When Dr Joachim Jimie boarded his flight to St Lucia in 2017, he was looking forward to a break from his work at Liverpool University Hospitals. Unfortunately, five hours into the flight, he was back on the job – performing an operation on the floor of the aisle in the premium economy cabin.
A passenger had fallen ill and the announcement came over the Tannoy: ‘If there’s a doctor on board, could they make themselves known to the crew.’ Dr Jimie obliged. And what he was confronted with was serious – a woman in her mid-50s gasping for breath.
He deduced she was suffering from tension pneumothorax, a dangerous build-up of air in the ribcage often seen in patients with lung diseases. Dr Jimie needed to insert an oxygen tube into her chest to allow her to breathe.
The on-board medical kit included a surgical knife allowing him to make small cut between two ribs, but the tubing provided was too flimsy, and he was unable to push it through the incision. He knew that every second he delayed, the risk of the woman dying increased.
So he improvised. Dr Jimie asked the stewardess for a coat-hanger. The wire, he reckoned, could be threaded through the tube and used to keep it rigid. It worked. The tube stayed in position and a steady stream of oxygen was delivered to the woman’s lungs.
Dr Jimie stayed with the woman for the rest of the flight, and when the plane landed, paramedics took her to hospital where she made a full recovery. The airline was quick to show its gratitude, offering Dr Jimie and his girlfriend business-class tickets to any destination of their choosing.
And while it might seem like a once-in-a-lifetime situation, for medics like Dr Jimie, scenarios like this are not a rarity. He says: ‘Only a few years after that, I had to treat a woman who had a severe allergic reaction on my flight. This is something most of my colleagues have had experience of at least once.’
Airlines admit that in the event of a medical emergency, they rely on passengers with medical training to help. Perhaps this explains why nearly nine in ten doctors have been called to attend to a passenger during a flight, research carried out by the Medical Defence Union shows. But how safe can this be for passengers unlucky enough to fall ill mid-air?
‘It is very likely a passenger who’s a nurse or doctor will be on any given flight,’ says Dr David Strain, senior clinical lecturer at the University of Exeter Medical School and an honorary consultant in medicine for the older adult.
A scene from the 1980 film Airplane! which sees people fall ill with food poisoning on while in the air
However, speaking to The Mail on Sunday, experts have raised concerns about a growing reluctance from doctors to come forward when help is needed. The tools they need to do their best work are often missing, with on-board medical equipment varying between airlines. And while cabin crew are trained in first aid, there’s the question of who takes responsibility should a sick person not make it.
‘Doctors have a moral duty to help when someone is unwell on a plane,’ says Dr Malcolm Finlay, a cardiologist at Barts Health NHS Trust. ‘But you’re thrown into a medical scenario you never asked to be in. So a lot of doctors keep their heads down and hope someone else raises their hand when the call comes.’
Medical emergencies in mid-air are surprisingly common. Roughly one in every 600 flights will involve such an event, according to a study published in The New England Journal Of Medicine. Considering that 1,300 flights take off or land daily at Heathrow Airport alone, this means there are calls for a doctor on UK flights every day.
More than a third of these medical events are stomach pains and sickness, but a quarter are neurological issues – including dizziness, fainting and seizures – and seven per cent are breathing difficulties.
Medical problems can range from the simple to the life-threatening, says Dr Strain. ‘Sometimes someone might be too drunk or having a panic attack. But I’ve also had to respond to a chap on a flight back from New York having a stroke. In that case, I had to tell the captain to turn around and land the plane so we could get the man into hospital.’
Particularly traumatic was delivering a stillborn baby on a flight from India. He adds: ‘We had to deliver the baby in one of the toilets. I don’t think most people were aware there was anything going on until paramedics came to collect the mother when we landed.’
Experts say the response to these emergencies can be hampered by the supplies provided in the on-board medical kit.
Last month, an American doctor sparked debate after she was called to assist in a medical emergency on a Delta Air Lines flight.
Dr Andrea Merrill, an oncologist at Boston Medical Center, tweeted: ‘Dear Delta, I just assisted in a medical emergency in the air.
‘Your medical kits need a glucometer [a device used to measure blood sugar], EpiPen [an injection that can save the life of a person having a severe allergic reaction], and automatic blood-pressure cuffs. Please improve this for passenger safety!’
Her tweet was shared more than 57,000 times, and scores of other doctors responded with similar complaints about on-board medical kits. NHS doctors say the same problems happen in the UK.
All British airlines are required to stock a medical kit with supplies set out by the European Union Aviation Safety Agency. This includes more than 60 different items including a blood-pressure monitor and IV fluids to treat dehydration. Certain medicines are also required, including antibiotics for infections, adrenaline for allergic reactions, and drugs to counteract hypoglycaemia, a potentially dangerous diabetes complication.
Experts warn that doctors are reluctant to step in if a passenger falls ill while an airplane is in the air
But vital equipment can be missing, according to reports.
Long-haul flights overseas are required by European and international watchdogs to carry defibrillators – equipment that can restart the heart in the event of cardiac arrest. But flights over land that take less than two hours are not. All UK aircraft carry defibrillators, but some foreign carriers, such as Aegean and Alitalia, do not.
