So far in 2024, several in-flight medical emergencies have made headlines around the world. In early January, a passenger on a Jet2 flight from Tenerife, Spain, to Manchester, England, died after being found unresponsive in the lavatory. Passengers on a Munich-bound Lufthansa flight in early February described the “absolute horror” onboard when a man began gushing “liters” of blood from his nose and mouth; the flight returned to Bangkok for an emergency landing, but the passenger died on the plane. A third incident occurred on a flight from Punta Cana to Charlotte in late February when a 41-year-old female passenger began convulsing; the flight was diverted, but she later died at a hospital.
While such tragedies garner plenty of media attention, most in-flight medical situations are less extreme. The most common event is syncope or near-syncope, which is the medical term for fainting or passing out, according to a 2018 study from JAMA, accounting for nearly 33 percent of all incidents. That is followed by gastrointestinal problems (nearly 15 percent), and cardiovascular symptoms (7 percent). A medical emergency occurs in approximately 1 in every 604 flights.
Statistically, that means your chances of being onboard a flight during a medical crisis are fairly slim, though that likelihood increases the more often you fly. However, aviation insiders and medical experts say there are ways that all passengers—whether they’re global jet-setters or fly only a handful of times a year—can be better prepared if trouble does strike at 30,000 feet.
“The primary goal in a medical emergency is the safety and well-being of the passenger experiencing the emergency,” says Bob Bacheler, managing director of Flying Angels, Inc., which transports people on commercial airlines with a flight nurse or doctor. “Anything you can do to support that is very, very helpful. You can help without being a medical professional simply by offering what assistance you can—or just staying out of the way.”
Here, a guide to what passengers should be aware of during an in-flight emergency, including tips from flight attendants, doctors, and aviation experts on what to do and how to help—even if you don’t have any medical training.
“Is there a doctor onboard?”
At the first sign of a medical emergency, flight attendants are the primary line of defense: They’re specially trained on what to do during in-flight emergencies, including administering basic first aid and operating an automatic external defibrillator, or AED (a device that analyzes the heartbeat of a person having cardiac arrest and, if needed, can deliver an electric shock to attempt to revive it). Flight attendants also must follow strict protocols, which involve communicating with the pilot and on-the-ground medical services that provide access to trained doctors who can give step-by-step instructions for administering care as needed.
Flight attendants also may ask if there are any medical personnel onboard who can assist. On that note, Bacheler, who’s a certified flight nurse, says it’s best practice for medical personnel to always travel with a copy of their licenses so that flight attendants can verify their qualifications; it’s also company policy for Flying Angels employees.
On some occasions, it can help to have an extra person or two who is willing to help—in flight crew terms, that’s an able-bodied assistant, or ABA—even if they don’t have specialized medical training.
“It’s really important not to assume that someone has already volunteered and that you aren’t more qualified, or that you can’t provide some additional assistance,” explains Jared Ross, a Charleston-based emergency physician and president of EMSEC, LLC, a medical education and consulting firm. “Sometimes it’s just helpful to have another set of hands of someone who can be calm and help follow the directions.” Case in point: when Ross needed someone to hold up an IV bag for a passenger he was assisting who had fainted.
And Good Samaritans shouldn’t worry about whether they’ll be sued, at least in the United States. Thanks to the Aviation Medical Assistance Act of 1998, volunteer physicians or other people who offer assistance during an in-flight medical emergency are protected from legal liability, except in cases of gross negligence or willful misconduct.
To divert or not to divert
Depending on the severity of the situation, a decision is made whether the flight will continue to its original destination or make an emergency landing, also known as a diversion, to a nearby airport.
There’s no official policy or government regulation regarding when a flight should be diverted. It’s a complicated equation that involves assessing many different variables: the status of the passenger with the medical issue, whether the closest airport has adequate resources to assist the passenger, and whether the diversion will require dumping fuel—to name a few.
“I really remind people, especially medical professionals, that you’re taking responsibility for the health and wellness of the patient, but at the end of the day, the pilot is in command of that aircraft and is responsible for the safety of hundreds of passengers and crew,” Ross says. “Ultimately, the decision rests with the pilot of the aircraft to determine are you going to divert and where are you going to divert. And usually they’re very, very receptive to what [they] need to do.”
Don’t rely on the in-flight emergency kit
Not surprisingly, in-flight medical emergencies are often tense, stressful situations, thanks to the cramped space of an airplane cabin and the limited resources onboard.
The Federal Aviation Administration (FAA) sets minimum standards for the equipment stocked in emergency medical kits on aircraft operating in the United States. These include an AED machine approved by the Food and Drug Administration (FDA), a first-aid kit containing supplies like alcohol wipes, gauze, bandages, a stethoscope, IV equipment, and medicines like antihistamines and epinephrine, both used for allergic reactions. (Antihistamines also can be used for nausea and motion sickness.)
However, some medical experts say the kits are long overdue for an upgrade. “We have very, very limited diagnostic and therapeutic equipment on U.S. flag planes,” Ross notes.
Which makes it even more essential for passengers with medical conditions such as severe allergies to make sure they bring their own supplies onboard, says Sabrina Childress-Miller, a former flight attendant who now runs her own Chicago-based public relations firm. “I have heard over and over again passengers literally say, ‘Oh, I don’t carry my EpiPen because I know y’all have it onboard,’” she says. “That is very dangerous.”
Communication is key
Passengers who are feeling unwell should alert a flight attendant as soon as possible, so they can monitor the situation as it’s happening. In addition, passengers should also communicate potential health issues to flight crew ahead of time, which can help avoid problems once the aircraft has already taken off.
“Just give us a heads up that ‘Hey, I’m not expecting anything. However, I have asthma, I have an allergy,’” Childress-Miller says.
This allows flight crew to make necessary adjustments ahead of time, for example, reseating passengers with a cat allergy away from passengers traveling with their pets onboard. “It’s better for us to just get that done up front, so we’re not having a problem at 35,000 feet in the air,” she says.
In addition, paying strict attention to flight attendants’ instructions during a medical emergency is key—especially if they ask you to remain in your seats to keep aisles free so they can move about as needed.
Also important: understanding that during a tense situation, flight attendants have their hands full tending to the passenger and communicating with the cockpit. In other words, Childress-Miller says, this is not the time to ask for another drink.
Another big no-no: It’s never appropriate to film a passenger during a medical emergency. “That’s just wrong on so many levels,” the former flight attendant says.
On the other hand, when passengers do follow directions, it goes a long way in making a chaotic situation a little less stressful. Childress-Miller recalls a scenario that was among the most distressing of her 10-year career as a flight attendant: A patient went into cardiac arrest not long before the flight began its initial descent. Flight attendants sprang to action, directing passengers to stay in their seats so they could move the distressed passenger to the galley where they could perform CPR.
Despite several rounds of CPR and use of the AED, the man did not survive. But as unfortunate as the outcome was, the incident also provided an example for what passengers should do during any medical emergency: remain calm, stay seated, and follow instructions.
She adds, “Fortunately, this was one of the times where the passengers did exactly what we asked.”
