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Inflight Medical Emergencies

© Richard Seagraves

What happens when a passenger suffers a medical emergency at 30,000 feet?

When someone gets sick or injured aboard an airliner, it often makes headline news. Fortunately, occurrences like those are rare. (The FAA does not require airlines to report medical emergencies, so data across all carriers does not exist.)

Cabin Conditions Contribute to Illness

It is important to understand why the aircraft environment is so harsh on us physically as well as its role as an incubator for medical maladies. Air travel makes us anxious, and when we’re anxious we become stressed. Added anxiety will exacerbate any sickness you’re currently suffering from or likely to contract.

The cabin environment makes conditions worse. Most aircraft cabins are not pressurized to sea level, but instead to 5,000–8,000 feet. A higher cabin altitude causes a drop in oxygen saturation of our blood to 90 percent of normal, even in healthy passengers. If a passenger suffers from heart or lung disease, he or she is slightly more likely to suffer the effects of mild hypoxia, an insufficient supply of oxygen to the body’s tissues. Combine the low relative humidity of cabin air with alcohol consumption, and you’ve got the perfect conditions for dehydration, which can worsen any existing medical condition.

Quite often, passengers board aircraft already suffering from illness without consulting their doctor. In many cases, their doctor would have recommended that they not fly, but most people have deadlines or other pressures influencing their decisions. When they do go, they’re putting others at risk, should they need medical attention that can be satisfied only by diverting the aircraft to an unintended destination.

Crew and Doctors Assess the Situation

Your chances of having a doctor on your flight are very good these days since flights are often booked to capacity. Medical professionals volunteering to help are protected by a “Good Samaritan” law, the U.S. Aviation Medical Assistance Act of 1998. Flight attendants are trained to request the assistance of doctors or other medical professionals when faced with in-flight emergencies, too.

I’ve experienced several in-flight medical incidents over my 20-year career with the airlines, and our detailed procedures guide us expertly when it comes to in-flight care. Years ago, I experienced an interesting situation as a junior captain flying a 737 domestically. We were cruising at 36,000 feet somewhere over the Midwest, en route from New York to Los Angeles, when I got a call from the lead flight attendant that a passenger had passed out and that we needed to divert immediately. I asked her to gather some information so we could make an informed decision as to our best course of action. My immediate concern is always for the stricken passenger, but I had to keep the welfare of the other travelers in mind as well.

I asked some basic questions about the passenger and found out she was a young woman (23) on her way to Los Angeles for a photo shoot at a modeling agency. To the flight attendants, she appeared to be healthy, but tired and maybe dehydrated. When the passenger regained consciousness, I asked the flight attendant to find out if she had eaten anything before getting on the airplane that morning, and the response was no. I recommended that she be given some orange juice and maybe something to eat to see if that might improve her condition. If it didn’t, then we would make a public address announcement asking the passengers if there were any doctors on board. Thankfully, the juice and food did the trick, and we continued on to our destination uneventfully, inconveniencing neither her nor the other passengers and crew.

This situation was an easy one to handle, but oftentimes medical emergencies are much more complex and require the help of real doctors and nurses.

Emergency Specialists Advise by Phone

When a live doctor, nurse or EMT isn’t on board, and a doctor’s advice is desperately needed, certified emergency physicians, registered nurses and communication specialists are standing by ready to assist flight crews. Every airline provides flight crews access to medical staff to advise during medical emergencies.

More than 60 airlines worldwide use the services of MedAire’s MedLink Global Response Center, which provides worldwide, real-time medical assistance 24 hours a day, seven days a week. MedAire handled 22,000 in-flight emergency medical calls in 2011 at its Global Response Center. When it receives calls from an aircraft it’s usually by way of a satellite phone patch from the plane. If a doctor is on board the plane, he or she can talk directly with the MedLink doctor to assess the passenger’s condition and vital signs. Some airlines also have remote medical diagnostic technology that will transmit a passenger’s vital signs directly to MedAire’s MedLink. Having that crucial data may avoid costly diverts by giving doctors a more accurate picture of the passenger’s health.

If there aren’t any doctors or other medical professionals on board, the flight attendants talk to the MedLink doctors. Depending on the seriousness of the emergency, doctors on the ground might advise an immediate divert to get the passenger into a hospital without delay. Company dispatchers confer with MedLink and will coordinate efforts to choose the best option. With concurrence of the flight crew, they’ll pick the nearest, most reputable medical facility from their database of thousands of hospitals and clinics worldwide.

The decision to divert is an expensive one. Landing fees, additional fuel and missed connections add up quickly and can turn a profitable flight into a money loser in a snap. Diverts can also cause pilots to exceed their FAA-sanctioned crew duty day limits, causing the entire load of passengers and crew an overnight stay in a local hotel.

While nobody wants to get sick on an airplane, it does happen. If you’re the unlucky one, put yourself at ease—there are people and procedures in place to take the greatest care to get you help, should you need it.

Did You Know?

Fainting was the most common in-flight event to generate calls to MedAire in 2011.

On Your Mind

Readers pose their questions on air travel.

Q: What happens when a pilot gets sick after the first leg of a trip? —John Wilkinson, Lodi, Calif.

A: The farther a pilot is from home, the harder the problem is to solve. I once flew with a captain who called in sick due to kidney stones after a flight to Tokyo. Replacing him for our return trip to LAX the next morning was impossible. By the time the new captain dead-headed to Tokyo and logged the required rest, two days had passed before the first officer and I could head back. Replacing pilots on domestic flights is much easier. Because airlines have crew bases all over the U.S., a reserve pilot from Chicago can replace a sick pilot from Los Angeles quite quickly.

Chris Cooke has been a pilot with a major domestic carrier for 20 years and currently flies long-haul routes on the 777. He began his career with the U.S. Marine Corps, received Navy flight training and was a Top Gun graduate. In 2012 he will log more than 300,000 miles, all in a window seat. Have a question you’d like Chris Cooke to answer in a future issue? Send it to editor@executivetravelmag.com..

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