What’s Available on a Flight?

FAA regulations require all U.S. commercial airlines weighing 7,500 pounds or more and serviced by at least one flight attendant to carry a defibrillator and an enhanced emergency medical kit. Flight attendants must be certified in CPR, including the use of an AED, every 2 years. Pilots must also be trained in the use of the AED.

An emergency physician responding to an in-flight emergency is unlikely to have an ACLS cart packed in his or her carry-on luggage. The standard emergency medical kit, which is based on recommendations by the Aerospace Medical Association’s (AsMA) air transport medicine committee, includes a stethoscope, syringes and IV catheters in a range of sizes, and commonly used medications (see box at left).

While most domestic airlines carry this kit, there are no international regulations requiring the complete kit to be available.

What Are Your Options?

There are no federal regulations or guidelines on the management of an in-flight medical emergency. A growing number of airlines now utilize the services of remote emergency response centers. MedAire, for example, offers 24-hour consultation via call centers staffed by emergency physicians. If medically trained passengers volunteer their assistance, they are required to work with cabin crew and the response center’s physician. If there is no call made to a call center, the volunteer physician must work with cabin crew and can suggest treatment or diversion options.

Medical-Legal Liability

Federal legislation contained in the Air Carrier Access Act of 1998 has provided limited protection and guidance for physicians and other medical professionals who volunteer their services during flight. Volunteers must be “medically qualified,” render care in good faith, and receive no monetary compensation to be protected under this Act.

The legislation states that “an individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.”

There are no documented cases of a physician being sued for providing assistance during an in-flight emergency. A review article published in 2002 by Grendau and DeJohn in the New England Journal of Medicine offers several suggestions for physicians who volunteer to help during an in-flight emergency (see box below).