The Canadian Medical Association Journal has published recommendations for doctors on how best to address in-flight emergencies. The recommendations, created with insights and collaboration from with Air Canada and West Jet provide a general overview of what type of medical equipment is available on flights, airline policies and procedures for addressing medical emergencies, the challenges of treating patients at altitude and on an airplane, and the legal and ethical duties of physicians responding to emergencies.

Why Address this Issue Now?

The authors of the recommendations point out that more and more people are travelling via airplane each year, with about 2.75 billion passengers flying on commercial airlines annually. In Canada alone, there has been a 27% increase in commercial air passengers since 2009. This growth in passenger traffic is also compounded by a larger proportion of older passengers and passengers with pre-existing medical conditions as well as longer routes and has led to an increase in the number of in-flight medical emergencies in recent years.

Dr. Ackery, the senior author of the recommendations and an emergency physician at St. Michael’s hospital, notes that:

Every health-care professional is likely to hear this call at some point while flying, but for most of us, treating patients on a plane is a completely unfamiliar scenario…[w]e wanted to provide a better understanding of what to expect and how to respond if you’re called to assist in one of these emergencies.

What Medical Resources are Available on Flights?

Under Transport Canada regulations, every plane with at least 100 passenger seats is legally required to have a medical kit on board. While Transport Canada also outlines the minimal requirements that the medical kit must have, it is up to the individual airlines to go beyond those minimal requirements.

In a video intended to supplement the recommendations, the co-authors of the recommendations, Dr. Ackery and his co-author, Dr. David Kodama, go through an Air Canada medical kit to show doctors what resources would be available to them on that airline in the event of an in-air emergency.

Dr. Kodama, an emergency medicine resident at the University of Toronto, notes that:

Each airline’s kit is going to look different, and the contents aren’t always going to be familiar, which adds another layer of complexity to an already stressful situation.

Legal and Ethical Obligations of Physicians

Quebec is currently the only Canadian province that imposes a positive legal duty on physicians to help a person involved in a life-threatening emergency. However, all Canadian jurisdictions have legislation protecting physicians who voluntarily provide assistance in an emergency or at the scene of an accident. As such, a doctor in Ontario who witnesses an accident or emergency or comes across such an incident is not obligated to stop and help, but if he or she does help, they generally cannot subsequently be sued for any injuries or death resulting from that assistance (unless there was negligence, or they did not meet the standards expected of a reasonable person acting under similar circumstances).

The Canadian Medical Association’s Code of Ethics states that physicians should “[p]rovide whatever appropriate assistance you can to any person with an urgent need for medical care.” Canadian Medical Protective Association (CMPA) encourages its members to “consider assisting when confronted with an accident or with sick or injured individuals in urgent or emergent circumstances” and notes that CMPA members who act as good Samaritans and provide care in an emergency are generally eligible for CMPA assistance “regardless of where the emergency care was delivered” (this includes situations that take place outside of Canada, or in international air space or on international waters).

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