Advocating for Patients Everywhere, Even in Flight

According to a 2020 publication in Health Equity, one in every 604 flights will have a medical emergency. With roughly 87,000 flights in the United States, that means there are about 144 medical emergencies per day. These can range from mild anxiety or fainting due to cabin pressure changes to serious medical conditions like heart attacks, which result in re-routing the plane. About 7 percent of cases end in this manner.

As doctors, it’s our duty to try to help when a medical emergency arises, no matter where it is. I went into medicine to care for people, and that’s not isolated to the hospital or to my own patients. So, when a medical emergency arose on my recent overnight flight to Portugal, I offered my help. When I got to the passenger in need, a flight attendant handed me a medical emergency kit.

Despite having flown my whole life, I had never participated in an in-flight medical emergency before and had honestly never thought much about what those kits contained.

In-flight medical kits have been required on planes since 1986. There have been a few updates since then: once in 1997, another time in 1998, and then a final time in 2004. It has not been updated since.

Unintentionally going viral

While the passenger thankfully ended up fine with minimal intervention, I was pretty shocked at how ill-equipped I would have been to take care of a more serious situation like a stroke, cardiac arrest, or overdose. There was no Narcan, Epipen, glucometer or pulse oximeter, and the disposable stethoscope was disassembled and wrapped in plastic. As I waited for customs, I quickly tweeted out to Delta that their medical emergency kits needed an upgrade to keep passengers safe. It almost immediately went viral, with medical professionals chiming in with similar experiences. Since that tweet, I’ve been interviewed by NPR, invited to join a Medscape podcast, and connected to a world I had never explored before.

To Delta’s credit, a nurse from their medical team called me to follow-up a few days later, as is their protocol with all in-flight emergencies. I was pleased to hear the airline had already been working on adding automated blood pressure cuffs, a pulse oximeter, and a real stethoscope to their kits.

Delta may not have seen my tweet before they called, but it seems to have brought a lot of attention to the issue and helped inform Delta and other airlines of needed upgrades. I’ve gotten a lot more attention than I expected or intended out of that tweet, but at the end of the day, if it accomplishes something good, that’s a good thing.

Prepared and willing to tackle systemic issues

Even in a hospital setting, there are times in medicine where we may not have what we need, and we have to be resourceful. But as a surgical oncologist, I prioritize speed and efficiency. With cancer, it’s important to get patients in and treated as quickly as possible. So, in these types of situations, I naturally look to see what we can fix in the process.

Therefore, I’m hopeful the conversation inspires even broader work by the Federal Aviation Administration (FAA) to require better emergency medical kits and better documentation of these incidents. Delta’s promise is wonderful, and I am heartened to hear that they are in the process of making changes. However, a broad, systemic, regulatory change is to ensure that all who fly have equitable access to the appropriate medical care regardless of which airline they choose.

Working at BMC, where we care for many patients who may lack access to essential resources, we see many systemic problems. Our patients are so wonderful and deserve great care, but the U.S. health care system can be really challenging and hard to navigate. I’ve learned to always be on the lookout for ways to improve systems to make the health care experience as easy as possible for my patients, and patients everywhere.