Management of in-flight medical emergencies.

MORE than two billion passengers board commercial airplanes every year.§ Airline travel is inherently safe and reasonably comfortable, but factors including psychological stress, jet lag, and preexisting disease cause a small number of passengers to become ill while flying. The average age of airline passengers is increasing with that of the general population, and older passengers may have one or more underlying illnesses that impair their ability to adapt to a potentially stressful environment. New, larger airplanes such as the Airbus A380 (Airbus S.A.S., Toulouse, France) may carry twice the number of passengers as current aircraft (more than 800 passengers), which further increases the probability that a medical emergency will occur on any given flight. Physicians who care for a patient who has a serious illness and who wishes to travel may refer to a comprehensive set of medical guidelines for air travel, including a list of contraindications to flight prepared by the Aerospace Medical Association. The regulations governing aviation are complex, and the laws of the aircraft’s country of registration primarily regulate training and the provision of emergency medical care aboard airplanes. This article focuses on US Federal Aviation Administration (FAA) regulations that apply to medical emergencies.