None of us likes to think about the possibility of a medical emergency in flight. But the worst can happen at 38,000 feet. Sometimes that happens over open water or while flying across rural land. Often, even the closest airport may still be hours from advanced medical care. But you might be better off if no one answers the page, “Is there a doctor onboard?”
What happens during medical emergencies?
A Bloomberg article spotlighted the services provided by Phoenix-based MedAire to over 100 airlines worldwide, as well as those of competitor STAT-MD. The service allows for air-to-ground communication between flight personnel and trained emergency physicians. The service provider notes that they reduce emergency diversions “that would otherwise be recommended by nervous and out-of-their-element doctors in the sky”. This allows the airline to provide more consistent medical care. But it is also an essential lifeline for airline personnel if there is no doctor on board.
Use of such services makes sense – the individual answering the page for a doctor on board may be a specialist with limited recent exposure to emergency or urgent care. Or they may want to err on the side of caution to avoid perceived liability. (This despite a federal law protecting care providers who assist in an emergency in the air). Ultimately, the pilot decides whether to divert for a medical emergency in flight. But without proper perspective or when there is no doctor on board, the service provides balanced medical advice. A dermatologist might not be the best primary decision-maker for a cardiac incident. An orthopedic surgeon might have little experience dealing with a pediatric respiratory issue. And a retired physician may be out of touch with current protocols for basic procedures.
Diversions are costly for airlines at $10,000 to $200,000 per incident. The New England Journal of Medicine estimates that a medical emergency occurs on 1 in 604 flights. Of those, 7.3% are diverted (or roughly one in every 4,409 flights). MedAire reports a much lower diversion rate – 1.6% – for flights where they assist. One might speculate that the airline would prefer there be no doctor on board to keep diversions low.
Still, if there is a medical emergency in flight, it is important to seek some form of advice. That can be with in-flight medical personnel, through a third-party service, or preferably both. The Bloomberg article reports on a passenger suing United for failing to obtain proper medical advice after United refused to divert a flight from Chicago to Rome in 2016. The passenger, suffering from acute pancreatitis, ended up spending three months in hospitals, allegedly due to a lack of timely medical attention.
Real-life experience
My luck with medical emergencies in flight is rather dismal. I’ve been on at least a dozen flights where a medical emergency in flight occurred. Four of those resulted in diversions, two of which were international. In all four diversion cases, the “Is there a doctor onboard” page was displayed.
What is your experience with medical diversions or a medical emergency in flight? If you were the ailing passenger, would you still hope someone would answer a page with “Is there a doctor on board?”
I think the people being affected the most would beg to disagree (flight attendant, patient, family members, friends).
I have assisted on board as a physician. I have also interacted with atleast 2 of these services. A few things – usually the doctor responding will make it pretty clear what they can help directly with. Nobody likes to work outside their comfort zone. But, usually, with assistance of ground staff, a doctor on board is better at taking care of the patient in the air than the flight attendants so trust me you want them there. Last time when I assisted a young girl who was having trouble breathing on way to hawaii, the flight attendants could not even take a blood pressure or pulse. Anyone gone through medical school has been in the emergency room, participated directly or indirectly in some of the emergencies where its delivering a baby or helping someone who has passed out. I can’t say the same about any of the flight staff. The girl just needed some sugar pills as she got hypoglycemia from skipping dinner (thanks to a diabetic who was carrying them) and was fine.
Now the flip side is that if you are trained in providing some/any emergency care, airlines are now legally bound to obey what their advisory ground medical support team are telling them. You may be able to manage someone well, but if the person on the ground (often not a physician in my experience) decides flight has to divert due to xxx, it will.
It would be informative to see an evaluation of the fate of the patients not diverted by these on ground consultants. There was a fairly recent case of a young woman who suffered an embolism. A doctor on board identified how ill she was and recommended diversion. The pilot, I think I recall reading, followed the ground advice, and did not divert. I need to look up the case but I think patient died. Part of the story described basic medical equipment thaT did not work.
I’ll take the doctor as a triage officer. To expect comprehensive treatment is unrealistic.