Getting Sick on a Plane

Medical emergencies are even more serious on planes

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The friendly skies aren't too friendly for those who fall ill.

It's estimated that a medical emergency occurs on 1 of 604 flights. Considered alone, this statistic (although probably an underestimate) isn't too scary. However, we must remember that getting sick on an airplane is far different from getting sick on land.

First, there is no guarantee that there will be a physician or other health care professional on board who can help you.

(In case there's no physician on board, airlines contract with ground-based consultation for support.)

Second, onboard medical kits often lack necessary equipment to treat an ambit of medical emergencies including pediatric equipment, obstetric equipment, and diagnostic equipment (think glucometers which measure sugar in your blood).

Third, getting a plane to land in case of a medical emergency is logistically tricky and ultimately lies at the discretion of the pilot.

Thus, it should come as no surprise that something super serious happens en route, like cardiac arrest, chances of survival are slim. More specifically, whereas only 0.3 percent of in-flight emergencies are due to cardiac arrest, 86 percent of on-flight deaths are due to this condition.

Let's take a look at how cardiac emergencies, stroke, and altered mental status are typically treated on a plane.

Cardiac Emergencies

In the case of acute coronary syndrome, which happens when a clot forms in a coronary artery, people present with chest discomfort, shortness of breath, sweating, nausea, and vomiting.

Of note, unstable angina and heart attack are two forms of acute coronary syndrome. With regard to acute coronary syndrome, you should first tell the physician or crew members about any previous history of heart conditions.

Possible treatments for acute coronary syndrome en route include aspirin and nitroglycerin (for chest pain).

However, these measures must be administered only when no contraindications exist. Fortunately, these medications are included in onboard medical kits. Supplemental oxygen can also be administered, and in order to improve oxygenation, the pilot can lower the altitude at which the plane is flying.

Cardiac arrest, where the heart actually stops, is caused by an arrhythmia or irregular heartbeat. Planes are equipped with an AED which can be used to shock the heart back into normal rhythm. Chest compressions (CPR) should also be performed.


Much like cardiac emergencies, stroke can take on various iterations and is a difficult problem to treat on a plane. Aside from diagnosing focal neurological symptoms by means of physical exam (weakness in certain nerves), without proper diagnostic equipment, it's impossible for a physician to infer much about the problem.

For instance, without imaging, it's impossible to know whether the stroke is ischemic or hemorrhagic. Consequently, aspirin shouldn't be given for suspected stroke on a plane because aspirin exacerbates hemorrhagic bleeds.

In case of stroke on an airplane, supplemental oxygen is usually given to people who are experiencing breathing problems.

This oxygen can mitigate further damage to nerve cells.

Another problem that can present as stroke but is usually far less severe is low blood sugar or hypoglycemia. Treatment for hypoglycemia may merely entail grabbing some orange juice off the beverage cart or hooking a patient up to intravenous dextrose (sugar).

However, hypoglycemia often isn't readily diagnosed en route especially without knowledge of previous episodes. Surprisingly, most onboard medical kits lack a glucometer which is used to test sugar in the blood.

Altered Mental Status

There are a myriad of causes of altered mental status and syncope (temporary loss of consciousness) including seizure, diabetes, vascular disease, infection, metabolic derangement, and hypoglycemia.

On a plane, finding out the exact cause of altered mental status is often impossible. Thus, all a physician can usually do for altered medical status is administer supplemental oxygen and, in severe cases, request that the pilot divert the flight.

Final Thoughts

If you or a loved one has a serious disease or disability that may manifest as a medical emergency during flight, there are things that you can do.

For example, you can choose an alternative means of transportation (car, train or bus) that allows you access to proper medical help in case of an emergency.

Alternatively, some airlines require medical clearance for certain passengers thus giving airline personnel an opportunity to take necessary precautions once you're cleared to fly.


"In-Flight Medical Emergencies During Commercial Travel" by JV Nable and co-authors published in NEJM in 2015.

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