What happens when there’s a medical emergency on an airplane

By Francesca Street, CNN

(CNN) — For Dr. Sij Hemal, it was a flight he’ll never forget.

It was December 2017. Hemal, then a 27-year-old second year medical resident, was returning home to the US from India, where he’d been celebrating his best friend’s wedding.

First, Hemal traveled from New Delhi to Paris. Then he boarded an Air France flight from Paris to New York City. Once he reached JFK, he was set to fly on to Cleveland.

The first leg of the journey was uneventful. At Charles de Gaulle airport, Hemal settled into his seat on the Air France flight, flicking through the movie options on board.

The aircraft took off, and Hemal plugged in his headphones. He was just contemplating ordering a glass of champagne when he heard the flight attendant’s voice ring out over the speaker system.

“Is there a doctor on board?”

Hemal tugged out his earphones, and glanced around. There was a bit of a murmur in the cabin. It turned out this was the second time the announcement had been made – the first time, it was in French and Hemal had missed it.

By coincidence, Hemal was sitting next to another medical professional, Dr. Susan Shepherd, a pediatrician returning from a stint with humanitarian group Médecins Sans Frontières (Doctors Without Borders).

The two doctors, who’d never met before that day, agreed Hemal would go investigate and Shepherd would assist if needed.

Hemal made himself known to the cabin crew. Then he was led through the cabin by a flight attendant to meet the passenger in distress.

She was a woman in her early 40s, complaining of back and abdominal pain. It wasn’t immediately clear what the issue was. Hemal’s first thought was kidney stones or appendicitis. He decided to ask Shepherd, his pediatrician seatmate, for her assessment.

Then, the passenger said two words that changed everything:

“I’m pregnant.”

That’s when it hit Hemal: The passenger might go into labor. On an airplane. On an airplane that was currently flying over the Atlantic Ocean, with no nearby airport in sight.

“You can imagine that there’s nothing around you where you can land this plane,” Hemal tells CNN Travel today. “You’re at 35,000 feet. You’re just surrounded by blue all around you.”

Hemal and Shepherd looked after the passenger for the next couple of hours, keeping her stable. Then, quite suddenly, she started having contractions. And then her waters broke.

The passenger was about to give birth on the aircraft. And Hemal, a urology resident who hadn’t delivered a baby since he’d completed the required seven deliveries in medical school, was about to lead the efforts.

“You just think to yourself, ‘Okay, get it together,’” recalls Hemal. “Because if you’re not going to do this, something’s going to happen to the patient. You’ve got to give it your best shot.”

Cut to a couple hours later, and Hemal, assisted by Shepherd and the Air France cabin crew, successfully delivered the healthy baby.

When the plane landed at JFK, the mother and child were safely disembarked and transferred to nearby Jamaica Hospital Medical Center. Hemal barely had time to think as he sprinted to his connecting Cleveland flight.

When Hemal made it on board his final flight, he realized he was somewhat in shock. But he was also thankful. Everything had gone smoothly. The experience only served to reaffirm his commitment to his profession.

“When you’re in that kind of situation, my conscience always tells me that I need to go help that person,” Hemal says. “That’s why I wanted to become a doctor in the first place.”

‘Is there a doctor on board?’

In movies and TV, the “is there a doctor on board” announcement is a bit of a cliche.

But yes, it really happens. And for medical professionals – or in fact, anyone with the prefix “Dr.” on their boarding pass – it’s a very familiar refrain. If you’ve got a PhD but no medical qualifications, you may find yourself politely declining a request to assist.

Of course, flight attendants are first-aid trained and able to deal with an array of inflight medical emergencies – and indeed some prefer not to request help from passengers at all. But sometimes getting expert assistance is necessary.

So for doctors, what’s it like to hear that announcement and to suddenly go from eating, sleeping, drinking or watching a movie to aiding a passenger in distress?

Hemal says making that mental switch isn’t that hard – it’s pretty normal practice. As a doctor, people are constantly asking him for medical advice when he’s off duty, it comes with the territory.

