Every year during the holiday season, millions of travelers board planes across the United States, with many anticipating potential delays or cancellations. Yet, for some medical professionals, the most dreaded announcement is not about flight schedules but rather the call for assistance: “Is there a doctor on board?” For emergency room physician Dr. Tushara Surapaneni, the anxiety stems from the realization that inadequate medical supplies may hinder effective treatment for sick passengers.
In-flight medical emergencies, while infrequent, occur more often than previously estimated. A recent analysis of data from 84 airlines revealed that such emergencies arise in approximately 1 out of every 212 flights. This is in contrast to an earlier study which suggested the rate was about 1 in 604. To put this into perspective, with the Federal Aviation Administration (FAA) overseeing around 44,000 flights daily, there could be as many as 70 to 200 medical emergencies occurring every day over U.S. airspace.
Flight attendants, trained in CPR and first aid, are the first responders in these situations. They may contact a ground medical team, which can include an on-call physician who provides guidance on treatment and whether a flight diversion is necessary. Dr. Surapaneni has volunteered her medical expertise on long-haul international flights, only to find herself as the sole physician on board during emergencies. On one occasion, a flight had to be diverted just before leaving American airspace to transport a passenger in need of urgent care.
Dr. Surapaneni’s experiences highlight the inadequacies of current in-flight medical kits. The supplies she encountered included only a stethoscope, manual blood pressure cuff, IV catheters, and limited medications like epinephrine and lidocaine for cardiac emergencies. Alarmingly, the FAA has not updated its requirements for these medical kits since 2004.
In 2024, Congress passed a reauthorization bill for the FAA, which mandates a review of the costs and benefits of enhancing emergency medical kits. This includes evaluating whether the kits can adequately address opioid overdoses and severe allergic reactions, known as anaphylaxis. If implemented, airlines would be required to carry naloxone, a medication to reverse opioid overdoses, and epinephrine in appropriate dosages for anaphylaxis.
While these potential additions are crucial, Dr. Surapaneni emphasizes that more basic medical equipment should also be included. She does not expect aircraft to function as emergency rooms, but believes that a few evidence-based provisions could significantly improve passenger care. Items she advocates for include:
– Pulse oximeters to measure oxygen levels.
– Glucometers for blood sugar monitoring.
– Automated blood pressure cuffs.
– Pediatric airway equipment.
– Injectable benzodiazepines for prolonged seizures.
– Naloxone nasal sprays for opioid emergencies.
– Epinephrine auto-injectors for anaphylaxis, in both adult and pediatric dosages.
– Oral glucose gel and glucagon for treating low blood sugar.
Some U.S. airlines, including Southwest Airlines and Delta Airlines, already carry a selection of these essential items, though not all airlines publicly disclose the contents of their medical kits. Official statements from major American carriers regarding their medical kits have been vague, leaving medical professionals wondering about the resources available during an emergency.
Enhancing transparency and standardizing medical kits not only benefits passengers but could also reduce the frequency of unplanned flight diversions, which can cost airlines between $70,000 and $230,000 each time. Although in-flight medical emergencies are rare, the FAA’s mission is to prioritize safety in every possible situation. Expanding the basic requirements for airline emergency medical supplies is crucial for ensuring standardized care and improving passenger safety.
It is imperative for the FAA to act on Congress’s directive and update its policies regarding in-flight medical kits. As air travel continues to grow, so too must the standards of care available on board.
