In-flight Emergencies Research Articles

Context-Sensitive Augmented Reality Assistance in the Cockpit

Synthetic vision on head-mounted displays (HMDs) has developed into an increasingly common type of assistance for pilots, both in commercial and in general aviation. As synthetic vision only augments the view on objects in the outside world, there is untapped potential to extend the use of HMDs to assisting pilots with augmented reality (AR) inside of the cockpit. We present two in-cockpit AR assistance designs for in-flight emergency assistance in a simulator study with fifteen licensed pilots. The two AR assistances were designed to be sensitive to either temporal context, or to spatial and temporal context. The simulator study revealed that the presented AR assistances proved effective for mitigating an unexpected failure. Pilots preferred the fully context-sensitive AR assistance overall, while only the AR representation with temporal context showed significantly shorter reaction times than the conventional aid. Our findings suggest that AR can be a valuable tool for assisting pilots in critical flight phases, contributing to increased safety in aviation.

Addressing a community need: assessing the confidence and attitude of senior medical students in responding to in-flight emergencies

Traveling physicians will likely be called for medical assistance on board. In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. This study evaluated senior medical students’ willingness, understanding, confidence, and attitudes toward IMEs and their willingness to respond to them. This cross-sectional study was conducted among senior medical students in the College of Medicine, King Saud University, Riyadh, Saudi Arabia. These medical students were sent a self-administered online questionnaire, which consisted of basic demographic data, a survey to evaluate IME experiences, and a 10-item questionnaire to assess the attitude of students. Among 302 medical students, 52.3% were males, while 66.9% were over 22 years old. The prevalence of students who attended life support training was 62.6%, which was highly significant among the 5th-year level (p = 0.001). Neutral attitudes were found in most students (87.7%); 4.6% had positive attitudes, while 7.6% had negative ones. Being at the 5th-year level and having previous participation in life support training were associated with an increased attitude toward in-flight medical emergencies. The attitude of senior medical students toward IMEs was less than desired. However, the attitude was better among 5th-year medical students who attended training courses on managing IMEs. Thus, participation in training courses influenced the willingness to manage such cases. Subsequently, longitudinal studies are needed to extract more data on the knowledge and confidence of medical students toward IMEs.

A Review of Training Procedures for Simulated Engine Failure after Take-Off Exercises with Twin-Engine Aircraft under 5700 kg

Engine failure after take-off (or one engine being inoperative) is an exercise conducted as part of multi-engine flight training and on-going competency checking. To prepare pilots to manage a real in-flight emergency, this exercise has traditionally been conducted immediately after take-off. This has led to increased risks of fatal accidents due to the reduced height at which these exercises are typically conducted. Yet, there is variation in the heights stipulated in training procedures published by different stakeholders worldwide. Additionally, the conduct of the exercise has resulted in fatal accidents worldwide. This paper aims to review the previous literature on aviation training and aviation occurrence data to determine what empirical data exists to support the method of conducting simulated engine failures. Peer-reviewed academic publications on aviation training, aviation occurrence databases such as aviation investigation reports, and guidance materials published by aviation authorities on simulated training exercises will be included in this paper. It was found that the previous research on these exercises has focused on the transfer of motion cues or pilot responses to abnormal situations, but did not include specific data comparing pilot performance at different heights above ground level. A review of aviation occurrences found that actual engine failures occurred at higher heights that those used in simulated engine failures. A comparison of the guidance published by aviation authorities identified variations in the minimum altitude published and differing justifications for the minimum height chosen. Future research is needed to compare pilot performance during simulated engine failures to determine the ideal height to conduct the exercise to be representative of an actual engine failure while maintaining safety margins.

Willingness and self-confidence of healthcare workers in Bahrain in assisting with in-flight emergencies.

