“Is there a doctor on board?”: Practical recommendations for managing in-flight medical emergencies

Medical professionals who voluntarily provide emergency medical assistance on a commercial aircraft are protected from liability. The cabin environment will affect patients' vital signs as well as how to measure them reliably -- e.g., normal oxygen saturation at 6000-8000 ft (1829-2438 m) is about 90% and aircraft noise may limit the usefulness of a stethoscope. Most of the medications in the medical kit can be administered via the intramuscular route; the administration of intravenous epinephrine should not be used for any indication other than cardiac arrest, unless the medical professional is comfortable doing so or it is done under the advice of the ground-based consultant. The working environment should be optimized by creating space, turning on the cabin lights and recruiting additional help. Flight attendants should provide the medical kit and contact ground-based telemedicine support early. Here, Kodama et al discuss practical recommendations for managing in-flight medical emergencies.