FAQ: What Should Happen During an Inflight Medical Emergency?

Jose V. Nable, MD; Christina L. Tupe, MD; William J. Brady, MD; Bruce Gehle, JD

Disclosures

November 10, 2016

Editor's Note: Last month, Tamika Cross, MD, a 28-year-old ob/gyn resident in Houston, wrote on her Facebook page about her experience in trying to help a fellow passenger who fell ill during a flight she was on. As was reported in the New York Times, Dr Cross says a Delta Air Lines flight attendant rejected her offer of help, not believing that she was a physician. Later she was asked to provide her medical credentials.

This incident got us thinking: What sort of proof do you need to show when presenting yourself as a physician during an emergency? We asked the authors of a review article, "In-Flight Medical Emergencies During Commercial Travel," published last year in the New England Journal of Medicine,[1] to answer our most pressing questions about in-flight medical care.

Q: If you’re on a flight and identify yourself as a physician, can the airline require you to show your medical credentials?

A: The Aviation Medical Assistance Act of 1998 provides airlines with liability protection from acts of responding providers so long as the carrier "in good faith believes that the passenger is a medically qualified individual." The Act defines medically qualified personnel as "any person who is licensed, certified, or otherwise qualified to provide medical care in a State, including a physician, nurse, physician assistant, paramedic, and emergency medical technician."[2]

The Federal Aviation Administration (FAA) further provides some guidance to airlines on this very matter. In a 2006 regulatory letter to all airlines, the FAA noted:

"Flight attendants should grant access to the equipment only to trained crewmembers or to other persons qualified and trained in the use of emergency medical equipment. The decision to allow passengers to assist another passenger and have access to medical equipment is up to the air carrier and its agents...It would be preferable for flight attendants to check the credentials of passengers holding themselves out as medical specialists."[3]

Q: What are the most common airline emergencies?

A: In a large study involving nearly 12,000 reported inflight medical events, the most common issues, in descending order of frequency, are[4]:

  1. Syncope

  2. Respiratory symptoms

  3. Nausea or vomiting

  4. Cardiac symptoms

  5. Seizures

  6. Abdominal pain

  7. Infectious disease

  8. Psychiatric issues

Q: What supplies are airlines required to carry in their medical kits?

A: The FAA mandates that the following medical equipment be aboard all US-based airliners. While airlines can enhance supplies, these are the minimum requirements[5]:

  • Sphygmomanometer

  • Stethoscope

  • Gloves

  • Airway and breathing

  • Oropharyngeal airways

  • Bag-valve masks (three sizes)

  • CPR masks (three sizes)

  • Intravenous access

  • Intravenous administration set

  • Saline solution, 500 mL

  • Needles

  • Syringes

  • Analgesic tablets, nonnarcotic

  • Antihistamine tablets

  • Antihistamine, injectable

  • Aspirin

  • Atropine

  • Bronchodilator inhaler

  • Dextrose, 50%

  • Epinephrine, 1:1000 solution

  • Epinephrine, 1:10,000 solution

  • Intravenous lidocaine

  • Nitroglycerin tablets

  • Automated external defibrillator (AED)

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