In-flight medical emergency (IFE) impose considerable challenges on healthcare workers (HCWs) because of limited resources, constrained environment, and medico-legal issues. This study assessed HCWs knowledge, willingness, and confidence in addressing in-flight medical emergencies. A cross-sectional study was conducted between June and August 2023 among nurses and physicians working in primary healthcare centers and governmental hospitals in Bahrain. Subjects were selected using stratified random sampling; a self-administered online questionnaire of high reliability (Cronbach alpha = 0.914) was used to collect the data. Logistic regression analysis were performed to determine association of knowledge, willingness, and confidence in dealing with in-flight emergencies with various characteristics of HCWs. The study included 805 HCWs with mean age of 35.5 years (SD=9.2). The findings indicated deficiency in training, with <10% of participants trained on IFE. A considerable proportion of participants exhibited low levels of knowledge (88.3%) and confidence (75.9%) with IFE. Nonetheless, more than half of the participants expressed the willingness to assist in IFE (59.1%). Non-Bahraini healthcare professionals (odds ratio [OR] = 2.901, P < 0.001) had higher knowledge of IFE. Nurses (OR = 1.642, P = 0.047) and participants with longer work experience had higher willingness to assist in IFE. In addition, professionals who were non-Bahraini (OR = 3.249, P < 0.001), working in secondary care (OR = 1.619, 95% confidence interval P = 0.021), had had training on IFE (OR = 2.247, P = 0.004), and had encountered IFE before (OR = 1.974, P = 0.006) had greater self-confidence levels. Considering the low levels of knowledge and confidence healthcare professionals in Bahrain had with regard to IFE, targeted training initiatives and educational programs are necessary to improve HCW's confidence and preparedness to deal with such emergencies.

Considerations for Medical Students' and Residents' Response to an In-Flight Call for Help.

INTRODUCTION: High quality cardiopulmonary resuscitation and medical care in an emergency can save lives, especially when resources are limited, as when in flight on a commercial airplane. A medical student or resident may be the most qualified person to offer assistance during an in-flight cardiac arrest; however, he/she may not yet have experience acting as a sole provider on the ground. Moreover, physicians-in-training may feel an ethical obligation to help a fellow passenger in need, but later worry that their help is subject to questions of tort liability action. This commentary will discuss who should volunteer to help in flight, considering the capability, ethics, and legal consequences of medical students and residents providing medical assistance on an airplane. It will also discuss how changes in medical curriculum due to the COVID-19 pandemic may aid medical trainees' ability to help during an in-flight emergency as well as propose further opportunities for training.Edelson J, Ruskin K. Considerations for medical students' and residents' response to an in-flight call for help. Aerosp Med Hum Perform. 2024; 95(1):59-60.

Assessing Family Medicine Residents' Knowledge, Attitudes, and Confidence in Managing In-Flight Medical Emergencies in Riyadh, Saudi Arabia.

The global increase in air travel has led to a rise in in-flight medical emergencies (IMEs), posing significant challenges to global public health. In a significant number of instances, physicians are often called upon to respond to IMEs during flights. These emergencies are unique due to the cabin environment's constraints, including confined space, ambient noise, and reduced atmospheric pressure. Various proactive measures have been introduced to mitigate IME occurrences, but many healthcare professionals, including family medicine (FM) residents, feel inadequately prepared to respond effectively. This cross-sectional study was conducted among all family medicine (FM) residents in Riyadh, Saudi Arabia, in January 2023. A self-reported questionnaire was used, including questions aimed at evaluating the sociodemographics, travel profiles, knowledge, confidence, and attitudes of FM residents toward IMEs and their ability to respond to such emergencies. A total of 189 FM residents participated in the study, revealing a young and diverse group of participants. Most were male (97 (51.3%)), averaging 27 years old. Nearly all held life support credentials (185 (97.9%)), particularly basic life support (BLS) and advanced cardiovascular life support (ACLS). Despite frequent travel, the majority lacked in-flight emergency training and experience. Allergic reactions (28%), cardiovascular (24%), and respiratory emergencies (24%) were the most common IMEs encountered. While 109 (57.7%) would assist during an IME, 87 (46%) were unsure of their competence, and 109 (57.7%) had medico-legal concerns. Most, i.e., 176 (93.2%) agreed with the need for more IME training, but 138 (73%) lacked clarity about in-flight medical supplies. In conclusion, this research underscores the importance of preparing FM residents and healthcare professionals for IMEs, advocating for specialized training programs that enhance their readiness to respond competently to an IME.

Free Fall Detection in UAV Missions

This research paper addresses the designing of high speed free fall detection and primary trigger generation problem as a part of an in-flight emergency technology developments for unmanned aerial vehicles. The primary trigger is the very first to be detected and to be generated with high speed and accuracy in designing protection mechanism. This trigger indicates that UAV started falling. Sequences of resulting mechanism such as airbag inflation comes secondly. Speed requirement is a deterministic factor when the flight altitude is low. In this paper a high speed analog module is proposed to achieve the primary trigger and performed relevant validation tests on linear free fall and rotational free fall which covers the majority of free fall patterns. The positive test results verify the design as a primary trigger generation module for linear and rotational free fall detection in low altitude UAV missions or which could be enhanced with additional features to form more complex system of airbag inflation in UAV in-flight emergency technology development.

