When Flying, Why Don’t You Ever Hear ‘Is There a Doctor on Board’?

Not that you would want to.

On television and in movies, hearing a panicked flight attendant call, “Is there a doctor on board?” is so common that many passengers are surprised they never hear this phrase in real life. Fortunately, you will probably never hear the flight crew call for a doctor because medical emergencies on airplanes are rare.

However, they do happen. Mary Jo Manzanares, who was a flight attendant for 33 years with a major American airline, has had to assist passengers who passed out, injured themselves in-flight, and had anxiety attacks. Other flight attendants have delivered babies in the air, treated allergic reactions, and dealt with head injuries and heart attacks. Just about any medical issue that can happen on the ground can happen in the air.

The response varies when a passenger experiences one of these medical emergencies on board. That’s because airlines are governed by different regulations based on where the airline is headquartered and where the plane is flying. Moreover, airlines each have their own internal policies about handling medical emergencies in the air.

Nevertheless, most airlines follow a similar protocol to ensure passengers get the assistance they need, says Manzanares. Almost every airline will ask if a doctor is on board—but only as a last resort.

Preparation

If a passenger needs assistance, “our flight crews can handle most medical incidents,” says Guðmundur Tómas Sigurðsson, the head of training and vice president of flight operations for Icelandair. On Icelandair flights, the flight crew starts by assessing the situation, using their extensive medical training, he says. The flight crew can often provide first aid and use onboard medical equipment if necessary without the assistance of a doctor, Sigurðsson explains.

That’s because, like the flight crews for most major airlines, Icelandair’s flight crew is trained extensively about handling medical issues. That includes first aid training, CPR, the use of defibrillators, and how to administer emergency oxygen. They can also manage “common in-flight medical issues,” including “heart problems, allergic reactions, seizures, and hygiene protocols for contagious illnesses,” Sigurðsson says.

Flight crews are also typically trained to handle emergency childbirth and how to best support passengers with disabilities who may need additional medical support, according to information provided by Vivanh Huynh, a spokesperson for Emirates Airline.

Airlines typically also train their flight crews about how to reassure passengers who are in distress. According to the information provided by Huynh, Emirates Airline flight attendants receive training about gaining consent to help a passenger in need, showing empathy to ill passengers and their families, helping them stay calm, when to stay with a passenger, and informing an ill or injured passenger about what is happening while they get help. They are also trained on the best way to tell difficult news to passengers or their families, according to the information provided by Huynh.

Because medical training for flight attendants at her airline is so comprehensive, Manzanares says that she used shorthand phrases to communicate a passenger’s needs to another flight attendant. For example, if she said “oxygen” to one of her colleagues, she says the other flight would spring into action immediately. They would know exactly where to go to get the oxygen, how to set it up, and how to help her administer oxygen, Manzanares says. “In an emergency, the repetitious training kicks into gear, and we automatically go to those procedures,” she explains.

Sigurðsson emphasizes that the flight crew undergoes medical training regularly to ensure they are prepared for a medical emergency. When she was a flight attendant, Manzanares was required to undergo medical training annually to renew her certification.

Support on the Ground

If the flight crew needs additional assistance, the next step is usually to contact support on the ground. Like many other major airlines, Icelandair consults MedLink, Sigurðsson explains. After contacting MedLink, the flight crew can get treatment advice and guidance about whether a diversion is necessary, he says. Typically, only a very serious medical incident, including a suspected stroke or heart attack, prolonged seizure, significant head trauma, or uncontrolled bleeding, would warrant a diversion, says Dr. Larry Fan, a surgeon and founder of 77 Plastic Surgery.

However, deciding whether to divert the plane is ultimately up to the pilot. Sometimes, diverting the plane is not possible due to the plane’s location or operational issues, such as no nearby airport that can accommodate an early landing. “Putting an aircraft on the ground is not something done lightly, and there are far more details involved than most people realize. Sometimes, it is quicker to continue to a destination than to get alternate flight plans and arrange for medical transport on the ground,” Manzanares says. She adds that in her over three decades of working as a flight attendant, she has never been diverted for a medical emergency.

‘Is There a Doctor on Board?’

If more support is still needed, the flight crew may seek assistance from a doctor or other medical professional on board. Sometimes, passengers with medical training identify themselves as flight crew members when they get on the plane, Manzanares says. If this happens, the flight crew may discreetly ask for assistance if needed, Sigurðsson explains.

As a last resort, the flight crew may make a public announcement asking if a doctor is on the flight. However, if this happens, some passengers may not hear the announcement because they have headphones on, Manzanares says.

If a doctor is on board, they will usually coordinate with the airline’s on-ground medical advisory service to provide care, Sigurðsson explains. In the United States, Good Samaritan laws may provide some legal protections to doctors who come to someone’s aid, Fan says. However, not all doctors are equally equipped to help. “Emergency medicine doctors will be the best,” Fan explains. However, other specialists can assist passengers if needed.

Once, one of Fan’s surgical colleagues resuscitated a passenger who had a heart attack while in the air. Although Fan is a surgeon, he has also helped passengers on planes on a few occasions. Most recently, a flight attendant asked him to assess a passenger with diabetes who had been drinking. The passenger felt lightheaded and was losing consciousness. Fan checked the passenger’s vital signs. After determining they were normal, he checked signs of stroke, trauma, and injury. After Fan determined that the passenger was stable, Fan sat with them for the rest of the flight. He periodically reassessed them to make sure their condition didn’t worsen.

When “the plane landed, a medical crew came aboard, and the patient received further care,” Fan says. To protect the passengers’ privacy, Fan did not get an update about what would happen next. “It was stressful, but I feel fortunate to have been able to help,” he says. Although Fan did not expect anything in return, the airline gave him a flight voucher to thank him for his help.

If Fan had not been on board, he doesn’t know exactly what would have happened. However, he suspects that “the crew would likely have continued their emergency medical protocol, including contacting the remote medical advisory service. The crew would have provided supportive care, and the medical advisor would have helped them triage.”

How Can You Avoid a Medical Emergency on a Flight?  

Sometimes, medical emergencies are unavoidable. However, Fan says there are some steps all passengers can take to keep themselves as healthy as possible while flying. He stresses that these are general tips and not medical advice.

1. Fan suggests that passengers take their medications as prescribed. Often, this means keeping their medication and supplies with them on their flight and making sure they are easily accessible. Manzanars has had to help passengers who forgot to take their medications or took them at the wrong time because they were flying across multiple time zones and did not follow their regular medication schedule.

2. Passengers should manage their medical conditions carefully while flying. Fan recommends that passengers with heart disease avoid excess salt, that those with diabetes monitor their blood sugar before and during the flight, and that anyone with a respiratory condition have their inhaler or oxygen easily accessible if needed.

3. Fan suggests that passengers with medical conditions consider wearing a medical alert bracelet when they fly. This can help the flight crew and medical support personnel better understand their medical history quickly if an emergency arises. Sigurðsson says bringing a doctor’s note explaining your medical conditions can also help.

4. Fan says that “in general, patients should ’get on their flight healthy.’” That includes “being well hydrated, avoiding excessive alcohol and sedatives, and consuming easy-to-digest foods,” he says.

5. Fan suggests “moving around while traveling.” Standing up and walking every hour, doing foot pump exercises, and wearing compression socks “can prevent blood clots, which can be caused by long periods of immobility like being on a flight,” he says.

If you do need assistance, don’t hesitate to ask. “Passenger safety and well-being are our top priorities,” and the flight crew wants to help, Sigurðsson says.

“Unless it’s something dramatic, we just take it all in stride,” Manzanares says. Just part of another day at 30,000 feet.”