With air travel resuming to pre-pandemic levels, a new study led by Duke Health researchers has shed light on the frequency and severity of in-flight medical emergencies. The analysis, published in JAMA Network Open on September 29, reviewed more than 77,000 medical events reported to an airline medical support center over a two-year period.
The research was conducted in collaboration with MedAire, a company specializing in aviation and maritime health solutions, which provided the data for the study. The findings offer insight into how airlines handle medical incidents during flights and what factors can lead to emergency landings.
“This is the largest and most comprehensive study of in-flight medical emergencies ever conducted,” said Alexandre Rotta, M.D., senior and corresponding author of the paper and chief of the Division of Pediatric Critical Care Medicine with the Department of Pediatrics at Duke University School of Medicine.
“It gives us a real-world snapshot of what happens when someone gets sick in the sky and how starkly the options differ from those in a hospital,” Rotta said.
The study analyzed reports from 84 airlines operating across six continents between January 2022 and December 2023. Researchers found that one out of every 212 flights experienced a medical emergency. Of these cases, about eight percent required hospitalization after landing. In addition, approximately 1.7 percent were serious enough to prompt flight diversions.
Suspected strokes, seizures, chest pain, and altered mental status were among the most common reasons for diverting aircraft. There were also 293 cases involving cardiac arrest; survival rates for these events were significantly lower compared to those occurring on land.
Medical volunteers—often physicians—were involved in nearly one-third of all emergencies studied. Their presence correlated with higher rates of flight diversion, likely reflecting their involvement during more severe incidents.
“It’s humbling to practice medicine in the air,” said Rotta. “You’re working with limited equipment, no lab tests and no backup. Even minor issues can become major challenges.”
Rotta pointed out that U.S.-based airlines are generally well-equipped due to regulations requiring defibrillators and basic medical kits onboard. However, he noted not all carriers have partnerships with ground-based medical support centers—a resource he considers vital during life-threatening situations.
“Airplanes aren’t hospitals, and we shouldn’t expect them to be,” he said. “But having expert guidance from the ground can make all the difference when someone’s life is at risk.”
The results may influence future airline policies regarding crew training or passenger advisories for those with chronic health conditions preparing for air travel.
Other authors contributing to this research include Paulo M. Alves, Karan R. Kumar, Justin Devlin, and Neil Nerwich.
Duke University Hospital is located in Durham, North Carolina and was established in 1925. It serves as both a treatment facility—with over 41,000 patient admissions reported in its latest annual review—and as a teaching hospital under President Craig T. Albanese.
https://www.dukehealth.org/hospitals/duke-university-hospital
