Is There a Doctor on the Plane?

A New York doctor was recently declared a hero after creating a makeshift nebulizer device for a toddler having an asthma attack during a transatlantic flight. Using nothing but what was immediately available, Dr. Khurshid Guru, director of robotic surgery at the Roswell Park Cancer Institute in Buffalo, New York, neutralized a situation that was potentially life-threatening for the 2-year-old -- a situation that may not have been necessary if the child's family had packed the right medication in their carry-on luggage.

What if it was you? Is there always a doctor on board? You shouldn't assume there will be, says Dr. William Brady, a professor of emergency medicine and internal medicine at the University of Virginia School of Medicine in Charlottesville.

"Before you get on a plane, you need to ask yourself the question: Is it appropriate for me to get on this plane based on my current health situation?" says Brady, co-author of a New England Journal of Medicine article highlighting how doctors can respond to the most common in-flight medical emergencies during commercial air travel.

That's why it's important to plan as much as possible. If you know you have a chronic illness, keep all your medications in your carry-on luggage, Brady says. If you've just had surgery and it's only been a few days, it's not appropriate to get on an aircraft for a six-hour flight, he adds. If you have lung or heart disease, ask your doctor if you'll need oxygen on the plane.

"Pay attention to your doctor's advice and do what your doctor says, because [he or she is] making a recommendation in your best interest," Brady says.

Still, despite the best of preparations, some medical emergencies come without warning.

A 2013 study, also published in the New England Journal of Medicine, found that there were 11,920 in-flight medical emergencies -- or one emergency per 604 flights -- resulting in calls to the University of Pittsburgh Medical Center's 24-hour, physician-directed medical communications center from January 2008 through October 2010.

Dr. Christian Martin-Gill, co-author of the study and a physician at UPMC, says the medical center is one of two primary sites that provide 9,000 airline medical consultations for in-flight medical emergencies every year -- such as fainting, stroke and food allergy incidents. The most common medical emergencies reported in the study included 37.4 percent cases of syncope or presyncope, also known as fainting or lightheadedness; 12.1 percent cases of respiratory symptoms; and 9.5 percent cases of nausea and vomiting.

Fainting

Daniella Knell, 47, of Boise, Idaho, who's been a Delta Air Lines flight attendant for nearly 25 years, says she's seen her fair share of passengers who faint. "Quite often, I fly coast-to-coast flights, from New York to Los Angeles, or Seattle to Amsterdam. People have been up all day, they're not eating right, they're on the road and they're exhausted," Knell says, adding that the sudden movement often causes people to faint.

Martin-Gill advises alerting a flight attendant if you notice another passenger has fainted or is complaining about feeling lightheaded or dizzy. In this situation, the flight attendant might tell the person at risk for a medical issue to breathe slowly and deeply, or ask the person to step out into the aisle or raise his or her legs.

"If you're awake and alert and able to do so, they'll probably have you drink some liquids," Martin-Gill says. "It turns out for these common situations, just those simple interventions of laying down [in the galley], giving yourself some time and trying to rehydrate yourself actually leads the vast majority back to normal."

He says the simplest way to avoid dehydration is to drink plenty of water before boarding an airplane.

Respiratory

Passengers should also be aware that a commercial aircraft that flies up to 30,000 to 40,000 feet is only pressurized at 8,000 feet. "So the cabin provides less oxygen than if you were on the ground," Martin-Gill explains.

That may be an issue for people who have chronic obstructive pulmonary disease, asthma or other respiratory illnesses that require supplemental oxygen. If you have one of these conditions, speak to your doctor and the airline ahead of time to find out which type of oxygen tank is OK to bring on board, because some aren't approved by all airliners.

In an unforeseen medical emergency that requires oxygen treatment, the overhead oxygen masks could be used temporarily. However, Martin-Gill emphasizes the importance of bringing your own devices or medications: "That's not the intention of oxygen available."

Stroke

People who are experiencing chest pain, shortness of breath, nausea and vomiting, or telltale signs of stroke -- such as impaired speech, weakness or numbness in one side of the body or face-drooping -- can also be assessed by the flight crew in the event of an in-flight emergency.

If someone is showing classic symptoms of stroke, it's important to notify the flight attendant immediately so he or she can get in touch with any medical providers on board, and/or work with ground-based physicians to make a determination of what to do next.

Martin-Gill says the ground-based physicians will provide recommendations for interventions like giving medications such as aspirin or antihistamines, which are available in the on-board medical kit, to help the passenger feel better. If it's more serious, they'll interact with the pilot to determine if the plane should be diverted for an early landing. But that's not a common occurrence, he says. In the recently published NEJM study, Martin-Gill and colleagues found that a diversion happened in only 875 of 11,920 emergencies.

Food Allergies

The Federal Aviation Administration requires every commercial aircraft carry certain medication and equipment. One of those items is an albuterol inhaler to treat an asthma attack. Other items include epinephrine solutions for injection and antihistamine tablets for allergic reactions.

As a mom of two kids with six of the top eight allergens, Knell knows the importance of having an epinephrine injection -- or EpiPen -- on board in case of an emergency. She's creator of the Smart Allergy Friendly Education website, which provides allergy awareness tools for parents like herself. Her 9-year-old has an anaphylactic allergy to peanut and tree nuts, and other allergies to kiwi, avocado and penicillin, dogs, cats and seasonal allergies. What's more, her 12-year-old daughter is allergic to dairy and some tree nuts. Neither of her children have had a problem in flight due to careful planning, she says, and she's been traveling with them since they were each 3 months old.

"You can't depend on the airline to have food available to you," she says. "You have to take responsibility for yourself when traveling."

She suggests bringing one bag with allergy-friendly snacks and one bag with any necessary medications. Let the flight attendants know where your EpiPen is before an emergency occurs so they're better equipped to care for you, she says.

If you're wondering why an airplane isn't stocked with everything you might require in any medical situation, consider this: "It's not an air ambulance. This is a commercial aircraft," Brady says.

Samantha Costa is a Health + Wellness reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at scosta@usnews.com.