelance writer and photographer Amanda Castleman also contributes to Afar, National Geographic and The New York Times. She founded the online academy Write Like a Honey Badger, which teaches storytelling and promotes representation in the media.
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