None of us like to think about the possibility of a medical emergency in flight. But it is possible for the worst to 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 of “Is there a doctor onboard?”
A recent Bloomberg article spotlighted the services provided by Phoenix-based MedAire to over 100 airlines worldwide as well as 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 more consistent medical care. But it is also an essential lifeline for the airline personnel if there is not a doctor onboard.
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 the caution to avoid perceived liability. (This despite a federal law protecting care providers who assist an emergency in the air). Ultimately the pilot makes the call as to whether to divert for a medical emergency in flight. But without proper perspective or when there is not a doctor onboard, 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 out of every 604 flights. Of those, 7.3% are diverted (or roughly one in very 4,409 flights). MedAire reports a much lower diversion rate – 1.6% – for flights where they provide assistance. One might speculate that the airline would prefer that there is not a doctor onboard to keep diversions low.
Still, if there is a medical emergency in flight it is important to seek advice of some type. That can be with inflight medical personnel, through a third-party service, or preferably both. The Bloomberg article reports that a passenger is suing United for failing to seek proper medical advice when refusing 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 lack of timely medical attention.
My own luck with a medical emergency 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 page for “Is there a doctor onboard” was answered.
What is your experience with medical diversions or a medical emergency in flight? If you were the ailing passenger, would you still hope someone answered a page of “is there a doctor onboard”?
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.