Research published in the New England Journal of Medicine found that in-flight medical emergencies occur on 1 out of every 604 flights. There are a lot of things you need to consider if a medical emergency occurs 39,000 feet in the air: What medical equipment is available? How quickly can you land and get to a hospital? Is there a medical professional on board who can help you? The truth is, flying with a serious health condition, such as cardiovascular disease, which could lead to a heart attack or stroke, can be riskier than you think, says Philip Rubin, MD, an assistant professor of anesthesiology at Yale School of Medicine in New Haven, Connecticut. Dr. Rubin knows firsthand just how precarious in-flight medical emergencies can be. In 2014, while he was flying from Phoenix to Detroit on a commercial airline, a fellow passenger experienced cardiac arrest; the passenger’s heart stopped, and he lost consciousness. After the “is there a doctor on the plane?” request came over the PA system, Rubin, the only physician on board, volunteered. He found the passenger — an overweight older gentleman — lying on the floor in the galley at the back of the plane. “The patient wasn’t responding and didn’t have a pulse,” Rubin says. And even though flight attendants are required to be trained in CPR and basic life support every other year, Rubin was surprised to find that no one was touching the patient. He performed CPR with chest compressions and inserted an IV to administer medication. But the on-board emergency medical kit was sparse. It lacked simple medical tools — such a pulse oximeter, a $10 device that measures oxygen saturation in the blood — and intubation equipment, which would have allowed someone else to push air into the patient’s lungs while Rubin tried other life-saving measures. Intravenous bags of fluid and needles were in short supply, too. Moreover, medical equipment can vary in how it operates, which left Rubin fumbling. “The flight attendants didn’t even know how to turn on the oxygen,” he says. As Rubin performed chest compressions, the plane was diverted to the nearest airport, in Kansas City, Missouri. When it landed, the plane taxied to the gate, a standard procedure that wasted precious time. “I couldn’t believe it,” Rubin says. “Why couldn’t we just park the plane on a safe area on the tarmac and get the patient off?” When the paramedics finally arrived, they were required to assess the patient all over again instead of taking over where Rubin left off. “Unfortunately, the passenger passed away,” Rubin says. He later learned that the patient had experienced a type of cardiac arrest that routinely has a poor outcome, even in a hospital.
A Journey to Improve In-Flight Medical Resources
Commercial airlines are not air ambulances. Still, since that life-changing experience, Rubin has been on a mission to bring awareness to the fact that airline policies and procedures for in-flight medical emergencies in the United States are inadequate. Although guidelines can vary by airline, in general, “flight attendants aren’t properly trained and educated on medical emergencies,” he says. Moreover, the mandated on-board medical equipment is lacking. The Federal Aviation Administration (FAA) requires that all passenger flights with at least one flight attendant have an automated external defibrillator along with a bag valve mask resuscitator and oral airways; basic medication, such as aspirin and nitroglycerin, is also required. The mandated equipment list hasn’t been updated since 2004, and it lags behind what is required on commercial planes in the European Union. Rubin also wants physicians and the general public to be aware of the risks of flying with a medical condition: There may not be a doctor on board, there are inadequate airline resources and procedures for handling medical emergencies, and flying in itself can be tough on the body. “The key physiologic concern is oxygen saturation,” Rubin says. When you’re on the ground, your oxygen saturation (the oxygen in your blood) is in the upper 90s to 100 percent. But in a pressurized airplane cabin, blood oxygen can fall to 90 percent. “That’s okay in a healthy patient,” Rubin says, “but if you have a heart condition, your blood oxygen level may already be at a baseline in the low 90s. When you go up in the air, your oxygen level can drop further, causing inadequate oxygen and leading to breathing trouble or even a heart attack.” The good news? Only 0.3 percent of in-flight medical emergencies are due to cardiac arrest resulting in death, Rubin says. Still, what if that 0.3 percent is you?
Know the Risks of Flying If You Have Heart Problems
The best advice is to prevent an in-flight medical emergency, if possible. To protect yourself, here’s what to do before flying.
Take a trip to the doctor. If you have a serious medical condition, such as heart disease, you don’t have to stay home. Still, see your doctor before your flight. “Get evaluated by your internist, pulmonologist, or cardiologist to make sure you’re optimized for air travel,” Rubin says. If you have a heart condition, you may need an exercise stress test or echocardiogram. “If you’re failing that test or the results are questionable or concerning, you should not travel,” Rubin says.If you’re cleared for travel, take your medication as directed. With packing, planning your itinerary, and getting to the airport on time, there’s a lot to think about before going on a trip. Be sure to take your medication as directed and to bring it along with you. Also, drink plenty of water during the flight, avoid alcohol, and get up out of your seat every three hours to reduce the risk of blood clots, which can happen anytime you’re sitting for long periods, whether you’re in the air or on the ground, Rubin says.If you’re not feeling well, don’t get on the plane. When the passenger Rubin tried to save boarded the plane, he looked a little dusky and he was breathing shallowly, a flight attendant later told Rubin. “The passenger may have already been in the process of having a heart attack,” Rubin says. If you’re having trouble breathing or showing other symptoms on the ground, such as chest pain, “it’s likely you’re going to have trouble in the air,” he says. Instead of marching on the airplane, reroute yourself to a doctor or, if you experience symptoms of a stroke, heart attack, or cardiac arrest, call 911.
Rubin is training to become an aviation medical examiner, who is certified by the FAA to recertify pilots annually or biannually. He will use that opportunity to gather information for pilots about in-flight emergencies and to meet with someone from the FAA to express his concerns, and potentially to change the policies in place.
