In-flight Medical Emergencies: How to Avoid Getting Stuck up in the air

Mark Gendreau, MD, knew he was in for an interesting flight when he spotted a group of rowdy men chugging beer and wearing “Las Vegas or Bust” T-shirts at 10 a.m. at Boston’s Logan Airport. Little did he know just how interesting.

“One of the men was seated next to me on the aircraft,” Gendreau, recalled. “Early into the flight he stood up and stepped into the aisle. His eyes rolled back and he fell right over.”

A frequent traveler and chief medical officer at Beverly and Addison Gilbert Hospitals, Gendreau sprang into action. This was the fourth time Gendreau has answered the call, “Is there a doctor in the house,” and helped a person on a plane. Luckily in this case, it was a fainting spell and the passenger did well. With 4 billion air travelers taking off from 41,000 airports in 2017, it’s not surprising that in-flight medical emergencies happen.

The stats speak for themselves: In-flight medical emergencies occur in one in 604 departures, cause one fatality per million passengers and result in the airplane diverting to another airport in one of five medical events.

So, what are these in-flight medical emergencies, and how can you avoid having one?

The five most prevalent in-flight medical emergencies all have one thing in common: They occur due to the increased pressure and decreased oxygen level experienced when flying, Gendreau said.

The medical emergencies include:

  • Vasovagal syncope or fainting: A sudden drop in heart rate and blood pressure after abruptly standing up or being dehydrated leading to fainting

  • Gastrointestinal, including abdominal pain or vomiting

  • Respiratory problems: Difficulty breathing caused by exacerbation of asthma, heart failure or chronic obstructive pulmonary disease (COPD)

  • Cardiac or heart issues: Atrial Fibrillation (Afib), which is a quivering or irregular heartbeat or rapid heartbeat

  • Neurologic: Altered mental state such as confusion or stroke

“Many people assume that when they get on a plane the cabin is pressurized to sea level. That’s not the case,” Gendreau said. “Cabins are usually pressurized to about 5,000 to 8,000 feet, which is the equivalent to plopping you on top of a mountain. Combine this with an aging population, existing medical issues and long flights, and you have more in-flight events.”

But, what about deep vein thrombosis or blood clots? It’s not a common in-flight emergency, Gendreau said, but flying increases the risk substantially in some cases.

  • Long flights: Flights over eight hours result in a one-four fold risk increase

  • Thrombophilia (group of conditions where the blood clots more easily than normal): 16-fold increase

  • Taking oral contraceptives: 14-fold increase

“If you are a smoker who has thrombophilia and takes oral contraceptives, you have a high, high risk of developing blood clots in the legs,” Gendreau said. “Speak to your doctor before flying.”

To stay healthier on flights, avoid dehydration by not drinking alcohol or caffeine (drink more water), get up and stretch, and speak to your physician if you have had surgery or normally have trouble breathing. If you wear an air cast or have a pneumatic splint, be sure to deflate it before takeoff.

“Medical events do happen frequently, but the good news is that most are minor – and coach versus first class does not make a big difference,” Gendreau concluded.

To learn more about healthy air travel, speak with your Lahey Health physician.


*The content on this website is for informational purposes only and is not medical advice. Please consult a physician regarding your specific medical condition, diagnosis and/or treatment.

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