How to deal with emergencies during flights

I know of friends who encountered medical emergencies during flights. As doctors committed to helping others, they volunteered their services mid-air (a case of pulmonary embolism and acute coronary syndrome, as far as I can remember) and were surprised to be rewarded with round-trip tickets. None of my flights have been as memorable.

Dr. Rachel Zang's experiences are featured in an interview published in JAMA [1].

As a frequent traveler—she has been to 30 countries, including medical missions to Tanzania and Rwanda—Zang wanted to be better prepared when the next in-flight medical emergency crops up. She researched domestic and international laws and learned what those airline medical kits are supposed to contain and what they lack.

In fact, Zang amassed so much material that she shared it with her colleagues during a grand rounds on in-flight medicine.

“Lots of people were interested,” she says. “[I]t’s something everyone’s a little uncomfortable with … so they want to know as much information as they can about it.”

Problems arise because of body changes caused by high altitudes:

The airplane causes a lot of unique changes in the body that we're not really aware of. Being on a flight is the equivalent to being at 6000 to 8000 feet of altitude. At sea level, oxygen saturation in all of us healthy people is 99% to 100%, but when we go up into the air, most of us would be about 92% to 95%. So you can see how anyone who had underlying respiratory or cardiac issues, if their oxygen saturation drops lower, it's going to exacerbate angina or make their COPD [chronic obstructive pulmonary disease] or asthma worse. In turn, the very low humidity in the airplane has been shown to exacerbate asthma and COPD because of the increased dehydration and the increased mucosal dryness.

Some of her recommendations include the formation of a governing body to mandate the procurement of necessary medical equipment, lots of IV cannulas, lots of IV fluids, obstetric and pediatric medications, anti-emetics, and a glucometer.

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[1] Voelker R. “Is There a Doctor on the Plane?”. JAMA. Published online June 27, 2018. doi:10.1001/jama.2018.6654