“Even when I’m at parties, or I’m out with friends – or I’m in an Uber, sometimes my driver will ask me, ‘I have this in this condition, what do you think?’” he says.

But while Hemal says his natural instinct is always to help, he suggests not all medical professionals would agree with him. Especially when it comes to helping on an airplane.

“Frankly, a lot of people don’t want to do it, because they’re scared, they’re nervous,” he says.

An airplane is a specific – and limited environment. And medicine is also wide-reaching and complex – there’s a high chance you might find yourself assisting with something you have no particular expertise in.

Hemal – who has helped with inflight medical situations a couple of times since the airplane birth – says he’s always signed what’s called a “Good Samaritan agreement.” Essentially, this paperwork protects the doctor from litigation and makes clear there is no requirement for compensation.

In the US, the Aviation Medical Assistance Act also protects individuals from legal liability for helping in an onboard medical emergency.

While Hemal is aware there’s always a risk the situation might not end in the way everyone hopes, he says he’ll always try to assist if he can.

His words are echoed by Dr. Lauren Feld, a US-based gastroenterologist with a focus on liver disease.

Feld’s helped with several inflight medical emergencies and while she’s never delivered a baby on a plane, she did once order an emergency landing – which, as Feld puts it, “does not make you popular with the rest of the people on the plane because it leads to a big flight delay, but you have to sort of act in that person’s best interest.”

“I think having medical training and an ability to help people – a toolkit of skills that can help people – to me, is a privilege,” Feld tells CNN Travel. “And so whenever I have the ability to help, I think it’s something that’s important to do.”

Like Hemal, Feld says making the switch from regular anonymous passenger to onboard doctor isn’t too difficult. She’s even been woken up by an inflight announcement asking for medical assistance and immediately gone into work mode.

“I feel comfortable helping even if I’m tired,” she says. “We – I would argue probably, unfortunately – are quite used to working while tired.”

Feld doesn’t drink on airplanes – she says she’s usually too busy wrangling her young kids, or catching up on sleep – but she suggests if a medical professional is called upon to assist after having had a few glasses of wine, or indeed if they felt ill-equipped in any way, the important thing is they “recognize the limitations” and make decisions accordingly.

Onboard assessment

Feld and Hemal say one of the trickiest aspects of handling an onboard medical emergency is coming in blind. Unlike in a hospital, you don’t have a patient’s medical history on hand. You don’t know what medications they’re on. You only have the context clues and information they give you.

First up, doctors start by assessing, and hopefully ruling out, the most serious of conditions –  a heart attack or a stroke, for example.

On airplanes, says Hemal, the most common situations include low blood pressure, vasovagal syncope – AKA a common cause of fainting – or anxiety attacks.

Of course, harmful conditions and less worrying ones can share similar symptoms. On a recent flight from New York to California, Hemal was called to assist an older man who was suffering from heart palpitations.

It turned out the cause wasn’t a heart attack – which immediately crossed Hemal’s mind due to the passenger’s age – but rather that he’d eaten too many marijuana brownies.

“He had ingested quite a few and had a bad reaction to it on the plane,” says Hemal.

Another difficulty for doctors responding to inflight medical scenarios is the potential lack of equipment. Aircraft have an onboard medical kit, but it can’t account for every eventuality.

When Hemal was delivering the baby on the airplane, he was conscious he didn’t have a suturing kit, so applying stitches wouldn’t be possible. Fortunately, he didn’t need to – but this was always in the back of his mind.

The airplane environment also generates its own – unusual – conditions, which doctors have to take into account. The pressure differential “can both exacerbate certain medical issues and make some of the treatments difficult,” says Feld.

Feld adds that the noise of the engine also makes hearing with a stethoscope difficult.

Another difference is while doctors usually track a passenger throughout their health journey, on an airplane it’s a brief, fleeting yet intense interaction between doctor and patient. Feld says it can be quite strange not knowing the outcome of the situation.

One thing that’s similar both on the ground and in the air is the need for teamwork. Feld and Hemal have both led inflight medical efforts, but they stress the importance of working as a team with whoever can assist.

