Is there a doctor onboard?

medical emergency
5 min read

Starting 11 October, Singapore Airlines’ newest plane, the Airbus A350-900ULR will travel on a record-breaking, globe-spanning flight that will reconnect Singapore to New York, nonstop in almost 20 hours.

While it is worth marvelling at the advancements in aviation technology, travellers might understandably wonder what might happen if they—or fellow passengers—experience a medical emergency during such a long journey.

From minor stomach upsets to life-threatening situations, the Association of Southern African Travel Agents (ASATA), takes a closer look at what happens when there is a medical emergency onboard.

Medical stats

The stats

Unbeknown to most of us, in-flight medical emergencies on commercial flights occur every day.

In 2013, it was estimated that 44 000 such events occurred worldwide every year. And, with air travel on the rise, the aging of the population, and the increasing number of air travellers with acute or chronic illnesses, there’s definitely a need for medical expertise in the air.

Lufthansa reported that the airline alone handles roughly 3 000 inflight medical emergencies each year, ranging from minor upsets to life-threatening situations. Around 50 situations annually are so serious that they require diverting the flight to the nearest airport. A few babies are born mid-flight every year.

According to Doctor Axel F. Sigurdsson’s blog, Doc’s Opinion, in-flight medical events occur at a rate of 15 to 100 per million passengers ,with a death rate of 0.1 to 1 per million.

Doctor Sigurdsson adds that it has been estimated that a physician is present in approximately 40 percent of in-flight medical emergencies. However, these numbers have been shown to vary widely. The Lufthansa registry reports that in more than 80% of cases, a physician or other medical professional (e.g., nurse, emergency medical technician) gave help on board.


Airline protocol during medical emergencies

The pilot, together with the co-pilot, has overall responsibility of each flight – passengers, the crew, the flight and the aircraft.

Dr. Sigurdsson explains that the cabin crew is responsible for managing in-flight medical emergencies. Cabin crew as part of their ongoing training are trained to recognise common medical problems and provide first aid and basic cardiopulmonary resuscitation. It is thus also the cabin crew who normally make the initial assessment of the ill passenger and are responsible for informing the captain about the situation.

The crew may then request assistance from onboard medical professionals as needed. A notable example is Lufthansa, which has its “Doctors on board” programme, encouraging physicians to put their name on a list of those willing to be called on should there be an in-flight emergency.

The idea is that, using the membership rolls, flight attendants will automatically know when a member doctor is on the plane and where he or she is seated. The plan has since been expanded to cover flights on partner airlines Austrian and Swiss. More than 10,000 doctors have signed on, mostly located in Europe and North America—culled from an initial outreach to some 15,000 doctors known to Lufthansa. Those who sign up can receive perks for their service, including bonus miles, but are not paid.

It is worth mentioning that a doctor does not have a legal obligation to step forward when assistance is requested. Yet, on the other hand, the doctor has an ethical and humanitarian duty to provide emergency care, unless circumstances prevent him/her from doing so or he/she is assured that others are willing and able to give such care.

Basically, by responding to the in-flight call of assistance, the doctor has taken on the role of what is known as a “Good Samaritan”. However, good intention does not protect against gross negligence or misconduct. The key is to do the best you can in the circumstances with the resources available, working within the limits of your competence, explains Doctor Sigurdsson.

In most instances, “Good Samaritans” are protected against negligence in the event of a worse case scenario, given that they followed and adhered to a list of strict conditions, which can include:

The Samaritan is medically qualified to perform the service
The Samaritan acts voluntarily
The Samaritan acts in good faith
The Samaritan does not engage in gross negligence or misconduct
The Samaritan receives no monetary compensation (seat upgrades and travel vouchers do not count as compensation)

Once a thorough medical assessment of an ill passenger is made, the captain may also decide to call ground-based medical support (GBMS) for advice. In this way, specialists in aviation and emergency medicine may assist from the ground.

Based on the condition of the passenger the captain may determine to continue the flight plan but request medical assistance upon arrival, he/she can also request expedited landing at intended destination or decide to divert the aircraft to a closer location.

Emergency kit

Medical resources on board

Airlines are bound under set legal requirements when it comes to the medical equipment that must be carried on board any commercial airplane, determined by the responsible aviation authority such as the Federal Aviation Administration (FAA) in the United States, and the European Aviation Safety Agency (EASA) in collaboration with the Joint Aviation Authorities (JAA) in Europe.

However, it is important to note that European airlines flying to the USA must meet both the requirements of both the FAA and the JAA.

The International Civil Aviation Organization (IACO) calls for three types of medical kits; First Aid Kit (FAK), Emergency Medical Kit (EMK) and Universal Precaution Kit (UPK):

FAK: Primarily for the care of wounds and burns, but may also include non-prescription medication.
EMK: The EMK is to be used only when a medically trained doctor is available for assistance. It contains medical equipment and drugs that can be used for the clinical assessment and treatment of the passenger. Diagnostic tools available in the EMK include a stethoscope and a sphygmomanometer. Some international aircraft have electronic blood pressure cuffs, pulse oximeters (for measurement of the oxygen saturation of blood) and glucometers (for measurements of blood glucose) in their EMK.
UPK: Contains personal protection equipment for crew members and volunteer health professionals who may be exposed to communicable disease.

Most airlines also carry automated external defibrillators on board.

Common In-Flight Medical Emergencies

According to a new study released by the University of Toronto, the top in-flight medical emergencies are:

Light headedness/loss of consciousness (37.4%)
Respiratory symptoms (12.1%)
Nausea or vomiting (9.5%)
Cardiac symptoms (7.7%)
Seizures (5.8%)