An overhead speaker rings several times and is followed by a brief burst of static.

“Ladies and gentlemen, if there is a medical doctor on board, please notify the nearest flight attendant. Once again, if there is a medical doctor on board, please notify the nearest flight attendant.”

On a recent US Airways flight from Phoenix to Philadelphia, this announcement was followed by tragedy with the death of a 73-year-old passenger. The plane made an emergency landing in Pittsburgh, where paramedics were waiting to provide emergency care. The man was pronounced dead at the scene, and a subsequent medical examiner’s report attributed the death to a cardiac condition.

Unique Aspects of In-Flight Emergencies

An emergency physician is ideally suited to volunteer to assist during an in-flight medical emergency. Emergency medicine provides a breadth of training across all age groups and organ systems. Our ability to improvise and focus on the diagnosis and immediate care of sick patients sets us apart as a specialty.

Providing medical assistance at 36,000 feet is nevertheless a daunting proposition. Lower air pressure (cabin pressure is maintained at 5,000 to 8,000 feet), cramped quarters, and the roar of engine noise make an overcrowded county ED seem an ideal working environment by comparison.

Common In-Flight Emergencies

The actual incidence of medical emergencies during commercial air travel is unknown. In a report using data from British Airways published in the BMJ in 2000, Nigel Dowdall estimated 1 in-flight emergency per 11,000 passengers. MedAire, a medical assistance company that provides remote assistance to several commercial airlines in the United States, responds to an average of 17,000 calls per year.

Common emergencies include chest pain, syncope, asthma exacerbations, and GI complaints. Air travel in the cheap seats has often been described as “economy class syndrome,” a sort of midair version of Virchow’s triad: dehydration, immobilization, and predisposing factors increasing the risk of deep vein thrombosis.