The Problematics of Gender for Aviation Emergency Communication during an Inflight Emergency: A Case Study

Due to the rarity of female pilots, aviation communication is typically conducted in a single-gender environment. The role of gender in interactions during inflight emergencies has not yet been adequately explored. This single case analysis uses a qualitative approach based on conversation analytic transcripts to investigate how gender may be relevant either explicitly or implicitly in radio transmissions between flight crew and Air Traffic Control (ATC) personnel, as well as internal ATC phone interactions as participants work to handle an inflight emergency. This incident involved a female pilot and a male copilot, thus providing a naturally occurring rare event to explore the potential relevance of gender. The analysis shows that explicit references to gender are limited to occasional asymmetrical use of gendered address terms and gendered pronouns. Participants also used interactional formulations that—while not explicitly gendered—have been associated in previous research with gender differences in interaction, for example, the use of indirect forms of requests or complaints, actions that imply inferences about the emotional state of participants, or possible confusion over the identity of the pilot given the transitions between male and female sounding voices speaking on behalf of the plane. The findings are discussed in terms of implications for how gender differences can impact aviation communication during emergency incidents.

Парирование нештатных ситуаций при пусках исследовательских баллистических ракет с созданием резервных условий входа объекта испытаний в атмосферу

The article is devoted to solving the problem of determining and implementing backup conditions for the research ballistic missiles entry with the test objects in the inflight emergency situations. A test object is understood as a descent vehicle entering the atmosphere and moving at the speed close to the first cosmic velocity. In emergency situations during launch and on the active trajectory leg, backup entry conditions are making it possible to carry out the guaranteed flight testing, albeit with less efficiency, but with exception of the launch emergency completion and complete failure in fulfilling the flight test tasks. Detailed study of this problem is quite suitable for practical implementation and goes far beyond the scope of this work, since it requires design studies, including aerodynamic, dynamic, thermal and strength calculations, as well as the development of additional onboard and prelaunch algorithms. This paper notes only certain main features in decision making to terminate or continue the flight after the emergency situations for а research ballistic missile with liquid rocket engines and solid propellant rocket engines. Mathematical apparatus of the external ballistic design is used to solve the problem.

Analysis of medical emergencies in commercial flights and utility of medical resources onboard

Objectives: Civil aviation in India is flourishing and has resulted in a substantial increase in air travel. Hence, the increase in the number of in-flight emergencies is not unanticipated. This study attempts to analyze the incidence of medical emergencies that occurred on board in a single major Indian domestic airline and to assess the adequacy of the medical equipment provided in the in-flight emergency kits. Material and Methods: A retrospective analysis was carried out of the narrative summaries of all medical events reported by the cabin crew of one major airline in the domestic sector. The data represented an average of 39.9% of total domestic passenger volume from January 2015 to December 2017. An assessment of available medical resources onboard and their utility in managing the medical events was carried out. A comparative study was also attempted on the Directorate General of Civil Aviation (DGCA) recommendations on onboard medical resources and those of other regulatory agencies. Results: A total of 221 in-flight emergencies were reported from the sample. Breathlessness (n = 52) was the most common presenting symptom and cardiovascular conditions (n = 68) were the most commonly diagnosed medical illnesses. Four deaths on board were reported. Medical kits recommended by DGCA, India, are comprehensive and carry most of the required medications. Conclusion: Civil aviation in India is growing with more citizens using airlines for regular commutes and, hence, the likely incidence of more in-flight emergencies. A standardized system for reporting all in-flight medical emergencies, including their outcomes, should be made available to have a better understanding of the problem statement and guide suitable mitigating actions.

The frequency and characteristics of epinephrine use during in-flight allergic events

