Medical Emergencies at FL380 - What Happens?

Real World Aviation
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What Happens if you Get Sick at 35,000 Feet?

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What is a Medical Emergency?
There’s a lot of things that can go wrong with a human’s health, but only some of them are classified as a medical emergency. A medical emergency, as it’s defined by the CDC, is ‘’an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.”

Some examples of a medical emergency are:

  • Heart Attack/Cardiac arrest
  • Stroke
  • Anaphylactic shock
  • Seizure
Medical Capabilities of Flight Crew
Flight attendants are well trained in basic first aid and treatment of major medical events, but they aren’t paramedics. They often rely on doctors on the ground who call in to treat critically ill patients. Flight attendants cannot administer medications without the approval of a doctor, unless a medical practitioner is present on the plane (more on that later). There is a relatively well stocked kit onboard the plane, but, again, there are limitations. ***
“Is There a Doctor Onboard?”
When a medical situation is discovered onboard an aircraft, the first step will be to ask if there are any doctors or medical professionals onboard who can assist. My grandfather, a family medicine physician, recounted his call to duty on board a Northwest Airlines flight from Minneapolis to Seattle in the 1990’s. The announcement was made for a doctor, and he pressed his call light. A flight attendant brought him back to the galley where a passenger was laying, suffering from severe chest pains. Apparently, the flight attendants were concerned he was having a heart attack.

My grandfather took a set of vitals and conducted a physical exam of the patient. The diagnosis: a bad case of gas. The patient was completely fine by the time he had landed, but the situation could have been much worse.

I’ve had this situation happen on a flight before, between New York and Minneapolis. The point is, a medical issue onboard isn’t all too uncommon. If you’re interested, YouTuber/physician Dr. Mike has a good video about his experience dealing with an allergic reaction on an overseas flight (linked HERE).

To Divert or Not to Divert
Diverting, or changing the landing point of a plane is not something to be taken lightly. There are all sorts of implications, from a delay to crew timing out to potential issues getting hotels for hundreds of passengers if need be. But, sometimes, a medical emergency can be so dire that hospital care is needed.

The ultimate call to divert is with the pilots, but they’ll typically defer to the medical team both onboard (if present) and on the ground. A friend who flies for Sun Country told me that while the decision to divert rests with the flight crew, it’s never really called into question when it’s recommended by the medical team. After all, they’re pilots, not doctors.

When a diversion is called, a few things are taken into account.

  • What’s the nearest airport? Can it handle our aircraft size? What’s the weather?
  • Do we need to burn/dump fuel to be below our maximum landing weight?
  • Does the nearest airport have the adequate medical facilities for our passenger? (For example, a hospital might need to have a specific kind of CAT scanner to diagnose certain types of strokes)

Dispatch and the flight crew look at these factors and make an informed decision about where to go.

On the Ground
When a medical emergency is identified, flight attendants can phone medical staff on the ground. Airlines typically contract out to these types of services to private companies. The highly trained doctors use the flight attendants as their eyes, ears, and hands on the scene. With the information they are relayed, they can help make decisions and administer treatments.

Sometimes, the situation is relatively straightforward. If a passenger is profusely vomiting for some reason, and they don’t think there is some kind of underlying issue like a stroke, the doctor on the ground can give the flight attendants the go ahead to administer Zofran (a powerful anti nausea medication).

Sometimes, the situation can be complicated. A stroke or heart attack can require higher levels of treatment to save a life. Chest compressions can only go so far - an AED and/or adrenaline is needed to bring people back to life.

When worst comes to worst, and the patient is believed to be deceased, the doctors on the ground can pronounce the passenger dead through the careful examination and monitoring. Without this declaration of death, flight attendants would be required to continue preforming treatments like CPR until the victim is handed off to paramedics.

If a diversion is decided upon, the ground staff will be tasked with determining which nearby hospitals have adequate treatment.

The pilots will radio ATC and request a diversion. The controller will then dispatch an ambulance to meet the aircraft. Sometimes, during a diversion situation, the aircraft will be given priority landing and taxi clearances to expedite the medical treatment.

Sources

https://www.asma.org/home

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In my 8.5 years in the airlines I’ve sadly been a part of diversions due to medical conditions, most of which didn’t turn out good. Very good post on this topic.

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Really cool topic. Would love to see more. I also sent you a pm. Keep up the good work.

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Unfortunately, survival rates for major medical emergencies onboard planes are low. The time it takes to get someone to a hospital can be hours longer then a simple ambulance ride, and there’s not much anyone can do about it.

Thank you!

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Nice topic. Well written. I suffer from a peanut and tree nut allergy but mine isn’t anaphylactic I still carry the medication needed for a mild reaction and worse case scenario an anaphylactic one. It is an annoying thing to have since most airlines serve nuts as part of their snacks. So far I’ve been very careful with what I eat and I aim to sleep most of the flight. Before every flight i do have to take into consideration that I might get a reaction if I’m not careful. This tends to stress me out but now it’s gone to a point when I’m fed up with it and looking for ways to overcome it like immunisation therapy. I get excruciating stomach pain and bad nausea and vomiting. This will tends to last hours mainly like 3-4 hours but it depends. I may also get loose motions as well. With all this in mind it gives me a bit of anxiety and stress as there is no magic pill to overcome all this. It’s not only for when I’m flying even if I go out to eat I’ll consider all of this and mainly choose a blander or plain option. Holidays are a problem since many of them do speak English but aren’t really educated on what a nut allergy is and how serious it can be. Someone can die from it depending on the severity of their reaction. Thanks for sharing this @Mort

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That’s pretty awesome! My grandfather is a pulmonologist, so he has a pretty good knowledge of medicine. Anyways, once I think he was flying to Puerto Rico, someone on board needed medical attention, and he stepped up to the plate and helped the passenger in need.

Now, the coincidental part was, on his return flight back here to Orlando, the SAME THING happened - is there anybody on board that’s a doctor? - and he stepped up again and helped the passenger. Now, the really funny part is, it was the same flight crew on both flights, so they all recognized him.

Just thought I’d share that story. Great topic!

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Similar thing occurred with my grandpa flying from West Palm Beach (PBI) to John
.F. Kennedy (JFK) when at FL370 the passenger behind him suffered a severe chest pain followed by severe vomiting, they diverted to Charleston (CHS) where they took the passenger off instead of landing at scheduled time of 4:35PM the aircraft landed at 11:20PM it’s insane how long it takes to clean the plane and re-do everything in order to prepare to continue the rest of the flight.

This was on JetBlue btw!

Anyways great topic as always Mort

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I remember flying from Orlando a while back and before we pushed back someone in the plane somewhere needed medical attention. We departed at midnight even though are scheduled departure time was in the evening local time. Luckily for the person who needed medical attention they weren’t in the air but it took a very long time. Hope they recovered quickly

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