In-flight Medical Emergencies Research Articles

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.

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.

Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study

Background In-flight medical emergencies (IMEs) are expected to increase as air travel normalized in the post-COVID-19 era. However, few studies have examined health professions students’ preparedness to respond to such emergencies. Therefore, this study aimed to investigate medical students’ knowledge, confidence, and willingness to assist during an IME in their internship program. Methods This cross-sectional survey utilized an online, self-administered questionnaire-based survey targeted at medical students at two medical colleges in Saudi Arabia. The questionnaire comprised three parts: sociodemographic characteristics, knowledge about aviation medicine (10 items), and confidence (7 items)/willingness (4 items) to assist during an IME. Odds Ratios (OR) and 95% Confidence Intervals (95%CI) were computed to detect potential associations between the knowledge levels and the other independent variables. Responses to confidence and willingness questions were scored on a 5-point Likert scale. Results Overall, 61.4% of participants had inadequate knowledge scores for providing care during an IME, and the proportion of participants did not differ between those who had or had not attended life support courses (60.4% vs. 66.7%, p > 0.99). Only frequency of air travel ≥ two times per year was associated with higher odds of adequate knowledge score [OR = 1.89 (95%CI 1.14–3.17), p = 0.02]. In addition, 93.3% of the participants had low, 6.3% had moderate, and 0.8% had high willingness scores, while 86.3% had low, 12.2% had moderate, and 1.5% had high confidence scores. There were no differences in the proportion of participants with low, moderate, and high willingness or confidence scores by attendance in life support courses. Conclusion Even though over 8 in 10 students in our study had previously attended life support courses, the overwhelming majority lacked the knowledge, confidence, and willingness to assist. Our study underscores the importance of teaching medical students about IMEs and their unique challenges before entering their 7th-year mandatory general internship.

Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine.

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board. As technology continues to evolve, the assistance of other artificial intelligence and augmented reality systems are likely to facilitate training and dynamic real-time needs during space emergencies. Summary: As space tourism continues to evolve, an organized methodology for POCUS use is advised to best prepare astronauts for space.

The Physician in Flight: The Moral and Legal Responsibilities of Physicians When Present for In-Flight Medical Emergencies

A physician boards the plane and sits down. Does that physician face risk beyond a plane crash? If there is a medical emergency in-flight, does the physician face moral/ethical/legal risk by acts of commission or omission in relation to the medical emergency? That may depend on whether the flight is within the United States or is an international flight. This uncertainty prompts the question: Do we need broader coverage for physicians in-flight and would legislation similar to the on-the-ground Good Samaritan law protect physicians who are passengers on a plane?

Pharmacist takes the lead during inflight medical emergency.

Pharmacist takes the lead during inflight medical emergency.

The knowledge, confidence and attitudes of medical students in managing in-flight medical emergencies

In-flight medical emergencies (IMEs) are common during commercial airline flights. These events occur once every 100 to 1000 flights with pressurization corresponding to an altitude of 5000 to 8000 feet during the flight, low oxygen partial pressures and low humidity. This study was designed to evaluate the knowledge, confidence and attitudes of medical students in Saudi Arabia with regards to managing in-flight medical emergencies. A cross-sectional study targeting all medical students in Saudi Arabia was conducted using an online questionnaire. In total, we analyzed 378 medical students and interns; only 18% possessed an adequate perception of knowledge relating to IMEs; 36.8% felt assured in their IME response, 36.5% believed they could provide competent care, and only 34.5% considered their medical education was adequate for the treatment of IMEs. Our analyses showed that medical students in Saudi Arabia have inadequate confidence and knowledge in managing IMEs. Consequently, there is a significant gap in current medical school curricula in the Kingdom of Saudi Arabia that could be filled by implementing focused training on the management of IMEs.

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.

In Flight Preterm Birth is There a Doctor on Board?

This case report a case of in-flight preterm birth. In-flight medical emergencies can occur when a passenger or crew member becomes ill or injured during a flight. Preterm birth, defined as birth before 37 completed weeks of gestation, is a significant public health concern worldwide due to its association with increased neonatal morbidity and mortality. Although in-flight medical emergencies and onboard deaths are uncommon, they pose a significant challenge to the airline industry. The medically austere environment, coupled with limitations on prudent practice and associated liabilities, requires physicians and other healthcare providers traveling on flights to be aware of these factors.