BackgroundAllergic reactions account for 2% to 4% of medical events in-flight and 5.5% of all medical events in passengers 18 years and under. ObjectiveTo evaluate the incidence of in-flight allergic events including availability, use of epinephrine, and final patient outcome. MethodsWe conducted a retrospective study of the ground-based medical service (GBMS) database from January 2017 to December 2019 for all allergic events and epinephrine utilization. ResultsA total of 140,579 in-flight medical events (IFMEs) were initially retrieved from the period between January, 2017 and December, 2019, of which 4230 (3.0%) unique cases were identified as allergic events. Epinephrine administration was recommended in 398 passengers by GBMS. Of those, 328 (82.4%) ultimately received at least 1 dose of epinephrine. In multivariate analysis, there was a significant difference in the involvement of volunteers (odds ratio [OR], 3.19; P value < .001; 95% confidence interval [CI], 2.43-4.16), availability of autoinjectors (OR, 2; P value < .001; 95% CI, 1.55-2.58), flight diversion (OR, 11.21; P value < .001; 95% CI, 3.60-34.89), and hospital transport (OR, 6.58; P value < .001; 95% CI, 4.62-9.38) between the 2 groups. Passengers older than 12 years of age were at a higher risk for epinephrine administration. In the secondary analysis of 51 airlines that consistently use GBMS for all IFMEs, the incidence of allergic events was found to be 0.91 cases per million passengers. The incidence of severe in-flight allergic emergencies requiring epinephrine administration was 0.08 cases per million passengers or 12.5 million passengers for 1 event. ConclusionIFME requiring epinephrine administration is rare with an incidence rate of 1 event in 12.5 million passengers. The risk for epinephrine administration is higher in passengers more than 12 years of age and is associated with significantly higher flight diversion, hospital transport, and involvement of medical volunteers.

Developing an innovative health monitoring device to improve communication between passengers and cabin attendants during Inflight Emergencies

Introduction Medical emergencies occurring onboard commercial flights are exceedingly rare, however if it happens, they put cabin-, flight crew and fellow passengers under enormous stress levels. The use of a Health Monitoring System could aid the cabin crew in early detecting critical health conditions. Additionally, for passengers there is no possibility to discreetly inform the crew about emergencies since there is only a Passenger Call Button available. Research Question This paper analyses passengers´ user acceptance of the Health Monitoring System as well as the Emergency Button. Method Participants needed to complete an online survey and were presented prototypes of the Health Monitoring System as well as the Emergency Button. User acceptance was measured using the Van der Laan scale. A total of 41 participants contributed to the study. Result The user ratings for the Onboard Health Monitoring System were low mainly due to privacy concerns of the passengers. Since only one use case for the Emergency Button has been presented to the participants of the study, the user acceptance ratings were also low. Discussion Passengers were reluctant to share sensitive data. However, the majority (over 70%, n≥ 11, effective sample size=16)) agreed to have the most important vital signs such as heart rate, blood pressure, body temperature, oxygen saturation measured. Conclusion To increase user acceptance of the Health Monitoring System it is important for the passengers to ensure that sensitive data is handled and stored carefully. Additional detailed usability assessments would be necessary for both devices to draw further conclusions about system design.

Aeromedical evacuation of a COVID-19 patient from a zonal hospital: A case report

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected the whole world including many healthcare workers. In this era of ongoing global pandemic, the patient surge for aeromedical evacuation is going to increase. Case Details: A 54-year, male healthcare worker with no known co-morbidities, presented with complains of fever, myalgia, and sore throat at a zonal hospital of Indian Air Force in the northeast part of India. He was diagnosed with COVID-19 related bilateral extensive pneumonia. Despite of standard treatment, his condition deteriorated. An aeromedical evacuation of the patient was carried out to a tertiary healthcare centre at Delhi which involved 4-h of flying time. The Airborne Rescue Pod for Isolated Transportation (ARPIT) isolation pod was used to minimize the risk of contamination. Discussion: This was the first time that a COVID-19 patient was air evacuated in an isolation pod in Indian Armed Forces to the best of our knowledge. Based on our experience, we recommend that air evacuation of such a patient may be resorted to only as a life saving measure. The use of an isolation pod remains an unsettled issue; whereas, it gives absolute containment to spread of infection, it poses unique challenges in terms of handling the patient in case of an in-flight emergency. Certain modifications in the isolation pod have been recommended.

A Comparison of In-flight and Ground-Based Emergency Medical Events on the Clinical Demand for Outreach Medical Services at Taoyuan International Airport, Taiwan.

