What occurs during an in-flight emergency? Here’s how airlines and passengers are expected to react.

In 2024, numerous in-flight medical emergencies have made headlines worldwide. In January, a passenger on a Jet2 flight from Tenerife to Manchester tragically died after being discovered unresponsive in the lavatory. Passengers aboard a Lufthansa flight to Munich in February described the “absolute horror” when a man started bleeding profusely from his nose and mouth; the flight made an emergency landing in Bangkok, but the passenger unfortunately passed away. Another incident occurred in late February on a flight from Punta Cana to Charlotte, where a 41-year-old woman began convulsing; the flight was diverted, but she later succumbed at a hospital.

While such unfortunate events receive a lot of media coverage, most in-flight medical incidents are much less severe. The most frequent occurrence is syncope or near-syncope, commonly known as fainting, which, according to a 2018 study published in JAMA, makes up nearly 33% of all cases. This is followed by gastrointestinal issues (about 15%) and cardiovascular symptoms (7%). Statistically, a medical emergency happens in roughly 1 out of every 604 flights.

Statistically speaking, your chances of being on a flight during a medical emergency are quite low, although that risk increases with the frequency of your flights. Nevertheless, aviation experts and medical professionals suggest that passengers—whether they travel frequently or just a few times a year—can take steps to better prepare themselves for potential emergencies at 30,000 feet.

“The primary aim during a medical emergency is to ensure the safety and health of the passenger facing the crisis,” says Bob Bacheler, managing director of Flying Angels, Inc., an organization that facilitates transportation for individuals on commercial airlines with a flight nurse or doctor. “Any support you can provide is extremely valuable. Even without medical expertise, you can assist by offering help where possible—or simply by staying out of the way.”

This guide outlines what passengers need to know during an in-flight emergency, featuring advice from flight attendants, medical professionals, and aviation experts on how to respond and assist—regardless of medical expertise.

“Is there a doctor on board?”

When a medical emergency arises, flight attendants are the first responders. They are trained to handle in-flight emergencies, which includes providing basic first aid and using an automatic external defibrillator (AED)—a device that assesses a person’s heart rhythm during cardiac arrest and can deliver a shock if necessary. Flight attendants also adhere to strict protocols that involve liaising with the pilot and ground-based medical teams to connect with qualified doctors who can guide them through the care process as needed.

Additionally, flight attendants may inquire if any medical professionals are present on the flight to provide assistance. Bacheler, a certified flight registered nurse, emphasizes that it is advisable for medical personnel to carry a copy of their licenses while traveling, enabling flight attendants to verify their credentials; this practice is also a requirement for employees of Flying Angels.

In certain situations, having an extra pair of hands can be beneficial; in crew terminology, this is referred to as an able-bodied assistant (ABA), even if they lack specialized medical training.

“It’s crucial not to assume that someone else has already stepped up or that you lack the qualifications to help,” advises Jared Ross, an emergency physician from Charleston and president of EMSEC, LLC, a medical education and consulting firm. “Sometimes, just having an extra set of calm hands to follow instructions can be invaluable.” For example, when Ross required assistance to hold an IV bag for a fainted passenger, that extra help was essential.

Good Samaritans need not fear legal repercussions, at least in the United States. The Aviation Medical Assistance Act of 1998 provides legal protection for volunteer doctors or individuals who help during in-flight medical emergencies, shielding them from liability except in cases of gross negligence or intentional misconduct.

To divert or not to divert

The decision to continue to the flight's intended destination or to make an emergency landing—known as a diversion—depends on the seriousness of the medical situation.

There are no official policies or government guidelines dictating when a flight should be diverted. The decision involves a complex assessment of multiple factors, including the condition of the passenger experiencing the medical issue, whether the nearest airport has the necessary facilities to provide aid, and whether fuel needs to be dumped for the diversion, among others.

“I often remind individuals, especially those in the medical field, that while they are responsible for the patient's health and well-being, the pilot is ultimately in control of the aircraft and is tasked with ensuring the safety of hundreds of passengers and crew members,” explains Ross. “The pilot makes the final call regarding whether to divert the flight and where to land, and they are usually very open to input on what actions need to be taken.”

Do not depend solely on the in-flight emergency kit

It’s no surprise that in-flight medical emergencies can be highly stressful and tense situations, largely due to the confined space of the airplane cabin and the limited resources available.

The Federal Aviation Administration (FAA) establishes minimum requirements for the contents of emergency medical kits on U.S. aircraft. These kits typically include an FDA-approved AED, a first-aid kit with items like alcohol wipes, gauze, bandages, a stethoscope, IV supplies, and medications such as antihistamines and epinephrine, which are used for allergic reactions. (Antihistamines can also help with nausea and motion sickness.)

However, many medical professionals argue that these kits are in dire need of an update. “The diagnostic and therapeutic tools available on U.S. flag carriers are very limited,” Ross points out.

This makes it even more critical for passengers with medical conditions, such as severe allergies, to bring their own supplies on board, emphasizes Sabrina Childress-Miller, a former flight attendant now operating her own public relations firm in Chicago. “I frequently hear passengers say, ‘Oh, I don’t bring my EpiPen because I know you have one on board,’” she states. “That’s extremely risky.”

Effective communication is essential

Passengers experiencing discomfort should notify a flight attendant as soon as possible, allowing them to monitor the situation in real time. Additionally, informing the flight crew about any potential health issues before takeoff can help prevent complications once the flight is airborne.

“Just give us a heads-up that ‘Hey, I’m not anticipating any issues. However, I have asthma or an allergy,’” advises Childress-Miller.

This proactive communication enables the flight crew to make necessary arrangements in advance, such as seating passengers with cat allergies away from those traveling with their pets. “It’s much better for us to handle that beforehand rather than facing issues at 35,000 feet,” she notes.

Moreover, it is crucial to pay close attention to flight attendants’ directions during a medical emergency—particularly if they instruct you to stay seated to keep the aisles clear for their movement.

Equally important is the understanding that in stressful situations, flight attendants are focused on assisting the passenger and communicating with the cockpit. As Childress-Miller emphasizes, this is not the moment to request another drink.

Another significant point: it is never acceptable to film a passenger during a medical emergency. “That’s simply wrong on so many levels,” asserts the former flight attendant.

On the flip side, when passengers adhere to instructions, it significantly alleviates the stress of a chaotic situation. Childress-Miller recalls one of the most harrowing experiences of her decade-long flight attendant career: a passenger suffered cardiac arrest shortly before the flight began its descent. Flight attendants quickly acted, instructing passengers to remain seated so they could transport the affected individual to the galley for CPR.

Despite multiple rounds of CPR and the use of an AED, the man did not survive. However, while the outcome was tragic, the incident exemplified what passengers should do during any medical emergency: remain calm, stay seated, and follow instructions closely.

She remarks, “Thankfully, this was one of those instances where the passengers followed our instructions perfectly.”