Health & wellness

In Practice

Is there a doctor or nurse on board?

Adapted from the In Practice blog on

For some reason, in my 30s, I began to feel anxious about flying. I’d had no bad experiences and I am not particularly phobic. I know I’m in good company: my patients. One of the most common prescription requests I get is for anti-anxiety medicine for people who are afraid to fly. Fear of flying is very common, affecting 20 percent to 30 percent of people.

What, exactly, are we afraid of? Crashing, of course, and terrorism, and then there’s claustrophobia (fear of closed spaces), and acrophobia (fear of heights), and agoraphobia (fear of environments over which we have little control).

Now, there’s something else to worry about in the air, something not common but much more common than most of the things we’re already worrying about: a medical emergency.


A recent study in The New England Journal of Medicine that looked at the outcomes of nearly 12,000 in-flight medical emergencies between 2008 and 2010 resulted in some interesting findings, most of them reassuring:

Get The Weekender in your inbox:
The Globe's top picks for what to see and do each weekend, in Boston and beyond.
Thank you for signing up! Sign up for more newsletters here

• The most common in-flight emergencies were syncope (fainting), gastrointestinal distress, and respiratory symptoms.

• Few in-flight medical emergencies required diversion of the aircraft. In fact, about a third of the emergencies were resolved such that no EMT services were requested after landing.

• Though AEDs (defibrillators) are available on flights, they were very rarely used.

• The in-flight death rate from medical emergencies is minuscule: a small handful, a tiny fraction of 1 percent, of the 2.75 billion passengers who fly annually.


The possibly less than reassuring finding is that in nearly 70 percent of in-flight medical emergencies, a doctor or nurse who happens to be on board is the first responder. Though the results mentioned above indicate that this usually isn’t a problem, and flight crews have some basic training in handling medical emergencies, this fact is a bit sobering. It means that, over the mid-Atlantic, your heart attack might be managed by a dermatologist or your baby delivered by a geriatric nurse — though that’s probably still better than no professional care at all.

It’s sobering for me and my colleagues, too — literally. We need to think twice before dipping into that complimentary champagne on the delayed flight to Paris, or popping an Ativan to take the edge off our own fear of flying.

Turns out, whether we realized it or not, we’re on call.

This story was originally published on the In Practice blog nearly a week before the crash in San Francisco. Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. Read her blog at