Typical Medical Problems on Board

Researches show that inflight medical emergencies are rare, occurring at a rate of approximately 15 to 100 per million passengers, with a death rate of 0.1 to 1 per million. (Management of inflight medical emergencies on commercial airlines by M. Prout, J. Pine, see Further Reading). On the other hand, if a serious health problem occurs on board, the access to medical care is limited.

While there is a plethora of medical issues that can arise during a flight, researches have shown that the most common problems are:

• Fainting;
• Heart attack;
• Dehydration;
• Nausea / vomiting.

Not every medical problem leads to the flight crew declaring a medical emergency. In many cases the flight crew and/or other passengers (e.g. doctors, passengers with medical education and experience) are able to successfully resolve the situation.

Contributing Factors for Passenger Medical Emergencies

The following factors, individually and in combination, can exacerbate a health problem that a person might already have (e.g. heart or lung diseases):

• Air travel is a source of stress and anxiety for some people;
• Cabin altitude for an airliner in cruise is generally in the range of 6000 to 8000 feet;
• Low air humidity and alcohol/caffeine drinks can contribute to dehydration;
• People usually sit, with minimal movement, for long periods of time.

Controllers' Actions

The advice given in this section is derived from good practices and common sense and is neither to be considered exhaustive nor intended to replace local procedures.

Generally, the ASSIST (A - acknowledge S - separate S - silence I - inform S- support T - time) routine should be followed, bearing in mind the specifics of the situation:

• Acknowledge the situation and clarify whether an emergency is being declared;
• Obtaining as much information as necessary, e.g. number of sick passengers, the exact nature of the medical problem or, if the medical problem is not determined, the symptoms being manifested plus any other relevant details of the situation. Determine, as necessary, if the passenger illness is recognised as infectious (e.g. symptoms such as constant productive cough and signs of fever);
• Clarify the intentions of the flight crew; most likely they will choose to land on the nearest suitable aerodrome;
• Assist the flight crew by:
  • Providing a shorter route to the aerodrome chosen;
  • Providing information on the aerodrome chosen (if requested);
  • Giving priority to the aircraft that has declared an emergency (e.g. issuing separation-related instructions to other aircraft);
  • Coordinate appropriate services on arrival;
  • Inform the supervisor. Outsourcing some of the workload (e.g. coordination with the aerodrome) could prove useful, especially in heavy traffic situations.

Considerations

• Unlike most other emergency situations (e.g. fire on board, engine failure, etc.), there is usually no abrupt peak in cockpit workload at the moment when a passenger medical emergency occurs. Therefore, it is unlikely that questions for clarification of the situation will be considered as harassment. The risk of not obtaining vital information (by avoiding possibly unnecessary questions) is higher than the risk of hindering crew performance (by too much communication). Be aware, however, that one of the pilots may be occupied with communication with a medical support service or with Company operations, and the remaining pilot may elect to defer the questions until those tasks have been completed.
• Focus on information quality rather than speed; there is usually sufficient time to obtain correct data and mishearing can lead to drastic consequences (e.g. “two sick passengers” might sound like “two-six passengers”).
• If there is/are suspected case(s) of highly contagious disease on board, a system to deal with the emergency situation should be ensured in coordination with the airport authorities as necessary (e.g. outbreak quarantine measures with restricted/controlled access to the aircraft, aircraft parked at isolated stand etc.) to avoid and to reduce the possibility of an infectious disease outbreak.

Further Reading

• An Analysis of In-flight Passenger Injuries and Medical Conditions, ATSB Safety Report, October 2006
• Outcomes of Medical Emergencies on Commercial Airline Flights, US National Library of Medicine, National Institute of Health
• Management of inflight medical emergencies on commercial airlines, J. Pine & M. Prout via UpToDate (clinical decision support resource, login required)
• CAP 757: Occupational Health and Safety on-board Aircraft - Guidance on Good Practice, UK CAA 2012
• CAP 745, Aircraft Emergencies, Considerations for air traffic controllers, UK CAA 2005