Background: Limited information is available covering all medical events managed by the airport-based outreach medical service. This study explores the clinical demand for emergency medical outreach services at Taoyuan International Airport (TIA), Taiwan.Methods: Electronic medical records collected from TIA medical outreach services from 2017 to 2018, included passengers' profiles, flight information, events location, chief complaints, diagnosis (using ICD-9 -CM codes), and management outcomes. Medical events distribution was stratified by location and ages, and were compared statistically.Results: Among 1,501 eligible records, there were 81.8% ground-based emergency medical events (GBME), 16.9% in-flight medical events (IFME) managed after scheduled landing, and 1.3% IFME leading to unscheduled diversion or re-entry to TIA. The top three GBME diagnoses were associated with neurological (23.3%), gastrointestinal (21.2%), and trauma-related (19.3%) conditions. The top three IFME diagnosis that prompted unscheduled landings via flight diversion or re-entry were neurological (47.4%), psychological (15.8%), and cardiovascular (10.5%). The chief complaints that prompted unscheduled landings were mostly related to neurological (42.1%), cardiovascular (26.3%), and out-of-hospital cardiac arrest (OHCA) (10.5%) symptoms. A higher frequency of IFME events due to dermatologic causes in patients aged ≤ 18 years compared with adults and older adults (19 vs. 1.5% and 0, respectively); and a higher frequency of IFME due to cardiovascular causes in adults ≥ 65 years compared with patients aged ≤ 65 (15.1 vs. 9%). Among all IFME patients, six out-of-hospital deaths occurred among passengers from scheduled landings and two deaths occurred among 18 IFME passengers who were transferred to local hospitals from flight diversion or re-entry. A statistically significant difference in outcomes and short-term follow-up status was found between patients with IFME and those with GBME (p < 0.001).Conclusion: Ground-based emergency medical events exceeded in-flight medical events at TIA. The most frequent events were related to neurological, gastrointestinal symptoms, or trauma. Results of this study may provide useful information for training medical outreach staff and preparing medical supplies to meet the clinical demand for airport medical outreach services.

In-flight medical emergencies during commercial travel.

Growing number of passengers travelling by air is associated with increased in-flight emergency medical events (IEMEs). However, there are scarce data regarding IEMEs during commercial travels. In this study, analysis of IEMEs occurring among adult and paediatric passengers during commercial international and domestic flights of a major airline company was targeted. Data regarding IEMEs recorded in all international and domestic flights of a major airline company between 1 January 2018 and 31 December 2020 were collected. Demographics, adult and paediatric IEMEs, in-flight deaths and aircraft diversions (ADs) were analysed. Total number of passengers was 177 400 748 and a number of 22 541 (0.012%) IEMEs occurred. The frequency of IEMEs per 1 million passengers was 127. The number of male patients suffering from IEMEs was 8387 (37.2%), while the number female patients was 10 853 (48.1%). Median age of adult and paediatric patients were 43, [32-57], 4, [2-10], respectively. The most common cause of IEMEs in adult patients was headache (3424 IEMEs, 15.1%) and it was fever in paediatric patients (688 IEMEs, 3.05%). Multiple symptoms were present in 8449 IEMEs (37.4%). On-board doctors managed events in more than half of IEMEs (13 295 IEMEs, 58.9%). AD was required in 255 (1.13%) IEMEs. The most common reason for AD was chest pain (45 IEMEs, 17.6%) in adult patients. The most common reason for AD in paediatric patients was epileptic seizures (nine IEMEs, 3.5%). A total of 46 (0.2%) patients, including 2 (0.008%) paediatric patients, died. Majority of IEMEs are not life-threatening conditions, which can be easily managed by cabin crew or on-board doctors without AD. Multiple symptoms can be present in a patient suffering from IEME. Ground-to-air medical assistance may help optimization of diagnosis and decision for AD.

Training Family Medicine Residents to Prevent and Respond to In-flight Emergencies.

In-flight emergencies (IFE) reportedly occur globally in about 1 in 604 flights1. During training, family medicine (FM) residents acquire the skills necessary to counsel patients who are at risk, provide comprehensive management, and respond in emergent situations. The purpose of this study was to assess FM resident's knowledge about IFE, counseling, and attitudes towards responding to IFEs. A 15-question survey was sent to FM residents in the Dallas-Fort Worth area. IFE training options were also reviewed. Survey results revealed gaps in knowledge, yet a willingness to assist if necessary. A didactic IFE training format was found to be more achievable.

Unmanned Aerial Traffic Management System Architecture for U-Space In-Flight Services

This paper presents a software architecture for Unmanned aerial system Traffic Management (UTM). The work is framed within the U-space ecosystem, which is the European initiative for UTM in the civil airspace. We propose a system that focuses on providing the required services for automated decision-making during real-time threat management and conflict resolution, which is the main gap in current UTM solutions. Nonetheless, our software architecture follows an open-source design that is modular and flexible enough to accommodate additional U-space services in future developments. In its current implementation, our UTM solution is capable of tracking the aerial operations and monitoring the airspace in real time, in order to perform in-flight emergency management and tactical deconfliction. We show experimental results in order to demonstrate the UTM system working in a realistic simulation setup. For that, we performed our tests with the UTM system and the operators of the aerial aircraft located at remote locations with the consequent communication issues, and we showcased that the system was capable of managing in real time the conflicting events in two different use cases.

