Dr. Celine Gounder has volunteered five separate times to handle medical emergencies on board an aircraft while traveling as a passenger. On one international flight, she struggled to care for an obese, diabetic passenger who appeared to be having a heart attack.
She couldn't hear his blood pressure with the manual cuff provided by the crew because of the loud airplane noise, and without the assistance of a nurse, she had trouble inserting an IV to give him fluids. Gounder, who is an infectious disease specialist, stayed up the whole night holding the man's oxygen as his blood pressure plummeted.
And once the plane landed, she and her would-be patient were the last off the plane and no medical teams were at the gate to assist.
"I was furious," Gounder told ABCNews.com. "The most frustrating thing is the airlines never give you feedback as to what happened. They may not even know themselves, and you are sort of left hoping the person made it through and if what I did was right or wrong."
|"In some ways, it's not fair. They are relying on our good will. And it's not just our good will -- it's an imposition." -- Dr. Celine Gounder|
In a 2013 article she wrote for The Atlantic, "Medical Emergencies at 40,000 Feet," she says, in general, the airlines are "unprepared" for the most serious incidents.
Medical emergencies happen 1 in every 604 flights, according to a 2013 study published in the New England Journal of Medicine. And about 75 percent of the time, a doctor, nurse or paramedic on board must deal with the passenger in distress.
Just last weekend, a Delta Air Lines flight from Seattle to Atlanta was diverted when a 16-year-old boy with cerebral palsy died of a heart attack on board. According to the Atlanta Constitution, the teen, whose name was not released, was traveling with family and headed home to Georgia for the holidays.
The incident happened about 30 minutes after take-off when the boy went into cardiac arrest, according to registered nurse Dan Goslin, who responded to the call from the crew. He told ABC's Atlanta affiliate WSBTV that he and a doctor and midwife assisted, but could not revive the teen.
The Federal Aviation Administration (FAA) only requires that the airlines report a death or a flight diversion because of a medical emergency, and those incidents are rare, say experts.
Of the 2.75 billion passengers who fly on commercial airlines annually worldwide, only one third of 1 percent ended in death, according to the NEJM study.
Researchers analyzed nearly 12,000 calls to the University of Pittsburgh Medical Center, one of two ground communication hubs that provide physician advisors when an emergency happens in flight.
Those calls represented 744 million airline passengers from five domestic and international airlines from five domestic and international airlines from 2009 to 2010.
The majority of cases (37 percent) involved fainting; other medical emergencies included respiratory (12 percent) and nausea or vomiting (9.5 percent). Aircraft diversion happened in 7.3 percent of the flights.
The NEJM study was co-authored by Dr. Christian Martin-Gill, assistant professor of emergency medicine who works at the communications center.
There, physicians advise about 20 major airlines on how to treat a patient or whether to divert a flight or organize medical treatment on landing via satellite telephone or radio. The center operates 24/7 and handles about one consultation an hour or about 8,500 a year.
"It happens more frequently than you think," Martin-Gill told ABCNews.com. "Flight crews are trained in CPR using defibrillators and are trained in using on-board medical equipment. Each flight they are required to have a medical kit and on-board oxygen."
About one-fourth of emergencies are handled by the flight crew, who are trained in basic first aid.
"Most medical emergencies are relatively minor and handled with the kit and do not require diversion of the plane," he said. "The most common emergency is someone is light-headed -- known as syncope. With simple hydration and lying down, they improve rapidly."