ZRH-BKK, LX180, 10:00 PM CET: We're on a long-haul flight from Zurich to Bangkok, operated with a Boeing 777, 320 seats. Everything is running smoothly, and some passengers are already asleep, dreaming of their upcoming vacation. However, the elderly man in seat 34A, sitting at the rear left, appears unusually pale.

The crew is always vigilant, even during quieter moments. As Cabin Crew Member Nadine checks the restrooms, she notices the passenger. She exchanges a brief look with her colleague Luca. “I’ll check on him,” she says, approaching the man. Could it be something more than just a slight weakness?

The Statistics

Before diving into the scenario, let's look at the statistics. Dr. Sebastian Herrgen from SWISS Medical Services explains how often such incidents occur onboard. “Statistically, one medical emergency occurs for every 15,000 to 20,000 passengers.” SWISS employs a team of 20 staff members, including doctors and medical assistants, responsible for the health of the crew, routine checks, ground staff, and assessments for passengers’ fitness to travel. The most common causes for incidents onboard large international airlines are circulatory collapses, gastrointestinal issues, or respiratory problems. On long-haul flights, there is a doctor onboard in 70-80% of cases. However, SWISS still has to make unscheduled diversions to alternative airports about five to ten times per year to provide passengers with the best and fastest possible medical care when treatment cannot be administered in the air. The cockpit crew ultimately decides which diversion airport to head for. While most of these incidents have a mild outcome, “unfortunately, there are one to three fatalities annually,” says the SWISS doctor, given a current annual passenger load of 16.5 million.

What happens during a medical emergency?

Nadine has now reached the passenger. She asks how he’s feeling, but his voice is weak. It could just be a slight weakness—or something more serious. For minor medical issues like motion sickness or headaches, the Cabin Crew, trained in first aid, can handle the situation independently. They are also well-trained in CPR, using a defibrillator, and administering ventilation. However, if the situation escalates, the next step is to make an announcement to locate any qualified medical professionals onboard.

“Ladies and gentlemen, we have a medical emergency. Is there any qualified medical personnel onboard? Please report to the economy galley or notify a cabin crew member,” announces Nadine. The tone remains calm, but every second counts.

Another crew member, Marco, brings the emergency equipment: a first aid kit, oxygen tanks, a defibrillator, and ventilation masks. Luca keeps the cabin manager (Maître de Cabine) updated, who in turn communicates with the cockpit. Nadine reassures the passenger, while Luca prepares the emergency protocol and passes information along precisely. If no qualified medical professionals are present, SWISS contacts MedAire, a telemedicine service, via satellite phone on long-haul flights. “It’s important that only facts and no interpretations are shared,” emphasizes Patricia Klaus, Head of Medical Training at Lufthansa Aviation Training Switzerland AG.

Flying helpers

The crew is well-prepared for such emergencies. “Every cabin crew member undergoes a 15-week basic training course and a four-day first aid course,” explains Patricia Klaus. This training is not just a requirement; it’s also a licensing condition regulated by the European Union Aviation Safety Agency (EASA). The topics covered are extensive: injuries, resuscitation, flight physiology, tropical medicine, childbirth onboard, and many other medical emergency scenarios. At the end of the basic course, the crew performs a “Dry Flight” exercise in a flight simulator, practicing realistic scenarios with smaller incidents in a situation training.

After the basic training, there are annual refresher courses. All medical trainers at Lufthansa Aviation Training have a medical background (nurses, paramedics) with possible additional qualifications in intensive care or emergency medicine. Some even bring experience as cabin crew or with the Swiss Air Rescue Service (REGA).

The "Doctors on Board" program – support when it matters

In moments like the one on the Bangkok flight, every bit of help counts. The elderly passenger is not the first to need medical attention. The “Doctor On Board” program ensures that the right expertise can be quickly accessed. Registered medical professionals are marked on the passenger list so that the crew can discreetly approach them in an emergency. The advantage: their specialty is already recorded during booking, so the crew knows whether, for example, a cardiologist or anesthetist is onboard. Additionally, Lufthansa Aviation Training offers the “Doctor on Board” course in Zurich, Frankfurt, Munich, and Berlin. “In this course, medical professionals learn about the SWISS equipment, the capabilities of the cabin crew during a medical emergency, and how they can best support the crew,” explains Patricia Klaus. “The course also simulates emergency situations in a flight simulator to train collaboration with the crew.”

Medical equipment onboard

According to European Aviation Safety Agency regulations, SWISS’s fleet is equipped with uniform emergency medical equipment. “This includes a first aid kit for minor issues like headaches or nausea, and an Emergency Medical Kit for more serious emergencies,” explains Dr. Sebastian Herrgen. “Additionally, there’s an automated external defibrillator, ventilation masks, and an adequate supply of oxygen tanks.”

In the case of the pale passenger in seat 34A, the first aid kit was sufficient. “Fortunately, it was just a mild fainting spell, and a soda brought some color back to his face,” reports Nadine with relief. But for the crew, these scenarios are not rare. “Medical emergencies can be triggered by the unique flight conditions, such as cabin pressure, which can resemble an altitude of 1,800 to nearly 2,500 meters above sea level, dry air, and limited mobility onboard,” emphasizes Dr. Herrgen. He also shares a few important health tips.

Preventive health tips for passengers

• Fitness to fly: Passengers with chronic conditions, such as heart or lung diseases, who require oxygen on the ground or are significantly restricted in their daily activities due to their condition or medication should have their fitness to fly assessed by a doctor and upload a certificate to SWISS’s medical portal in advance. This way, SWISS Medical Services can check if the trip can be approved. It’s advisable to avoid flying if you’ve recently had a stroke or heart attack.
• Hydration: To prevent dehydration from the dry air in the aircraft, passengers should ensure they drink enough fluids. Alcohol and caffeinated drinks should be avoided.
• Movement: Especially on long-haul flights, it’s important to get up regularly and perform simple foot and leg movements to stimulate circulation. For some passengers, compression stockings or anti-thrombosis medication might be beneficial, but this should be discussed individually with their doctor.
• Pressure Equalization: If pressure equalization is not possible before the flight, it is advisable to refrain from traveling. This is particularly important for infants.

With these precautions in mind, we wish all passengers a safe and emergency-free journey!