How Common Are Allergic Reactions During Commercial Flights? A Systematic Review and Meta-Analysis

Global passenger demand for air travel has increased by over 7% annually since 2006, with a strong recovery following the COVID-19 pandemic. Prior to COVID-19, individuals with food allergies reported significant concern and anxiety over the risk of reactions when travelling by air. However, published data of in-flight medical events (IMEs) due to allergic reactions are limited. To undertake a systematic review with meta-analysis to estimate the incidence of in-flight medical emergencies (IMEs) due to allergic reactions on commercial flights. We searched MEDLINE, Embase, PsycINFO, TRANSPORT databases and the Cochrane Register of Controlled Trials for relevant studies reporting IMEs of allergic etiology, published since 1980. Data were extracted in duplicate for meta-analysis, and risk of bias assessed. PROSPERO CRD42022384341. 17 studies met the inclusion criteria. At meta-analysis, a pooled estimate of 2.2% (95%CI 1.6%-3.1%) of IMEs are coded as being due to allergic reactions. This may be higher in children (3.1%, 95%CI 1.5%-6.7%). The incidence of allergic IMEs at meta-analysis was 0.7 events per million passengers (95%CI 0.4 to 1.1). Reassuringly, the rate of allergic IMEs has been stable over the past 30 years, despite increasing passenger numbers and food allergy prevalence. Allergic reactions coded as IMEs during commercial air travel are uncommon, occurring at an incidence around 10-100 times lower than that reported for accidental allergic reactions to food occurring in the community. Despite increasing passenger numbers and food allergy prevalence, the rate of allergic IMEs has not changed over the past 3 decades.

In-flight medical emergencies and their outcome in a commercial airliner

Introduction: Super-connected modern era facilitated an unprecedented no. of air passages all around the world, simply because the number of people has doubled over the past 50 years culminating to around 4 billion air trips annually. An ever-increasing number of elderly passengers traveling with antecedent medical morbidities resulted in an upsurge in the In-flight Medical Emergencies (IME). Objective: Considering the trend, it was decided to ascertain the type of IMEs based on various organ systems and their outcome aside causes of flight diversion due to IME and types of in-flight medical assistance rendered by onboard physicians and paramedics. Material and Method: Crew safety report from March 1, 2015, to March 31, 2019, in a commercial airline of a Middle-Eastern country was analyzed for IMEs along with allied issues. Results: There were 614 IMEs during the period of study resulting in 01 IME for every 336 flights. About 81% of IMEs occurred during the main cruising phase of the flight. Nine onboard deaths were recorded during the study tenure. Causes of death were two each for Myocardial Infarction (MI) and malignancy, one due to cardiac failure with arrest and uncertain in four cases. The most common IME was syncope (35.5%) followed by trauma (26.8%) and respiratory difficulty (17.3%). Gastrointestinal symptoms accounted for 10% of cases. Diversion of aircraft was carried out on 16 IME incidents. The main causes of diversion were MI, epilepsy, stroke, and Bell’s palsy. Onboard assistance from physicians and nurses was sought in 62 % and 27% of incidents, respectively. Oxygen and onboard medications were used in 74% and 32% of cases correspondingly. Conclusion: There is no comprehensive globally accepted reporting and management of IMEs. Every airline has its own protocols for the same. Onboard healthcare professionals play a key role in the outcome of IMEs.

A First-Class Simulation: In-Situ In-Flight Medical Emergencies Curriculum for Emergency Medicine Residents Aboard a Commercial Airliner.

In-flight medical emergencies occur in an estimated one out of 604 flights. Responding in this environment poses a unique set of challenges unfamiliar to most emergency medicine (EM) providers, including physical space and resource limitations. We developed a novel high-fidelity in-situ training curriculum focused on frequent or high-risk in-flight medical scenarios while replicating this austere environment. Our residency program coordinated with our local airport's chief of security and an airline-specific station manager to arrange the use of a grounded Boeing 737 commercial airliner during late evening/early morning hours. Eight stations reviewing in-flight medical emergency topics were reviewed, five of which were simulation scenarios. We created medical and first-aid kits that reflect equipment used by commercial airlines. Residents' self-assessed competency and medical knowledge were assessed both initially and post-curriculum using a standardized questionnaire. Forty residents attended the educational event as learners. Self-assessed competency and medical knowledge increased after curriculum participation. All tested aspects of self-assessed competency had a statistically significant increasefrom a mean of 15.04 to 29.20 out of a maximum score of forty. The mean medical knowledge score increased from 4.65 to 6.93 out of 10 maximum points. A five-hour in-situ curriculum for reviewing in-flight medical emergencies increased self-assessed competency and medical knowledge for EM and EM-internal medicine residents. The curriculum was overwhelmingly well-received by learners.

