“Is there a doctor on board?”

Hearing this call go out at 36,000 feet can be anxiety-provoking for any physician and may trigger a dilemma of whether to respond, or wait to see if anyone else will offer their expertise.

That’s why physicians at St. Michael’s Hospital have developed practical recommendations for in-flight medical emergencies for health-care professionals, published online today in the journal CMAJ.

More and more people are traveling by plane each year, with approximately 2.75 billion passengers flying on commercial airlines annually, according to the authors. In Canada, there were 133.4 million airline passengers in 2015, a 27% increase from 2009, they said.

This increase in patient traffic, along with longer flights that increase the stress of flying on the body and a greater proportion of older passengers and those with pre-existing medical conditions, have led to an increase in in-flight medical emergencies in recent years, according to the authors.

“Every health-care professional is likely to hear this call at some point while flying, but for most of us, treating patients on a plane is a completely unfamiliar scenario,” said Dr. Alun Ackery, an emergency physician at St. Michael’s Hospital and senior author of the recommendations. “We wanted to provide a better understanding of what to expect and how to respond if you’re called to assist in one of these emergencies.”

The recommendations, developed in collaboration with Air Canada and WestJet, provide an overview of the available medical equipment, the environmental challenges of treating patients on a plane, the airlines’ policies and procedures, as well as the legal and ethical duties of physicians to respond to a call for assistance.

Every plane with at least 100 passenger seats is legally required to carry a medical kit, according to Transport Canada. Although Transport Canada also outlines the minimal requirements the medical kit must contain, individual airlines have the flexibility to enhance the contents as they see fit, the authors said.

“Each airline’s kit is going to look different, and the contents aren’t always going to be familiar, which adds another layer of complexity to an already stressful situation,” said Dr. David Kodama, an emergency resident at the University of Toronto and lead author of the recommendations.

In Canada, Quebec is the only province that imposes a legal duty on physicians to come to the assistance of a person in a life-threatening emergency, the authors said. All jurisdictions, however, have legislation that protects physicians who voluntarily provide emergency medical assistance at the scene of an accident or in an emergency, they said.

The Canadian Medical Association and the Canadian Medical Protective Association both suggest physicians have an ethical obligation to provide their best assistance during an emergency, according to the authors.

“We recognize that hearing the call go out for a physician on board a flight can be unexpected, but we do have an obligation to respond,” said Dr. Ackery. “We hope these recommendations will provide health-care professionals with enough knowledge to make that call a little bit less anxiety-provoking in the future.”