Cardiovascular screening for pilots, aircrew, and high performance &amp; spaceflight passengers

Heart disease is the #1 cause of disease-related death in pilots & astronauts in the world and coronary artery disease (CAD) is found in 85% of pilot autopsies after fatal accidents [1], [2], [3]. Acute cardiovascular incidents in flight crew can result in in-flight emergencies requiring emergency diversion, or at worst a major aircraft accident. When including passengers, emergency landings, to include airport diversion, occur in 1 out of every 604 flights at an average cost of $38,000 and are most commonly caused by cardiovascular processes including myocardial infarction and syncope [4]. Medical flying standards in aviators with coronary artery disease (CAD) are well established by the United States Air Force and other military branches such as the Army, Navy, and Coast Guard as well as the Federal Aviation Administration (FAA), National Aeronautics and Space Administration (NASA), and United States NATO allies. However, CAD screening standards vary widely from one aviation organization to another and are strikingly absent in some. In this article, the authors propose an evidence-based CAD screening algorithm based on published literature from 70 years of aircrew specific cardiac data gathered from nearly 1.3 million studies performed on over 300,000 aircrew. Given the advancement of space flight and the commencement of high performance recreational flight opportunities, there is a new era of passengers that will need baseline medical screening and clearance prior to embarking on their adventures. The following proposed screening and disposition algorithms offer evidence-based models for this need.

Investigating Offshore Helicopter Pilots’ Cognitive Load and Physiological Responses during Simulated In-Flight Emergencies

ABSTRACT Objectives: This study was designed to explore pilots’ emergency response performance by collecting real-time physiological and cognitive workload data during pre-defined offshore helicopter scenarios in a flight simulator. Background: Qualification processes require helicopter pilots to complete scheduled simulation training to ensure competency in areas that would otherwise be too dangerous to practice while flying the actual helicopter. Unfortunately, little is known about how effective this simulation training is in regard to cognitive and physiological responses. Methods: Ten qualified pilots completed six flight simulations while real-time eye tracking and physiological data were collected. The pilots were assigned to one of two groups based on their regular flying position (First Officer (FO) or Captain). Results: The findings indicated that there is a significant difference in maximal Index of Cognitive Activity (ICAmax) and maximal heart rate (HRmax) values between the two groups while completing the same in-flight emergency scenarios. Conclusions: Results suggest that FOs found the sessions more cognitively demanding and also indicated they would benefit from learning how Captains conduct their radial scan of instruments. Therefore, it is recommended that visual search patterns are included in initial training, all flight simulator training includes eye tracking, heart rate data are collected, and that future longitudinal research follows new pilots through their training/upgrading process.

In-Flight Emergency: A Simulation Case for Emergency Medicine Residents.

IntroductionIn-flight medical emergencies are common occurrences that require medical professionals to manage patients in an unfamiliar setting with limited resources. Emergency medicine (EM) residents should be well prepared to care for patients in unusual environments such as on an aircraft.MethodsWe developed a simulation case for EM residents featuring a 55-year-old male passenger who suffers a cardiac arrest secondary to a tension pneumothorax. We conducted this case eight times during a 5-hour block of scheduled simulation time. Participants included EM residents of all training levels from one residency program. We arranged the simulation lab as an airplane cabin, with rows of chairs representing airplane seats and a mannequin in a window seat as the patient. Residents were expected to manage cardiac arrest and perform needle thoracostomy on the patient. Residents also evaluated and treated a flight attendant with a near syncopal episode. Throughout the case, residents were expected to practice teamwork skills, including leadership, communication, situational awareness, and resource utilization. Participants were debriefed and completed voluntary anonymous evaluations of the session.ResultsSeventeen EM residents participated in the simulation. Overall, all 17 found the simulation to be a valuable educational experience. In addition, all agreed or strongly agreed that they felt more prepared to respond to an in-flight emergency after participating in the simulation.DiscussionThis simulation was determined to be a valuable part of EM resident education. The challenges presented and skills practiced in this in-flight medical emergency simulation case are transferable to other resource-limited environments.