Hitna medicinska stanja tokom komercijalnih letova avionom - "Ima li lekara u avionu?"

Almost four billion passengers travel aboard commercial airliners every year. Last year In-flight medical emergencies (IMEs) were relatively common and occurred in a complex environment with limited medical resources. More recent data shows that IMEs occur in one passenger for every 604 flights or 24-130 IMEs for every one million passengers, more often in people over 70 years old. Due to the drop in barometric pressure, there are specific conditions in the aircraft passenger cabin that can affect the occurrence of IMEs. Most importantly it is hypobaric hypoxia, which can lead to the development of hypoxia-related symptoms in chronic patients with respiratory, cardiovascular, and hematological diseases. With reduced barometric pressure gases in body cavities and medical equipment can expand by 30%, this can lead to IMEs in recently operated patients (wound dehiscence, bleeding), middle ear and sinus diseases, subocclusions, and lung problems (pulmonary bulla). Other factors that contribute to the occurrence of IMEs are limited movement (deep vein thrombosis), dry and cold air (dehydration), jet lag, turbulence, and psychological stress. IMEs most commonly involve syncope or near-syncope (32.7%), gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Because of ethical, and in some countries also legal responsibilities, doctor-passengers are a great help in the treatment of IMEs. Emergency landing of the aircraft when an IME occurs happens in an estimated 4.4% of cases. Knowing the influence of the specific ambient conditions in the plane on physiological processes in the body is of great importance for determining the absolute and relative contraindications for flying by plane. Doctor-passengers have an important role in the treatment of IMEs. This work aims to introduce us to the specific ambient conditions in the aircraft cabin and their influence on the physiology of the human body, the most common IMEs that occur under the influence of those conditions, the role of the doctorpassenger as well as the absolute and relative contraindications for flying by plane.

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.

Fitness to Fly in Patients with Lung Disease

These cases may go unrecognized, and even among those who are known to be hypoxemic, some do not use supplemental oxygen. During air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate in patients with lung disease despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. Each year worldwide, more than 2.75 billion passengers travel by air, 736 million in the United States alone1. One study reports that over an approximately 3-year period, there were 11,920 In-flight medical emergency calls made by airlines to a medical communications Center; this was estimated to represent almost 1 medical emergency for every 600 flights2. Respiratory symptoms accounted for 12% of this in-air emergencies. The development of respiratory symptoms during flight was associated with an increased risk of hospitalization after air travel (odds ratio [OR], 2.13), second only to possible stroke (OR, 3.36). A previous study reported an average of 72 in-flight deaths per year3, from a population representing approximately 50–60% of the total estimated number of worldwide passengers for that period. Of those deaths, 69% occurred in passengers with no known previous medical illness3 as such, a thorough assessment of patients with chronic lung disease and cardiac disease who are contemplating air travel should be performed.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 116-125

In-Flight Medical Emergencies Management by Anesthetist-Intensivists and Emergency Physicians.

BACKGROUND: In-flight medical emergencies (IME) are challenging situations: aircraft cabins are noisy and narrow, medical supplies are scarce, and high-altitude related physiological changes may worsen chronic respiratory or cardiac conditions. The aim of this study was to assess the extent to which anesthetist-intensivists and emergency physicians are aware of IME specificities.METHODS: A questionnaire containing 21 items was distributed to French anesthetist-intensivists and emergency physicians between January and May 2020 using the mailing list of the French Society of Anesthesia and Intensive Care Medicine and the French Society of Emergency Medicine. The following topics were evaluated: high-altitude related physiological changes, medical and human resources available inside commercial aircraft, common medical incidents likely to happen on board, and previous personal experiences.RESULTS: The questionnaire was completed by 1064 physicians. The items corresponding to alterations in the arterial oxygen saturation, respiratory rate, and heart rate at cruising altitude were answered correctly by less than half of the participants (respectively, 3%, 42%, and 44% of the participants). Most responders (83%) were interested in a complementary training on IME management.DISCUSSION: The present study illustrates the poor knowledge in the medical community of the physiological changes induced by altitude and their consequences. In addition to offering specific theoretical courses to the medical community, placing sheets in commercial aircraft summarizing the optimal management of the main emergencies likely to happen on board might be an interesting tool.Diop S, Birnbaum R, Cook F, Mounier R. In-flight medical emergencies management by anesthetist-intensivists and emergency physicians. Aerosp Med Hum Perform. 2022; 93(8):633-636.