‘With a cardiac arrest, you’ve got just minutes to respond,’ says Geraldine Lundy, director of Accessible Travel Consultancy. ‘So it shouldn’t matter whether a flight takes under an hour or ten.’ Doctors who have used the medical kits also say they find that they are often not restocked after use. ‘Sometimes they are missing vital injections such as adrenaline, which you need if someone is having a life-threatening allergic reaction, or drugs to help a diabetic if their blood sugar falls too low, which again can be fatal, or there aren’t enough needles,’ says Dr Strain.
There are concerns, too, that while cabin crew receive first-aid training, they are not prepared for life-or-death scenarios.
In 2016, Natasha Ednan-Laperouse, 15, died after having an allergic reaction to a sandwich while travelling on a British Airways flight to France. Natasha, who was severely allergic to sesame seeds, collapsed on the flight, and despite her father administering two shots of EpiPen, she did not survive.
A coroner’s inquest praised junior medic Dr Thomas Pearson-Jones, who was on the flight and tried to save Natasha. He had graduated from medical school just the day before.
BA was criticised for keeping the defibrillator at the back of the plane, where it was difficult to access – and while it would not have helped Natasha, this was a potential safety risk. And doctors on board are not always equipped for the job at hand.
‘These days, the majority of doctors have a particular speciality, like cancer, and don’t have any recent experience of emergency medicine,’ says Professor Thomas Powles, director of the Barts Cancer Centre.
‘If someone collapses on a flight, a paramedic is more useful than a gynaecologist. But sometimes that’s all you’ve got.
‘So you end up in a situation where a doctor is making a decision on something they’re not qualified to do.
‘That’s quite risky territory. You also have to hope that the doctor hasn’t already had a few drinks on the flight or is running on no sleep.’
But what if something goes wrong while treating a patient?
From chest pains to sore ears… when you really shouldn’t fly
Do not ignore signs of ill health before flying, medical experts warn.
As well as being out of reach of hospital, doctors say the change in pressure during a flight can be dangerous to those with underlying health conditions.
GPs will advise people who have had a stroke or heart attack in the previous two months not to fly.
Likewise, anyone who is experiencing chest pains and breathlessness should see a doctor before flying.
Women who are more than 36 weeks pregnant, or 32 weeks with multiple pregnancies, are generally not allowed by commercial airlines to travel due to the risk of an unexpected birth while in the air.
Those suffering from ear or sinus infections are also advised not to fly.
According to Dr David Strain, the length of a flight is important.
‘When you fly long distances overseas, the plane cruises at really high altitudes, to the point where the pressure is akin to standing at the top of a mountain.’
Experts say too many people ignore health issues when flying.
‘People just want to get home or don’t want to miss a hotel reservation,’ says Dr Paulo Alves, global medical director of aviation health at remote health support firm MedAire.
‘That can sometimes be a dangerous decision. Flying is not a threat to your health, but your underlying condition can be.’
Doctors are unlikely to ever be considered legally liable. Medics are protected by the internationally recognised Good Samaritan laws, which shield doctors – and non-medically trained individuals – from negligence claims if they pitch in to help during emergencies, providing they act responsibly.
But the grave responsibility of treating a person mid-flight is enough to put many doctors off.
‘Once you put your hand up to help, that passenger is in your care for the rest of the flight, so that could be up to 12 hours,’ says Prof Powles.
‘That’s a lot to ask of a doctor who until a minute ago was on their holiday.
‘I think most doctors would tell you they wait to see if someone else will get up and help first, before they put their hand up, because of this.’
Dr Strain, however, adds that most doctors see it as a duty, rather than something they should be paid for. ‘You might hope to get a nice glass of wine or something, as thanks,’ he suggests.
Some don’t even get this. In 2016, a Devon-based GP lodged a complaint with easyJet after he treated a seriously ill patient on a flight to Greece, only to be told when he requested a KitKat bar that he must pay for it.
Health firms can provide airlines with paid, on-call doctors who can instruct cabin crew during medical emergencies, over the phone. The senior medics are available round- the-clock when flights are in the air, and can decide if emergency landings are needed, or if help from cabin crew will suffice. British Airway and Virgin Atlantic use these services.
Dr Paulo Alves, global medical director of aviation health at MedAire, a company that provides remote health support for travel, says relying on medically trained passengers ‘is not a sensible policy’. ‘If you are in a hotel and there’s a fire, would you count on guests who happen to be firemen, or would you prefer that the hotel has a system in place to put the fire out?’
Doctors agree that airlines should have remote support services such as those offered by MedAire in place.
‘Airlines are much better off having someone on the ground who can help make these calls,’ says Prof Powles.
But experts say that falling ill while aboard a plane will always be risky.
‘If you’re in a metal tube flying over the Pacific for ten hours and something goes wrong, there’s only so much that anyone can do to help – doctor or not,’ says Dr Finlay.
‘Thankfully the majority of people will go through life without something like this happening to them. But that’s the risk we take by getting on a plane.’