In-flight medical emergencies aren't all that common, but they can be deadly. 
With the growing number of air travelers and an aging population, the number is sure to grow.  A recent report says some airlines are well prepared for ailing passengers, while others aren't.

The report was written by doctors at Beth Israel Deaconess Medical Center in Boston and is published in the Journal of the American Medical Association. The authors found that in-flight medical emergencies are far more common than engine failure, crashes and near misses.  The authors noted that there were ten thousand in-flight medical emergencies over a five-year period reported by European airlines. 

The doctors identified significant problems with how onboard medical emergencies are handled.  First, each airline has it's own individual system for reporting medical emergencies, making it difficult to compare one airline's record with the others.  Second, though each airline has to stock a medical kit containing medications and equipment, the kids vary according to the airline.  Emergency kits may be inadequate and poorly organized.  Third, at least one regulator  - the US Federal Aviation Administration or FAA - mandates that flight attendants take training in cardiopulmonary resuscitation or CPR and on the use of automatic external defibrillators, it doesn't standardize what's taught to flight attendants nor how their knowledge is tested.  The area in which the doctor is intended to work in the cabin is often cramped.  Finally, flight crews may be unaware of how to assisted doctors, nurses, and other health personnel. 

On the plus side, they noted that just having a defibrillator on board is a huge improvement compared to not having one.  The airlines tend to stock more sophisticated medications.  And most if not all of the airlines that do long-haul flights have hired doctors on the ground to be available 24/7 to provide advice during medical emergencies.

The doctors who authored the study have called for a four-step plan to improve the management of in-flight medical emergencies.  First, they recommend a standardized recording system for all in-flight medical emergencies with mandatory reporting of each incident to the authorities. They say there should also be systematic debriefing of anyone directly involved with the in-flight medical emergency after the fact so the airline and all concerned can learn lessons about how to handle the emergency better next time. 

Second, they say airlines should get experts to recommend what drugs and equipment to put in the medical kit and insist that every airline have a standard kit stocked with the same stuff.  When a doctor steps forward, one of the flight attendants should be trained to show the doctors what's available. Third, they also recommend that flight attendants receive more training and that during a medical emergency, one attendant be assigned to remain at the passenger's side until the passenger is safe or until care is transferred upon landing.  Finally, the authors recommend that all communication between the flight crew and MDs on the ground be standardized and available on all flights when there are no health care professionals available.

So much for equipment.  The willingness of doctors to volunteer in the event of an emergency is another story altogether.

I've met colleagues who always step up in an emergency.  I've also met doctors who recommend downing a couple of scotches as soon as they get to cruising altitude so they're too intoxicated to help.  An obstetrician refused to volunteer even when a woman in her third trimester of pregnancy collapsed at his very feet!  How doctors respond also depends on where they practice.  Seven provinces and territories in Canada encourage health professionals to come to the rescue with laws that protect us from being sued if anything goes wrong.  Quebec, passed a law obliging everyone - health professional or not - to step up in a life threatening emergency unless doing so puts the Good Samaritan's life at risk. 

Many MDs expect no reward, but even the most altruistic can feel had.  Montreal family physician and Good Samaritan Dr. Henry Coopersmith took Air Canada to small claims court and won after he came to the aid of a passenger on several occasions during a transatlantic flight back in 2006..

So far, I've talked about the responsibilities of airlines and of Good Samaritans.  Passengers have a role to play as well.  A study found that two-thirds of in-flight emergencies are related to complications from pre-existing medical problems.  The lesson is clear.  Passengers with underlying health conditions who intend to take a long-haul flight should declare them to airline medical staff well in advance of flying to obtain pre-flight clearance to fly, and minimize the risk of an in-flight medical emergency.  People age seventy and up should check with their family doctor to make sure that any medical conditions they have are stable before they fly.  Air travel usually presents no special risks to women with healthy pregnancies, but all pregnant women are generally advised to talk with their doctors before flying.  The second trimester is considered the safest time to travel since the chances of either miscarriage or spontaneous labour are lowest.  Doctors often recommend against air travel after the thirty-sixth week of pregnancy, and many airlines have policies restricting travel in the third trimester. 

When in doubt, check with the airline before buying a ticket.