In Flight Cardiac Arrest (IFCA) Survival: A Concept Analysis

Background: The number of inflight medical emergencies has risen in recent years, mainly due to moreand more of us jetting off each year. Sudden Cardiac Arrest can strike at any time. Managing cardiacarrest in flight is really challenging and the survival depends on many factors. It’s been estimated that1000 people die during commercial flights each year. This study clarifies the concept of Inflight CardiacArrest survival by using concept analysis. Methods: To analyze the concept, relevant literature wasanalyzed using Walker and Avant’s concept analysis. Results: The major antecedents of inflight cardiacarrest are cardiac causes, non -cardiac causes, flight conditions and lethal cocktail. Defining attributes ofinflight cardiac arrest survival are in flight attributes, Chain of survival, availability of trained personneland emergency equipment and remaining flight time to destination. Consequences of inflight cardiacarrest are physiologic consequences of victim and emotional consequences of the victim, family,personnel involved and co passengers. Conclusion: Inflight cardiac arrests are increasing in incidence.Lack of a carotid pulse is the gold standard for diagnosing cardiac arrest. Good quality CardiopulmonaryResuscitation and early defibrillation are key factors for inflight cardiac arrest survival.

In Flight Cardiac Arrest (IFCA) Survival: A Concept Analysis

Background: The number of inflight medical emergencies has risen in recent years, mainly due to moreand more of us jetting off each year. Sudden Cardiac Arrest can strike at any time. Managing cardiacarrest in flight is really challenging and the survival depends on many factors. It’s been estimated that1000 people die during commercial flights each year. This study clarifies the concept of Inflight CardiacArrest survival by using concept analysis. Methods: To analyze the concept, relevant literature wasanalyzed using Walker and Avant’s concept analysis. Results: The major antecedents of inflight cardiacarrest are cardiac causes, non -cardiac causes, flight conditions and lethal cocktail. Defining attributes ofinflight cardiac arrest survival are in flight attributes, Chain of survival, availability of trained personneland emergency equipment and remaining flight time to destination. Consequences of inflight cardiacarrest are physiologic consequences of victim and emotional consequences of the victim, family,personnel involved and co passengers. Conclusion: Inflight cardiac arrests are increasing in incidence.Lack of a carotid pulse is the gold standard for diagnosing cardiac arrest. Good quality CardiopulmonaryResuscitation and early defibrillation are key factors for inflight cardiac arrest survival.

Medical Legal Implications When Providing Emergency Care on a Commercial Flight.

INTRODUCTION: U.S. airlines often request a healthcare professional to volunteer to assist an ill passenger. Litigation from a Good Samaritans care of an in-flight medical emergency (IME) is considered improbable. The 1998 Aviation Medical Assistance Act (AMAA) encourages health care professionals to volunteer with indemnity for standard and good medical care. It does not offer legal or financial assistance. Our review explored the legal support malpractice companies and U.S. airlines provide if litigation is initiated for IME care. Malpractice insurance policies can differ on IME coverage. We found most private practice physicians policies include IME. Medical institutions may have policies restricting their physicians coverage to the institutions location. Those without malpractice coverage will need to retain and pay for a legal defense to demonstrate no gross negligence and no willful misconduct. The physicians, airline crews, and on-ground IME documentation support should be retained by the Good Samaritan especially for a pediatric or adolescent ill passenger. U.S. airlines consider a Good Samaritan medical volunteer as a passenger and do not extend legal assistance. This contrasts with some foreign airlines that do provide liability protection. Knowledge of the malpractice policy IME coverage is essential prior to traveling by air. After completing care for an ill passenger, physicians should generate their medical documentation and request the IME documentation generated by the airline and on-ground medical expert. We also believe U.S. airlines should assume responsibility to provide legal assistance to a Good Samaritan physician in the event of IME litigation.de Caprariis PJ, Di Maio A. Medical legal implications when providing emergency care on a commercial flight. Aerosp Med Hum Perform. 2021; 92(7):588592.

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.