By Matthew Klint

When a medical emergency occurs onboard a flight, what do airlines do if there is no doctor onboard? As it turns out, often the same thing they do when there is a doctor onboard: consult with professionals on the ground.

An interesting article asserts that airlines may even LIKE it when no doctor is onboard: "A medical emergency sets in motion a high-altitude calculation with human lives in the balance. While pilots are the ultimate decision-makers, airlines have earth-bound medical consultants that help bypass on-board volunteers — reducing expensive emergency landings, but with the potential of providing expert decisions in real time."

Take the story of Lewis Christman. He suffered from an acute pancreatitis attack aboard a United flight from Chicago to Rome in 2016. For seven hours, he writhed in pain in a fetal position on the floor. Upon landing in Rome, he was transferred to hospital and spent the next few months in and out of hospitals.

He’s now suing United for failing to divert. A doctor onboard had recommended the aircraft divert, but the captain chose to continue to Rome. This case may hinge on whether United contacted any medical consultants on the ground. Was this cost/benefit analysis made with improper weight given to the cost of a diversion, which can run as little as $10,000 and as much as $200,000?

A company called MedAire Inc., based in Arizona, offers in-flight medical advice to 100+ airlines. Interestingly, only 1.6% of medical emergences in which MedAire is consulted on have led to diversions.

Paulo Alves, Global Medical Director of Aviation Health at MedAire explained: "If the model was not financially interesting for them, then they wouldn’t hire us. Doctors, they tend to recommend diversions more than we do, because of course they don’t want to assume the long-term responsibility."

How often do medical emergencies occur onboard an airplane?

According to a 2013 study, one out of every 604 commercial flights in the USA encounters a medical emergency. Of that, 7.3% of flights are diverted.

CONCLUSION

It is never an easy case, is it? On the one hand, there is a desire to divert, even if nothing else but for an abundance of caution. On the other hand, when a diversion is not necessary, the airline loses a massive amount of money, other passengers become stranded or delayed, and a ripple effect across the network ensues.

Perhaps taking the decision from an onboard doctor and instead using that doctor as someone who collects data or follow telephone instructions is indeed a better path. Companies like MedAire or STAT-MD provide specially-trained doctors within minutes to address the specific incident onboard.

Doctors are protected from liability for providing medical consultation and assistance onboard a plane (by federal law). Even so, the onboard drama often compels them to err on the side of the caution. For that reason, airlines prefer to consult ground-based help. That makes sense to me.