How many of you have been settled, albeit uncomfortably, at 30,000 feet enjoying a movie or hastily putting the finishing touches to the PowerPoint presentation you are due to give in a couple of hours when you hear a familiar chime, followed by the flight attendant asking: “Is there a medical professional on board this aircraft?” Every year, more than 500 million people travel by air in the U.S. Not surprising then, that medical emergencies aboard aircrafts occur. In fact, an estimated 1:10-40,000 passengers will experience one. With commercial air traffic increasing, these emergencies are expected to become more frequent, especially as the percentage of older people increases. Although flight attendants are required to undergo initial and recurrent training on aviation medicine, first aid, CPR and automated external defibrillator (AED) usage every 12–24 months, EMTs, paramedics and other medical professionals are still called upon to provide assessment and treatment of passengers who become ill in flight. Now, two U.S. physicians from Boston’s Beth Israel Deaconess Medical Center have called for a standardization of the processes and the equipment for dealing with in-flight medical emergencies. Within the current issue of the Journal of the American Medical Association, Melissa Mattison, MD and Mark Zeidel, MD, note that the kinds of approaches that have improved flight safety have not been extended to providing optimal care for passengers who become acutely ill while on board airplanes. 
Each airline has its own reporting system and protocol. And while emergency medical kits are mandated to contain medications and equipment, actual kits vary by airline. As a result, paramedics and physicians responding to emergencies can face a broad array of challenges including cramped physical space, emergency kits whose contents are unfamiliar, inadequate, and poorly organized, and flight crews unaware of how best to assist the physicians. Mattison and Zeidel offer a four-step plan to improve the treatment of passengers who become ill in-flight:
- A standardized recording system for all in-flight medical emergencies, with mandatory reporting of each incident to the National Transportation Safety Board. This approach should include a systematic debriefing of anyone directly involved with the in-flight medical emergency.
- Airlines should create a standard emergency medical kit with identical elements available in identical locations on every flight.
- Enhanced and standardized training for flight attendants, including the clear obligation that a single flight attendant is assigned during emergencies and stay nearby until the patient is safe.
- Standardized flight crew communication with ground-to-air medical support available on all flights when there are no health care professionals available.
As both a frequent flyer and paramedic, I applaud the authors for this long overdue common sense approach. Have you ever helped with an in-flight emergency or perhaps been the victim of one? If so, SRxA’s Word on Health would love to hear from you. 
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