Medical emergencies in flight are pretty rare, but when you consider the numbers, it is inevitable that some will happen.

With 50 to 350 people on an airplane, some of whom already have underlying health issues and may be experience more stress than normal because of the travel experience, someone will eventually get sick. Hopefully, it is relatively minor and not a life-threatening event, and better still if there is a medical professional of some sort on board.

In my days at the regionals, the decision to execute a diversion was almost entirely in the hands of the crew. As you can imagine, this led to a lot of second-guessing, but pilots are pilots, and not doctors. Given the choice, they will act in a conservative fashion and land so as not to risk the burden of a serious illness or death on one of their flights.

At the majors, the carriers utilize more resources. Almost every airline has a contract with a medical service that has a team of doctors on call 24/7/365 to help evaluate a situation. The pilot is expected to gather as much information as possible—passenger name, gender, age, symptoms, pertinent medical history/current medications—and relay that to the folks on the ground. During this conversation, the flight dispatcher is usually listening in. The dispatcher will coordinate with a diversion airport if necessary, and will also have EMTs and paramedics meet the airplane when necessary.

Diversions can be major disruptors to the schedule, and they are expensive. Making one unnecessarily doesn’t do anyone any good, so it’s important to make the right decision. Taking the decision out of the hands of the crew and putting it in the hands of the medical professionals takes the pressure off the crew—if not off the airline—and allows the experts to call the shots.

I’ve had a handful of medical events over the years, and the last several years it has averaged about one per year. Usually, it is someone who is just sick or doesn’t feel well. There was only one where I disagreed with the decision to press on versus a diversion, but it wasn’t my call to make. One memorable day I had medical emergencies on back-to-back flights. That was fun. The second one was on a relatively short flight, and the destination was the only real option, but it was a compressed time frame, and we were incredibly busy trying to coordinate things with ATC, the station, and the cabin crew.

International flights pose their own challenge because of Customs and Immigration procedures. Incidents over water are challenging because the ability to communicate with the company and medical folks may be limited, and the time to an airport may be longer than you’d like. I’ve experienced more than one event coming in from the Caribbean, which always leads one to hope that someone just had a bit too much fun on vacation.

Every company has their own procedures in place for dealing with and properly reporting an event. It behooves even new-hire pilots to be as familiar as possible with those procedures early on, because once the cabin crew calls with an event, the workload—and stress—can rapidly escalate. Knowing where to find your help and what to do with it will go a long way toward ensuring a favorable outcome.—Chip Wright