The first time Held assisted with an inflight emergency, she was a very recent medical school graduate. Two other medical professionals happened to be on board the flight and offered to also assist.

“One of them was a physician assistant, in a cardiothoracic unit. And the other person was an oncology researcher – so someone who had not done clinical medicine and was focused exclusively on research,” Feld recalls.

While Feld was the youngest and least experienced, she was the only trained doctor. The other two passengers bowed to her expertise, and helped her get her voice heard in a situation when she occasionally felt overlooked as a young woman.

“The three of us worked together,” says Feld.

During medical emergencies, flight crew also remain in contact with ground medical teams who help make decisions and give permission for certain medicines to be administered.

Hemal says when he delivered the baby on the Air France flight, it was a “team effort.” He assumed the role of the leader, fellow doctor Shepherd assisted and the fight attendants did everything and anything they could.

His taking the lead over Shepherd was, he recalls, partly because he was a surgeon, but was also “a spontaneous decision because everything happened and progressed so quickly, that we didn’t stop to think about it. Given that she was a pediatrician she would have better assisted in looking after the baby following delivery.”

Hemal recalls the Air France crew making crucial executive decisions – early on, a choice was made to move the pregnant passenger into the largely empty first class cabin, both for privacy’s sake and so she could lie down.

The flight crew remained in constant contact with the pilots, who Hemal says avoided turbulence if at all possible to help make the delivery as smooth as could be.

Looking back, Hemal finds it quite moving that a group of strangers from across the globe on a transcontinental flight worked together to ensure a successful outcome. Some were medically trained, some weren’t. Some spoke the same language, some didn’t. What united them was their desire to help.

“Everyone just dropped who they were, where they’re from, and just came together for one common cause,” Hemal recalls. “I thought it was very beautiful, looking back at it, and retrospectively just thinking about it.”

Advice to passengers

While doctors generally don’t want passengers who aren’t medically trained to step up and help in medical situations on airplanes, Feld is a big advocate of the general public taking basic life support classes and she suggests knowing first aid “is a good skill set for a plane, for walking down the street.”

If you’re on an aircraft and a passenger next to or near you is experiencing medical difficulties, Feld says calling for help and alerting the flight attendant is the best plan.

If you are first aid trained, taking the person’s pulse and, if need be, beginning chest compressions is, says Feld, “a great first step for things to do while you’re calling for help.”

She suggests passengers with health conditions should speak to their doctor before flying. Feld works with people with chronic liver disease and is always committed to supporting them living their lives and enjoying travel safely.

Five years on

Doctors who help out with inflight emergencies are sometimes rewarded with a bottle of champagne, flight voucher or air miles.

This doesn’t always happen – there’s no set policy, and Feld says it’s “certainly nothing I’d expect.” Ethically speaking, she says she’d always consider rejecting a gift that felt too extravagant.

When Hemal went back to work after delivering the baby on the airplane, he didn’t initially share the story with his colleagues. It was a bottle of champagne that gave the game away – a few weeks after delivering the baby on the airplane, the fizz arrived in his hospital mailbox, along with a flight voucher and a thank you note from Air France.

“And boom, it went viral in our residency, and our media person heard about it,” recalls Hemal. A press release went out. Within days, Hemal was featured on CNN and in People magazine. The story circulated far and wide.

The attention was a little overwhelming. While many people showered Hemal in praise, inevitably others were more critical – some of his fellow doctors expressing envy, or suggesting he shouldn’t have stepped in to help in the first place. And for months afterwards, wherever he went Hemal was introduced as “that guy who delivered the baby on the plane.”

Five years on, Hemal says the situation was a learning curve in more ways than one. “You cannot control what other people’s reactions are going to be,” he says.

And while Hemal still gets recognized from time to time – often at medical conferences – in general, the attention has ceased and he usually plays down the story: “I feel like medicine overall is such a humbling profession,” he says.

Still, all that said – he’d do it again in a heartbeat if needed.

“If you’re not going to help them, no one else will,” he says. “So, go do your best – that’s sort of what I live by.”

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