1. Generally, are there any risks involved for any sick passengers traveling by plane?

First of all, airlines will not usually accept ill patients as it will be an added burden on them. Risks will be there depending upon what kind of illness and the severity of the illness.

Thus, depending upon severity, non-medical and medical escorts accompany patients. Medical escorts maybe nurse, paramedic or the doctor himself/herself, again depending upon illness. In case of severe illness, air ambulances are used which of course can be very expensive.

The risk itself is that because one is in the air and if something were to happen then hospital facilities would not be available besides first-aid and oxygen supplement. Type of risks will depend upon the type of illness involved.

Of course, all sick patients have to obtain a 'fit to fly' certificate from the concerned doctor before their flight.

2. Are there any special services for sick passengers on board (inside the plane) ?

On board aircraft medical facilities depend on aircraft size, flight duration and domestic or international flight.

Thus, in short hop domestic flights using small size aircraft not carrying 20-50 passengers, the medical facility will be limited to a first aid box just carrying basic items like bandages, antiseptics, antacids, anti empties, painkillers etc.

Larger international aircrafts will contain comparatively more different kinds of oral and liquid medications. Such aircrafts may also contain oxygen supplements and even a portable defibrillator called AED (automatic external defibrillator).

A defibrillator is a device that produces an electrical charge or current in the heart to restore (bring) the heart's rhythm to normal state. It is used in cases where the heart has stopped beating due to cardiac arrest.

3. If a person suddenly falls ill on the plane, how would they be taken care of ?

It all depends upon the type of illness.

For e.g., it could be a panic attack, which is quite often seen with Nepali laborers returning from the middle east countries. In such cases, besides providing assurances, water, oxygen and also tranquilizers are given.

Another example is that there could be sudden breathing issues due to asthma attacks. During such a situation, the patient's oxygen level maybe monitored by fingertip oximeter, after which nasal oxygen (supplemental oxygen) and bronchodilator inhalers maybe provided according to the situation.

Another example is acute vomiting or dizziness, where appropriate medications are given. In the worst scenario, if it is a case of acute heart attack or case of brain hemorrhage or clot then the concerning patient would have to diverted to the nearest airport and transported to a hospital.

So, in conclusion, the plane's medical staff would try to handle the situation to the best of their abilities within the plane, depending upon the nature of illness. If it's not possible, the plane should be diverted to the nearest airport.

4. What would be done if a passenger faints inside the plane ?

The causes of fainting are multifold.

If it is a case of fainting due to panic or flight phobia then monitoring of vitals like pulse rate, oxygen saturation and blood pressure and providing assurances would suffice.

Other cases of fainting could be due to high or low blood sugar. During such a situation, blood sugar level maybe measured via a glucometer. Depending upon the reading, supplement sugar medication is provided for patients with high blood sugar reading. Food rich in glucose is provided to the patients with low blood sugar reading.

Fainting could also be due to fasting, alcohol abuse and extreme hyperventilation due to fear of plane ride.

Thus, in simple first step it is important to:

Lay the concerned patient down in an open space without crowding.

Raise the patient's legs

Monitor the patient's vitals like blood pressure, pulse and oxygen.

In the worst case, if the cause of fainting is due to cardiac or cerebrovascular accident, then the flight would have to be diverted to the nearest airport.

5. Can a pregnant passenger travel by flight ?

The enclosed table makes it very clear how pregnancy cases are accepted or rejected for flights.

Of course, every now and then we hear about delivery cases on flight. Late pregnancy cases are usually not accepted in flights, which means females after 35 weeks of pregnancy. Similarly, advanced pregnancy which are complicated, like with malposition (child's head is in a wrong direction inside the mother's womb) or twin pregnancies are not accepted in flights.

By and large, females till 28 weeks of pregnancy are accepted. Females with more than 28 weeks of pregnancy would have to get a medical certificate stating 'fit to fly' from a gynecologist and an airline doctor.

6. In emergencies, are sick passengers permitted on board or not? If they have to travel by air, what should be done?

Normally, sick passengers aren't permitted in flights as they serve as a 'burden'. If it's an emergency, it depends upon the kind of emergency.

In unplanned cases like accidents, anything is possible where a helicopter brings in sick injured cases or even a small plane is used to ferry the victim.

However, for planned cases, a paramedic like a nurse and a non-medical escort maybe deputed to handle lighter cases. During such situation, only medications, esp. parental (medications provided via injections), have to be administered and the concerned case has to be monitored on a regular basis.

In more severe cases where some untoward events may be anticipated, a doctor-escort is deputed. For e.g., there may be severe difficulty in breathing in patients with long-time asthma cases in long haul flights. During such a situation, parental steroids and bronchodilators would have to be administered.

Lastly, where commercial planes are not deemed unsuitable for the severely sick patient, then if the concerning patient is able to afford, air ambulances are used. Such air ambulances have all the amenities of a mini-hospital, nurse and doctor attendant.

(Dr. Ranjeet Baral is a senior aviation medical consultant, cardiologist and general physician of Nepal. He studied aviation medicine at King's College, University of London, UK. He is currently working at the Shahid Gangalal National Heart Centre (Bansbari) and Vayodha Hospital (Balkhu) in Kathmandu.)