Sponsored by: 

Anna-Maria Carvalho

Anna-Maria Carvalho is an emergency physician with a subspecialty in aviation medicine. She has worked in both fixed and rotor wing medical evacuations, trained as a flight surgeon with the Canadian Forces, and currently specializes in commercial aviation medicine. Her passion is at the intersection of emergency medicine and aviation medicine: the management of inflight medical emergencies.

Anna has worked as a consultant to a number of Canadian airlines and is a Civil Aviation Medical Examiner for Transport Canada. She is currently senior medical advisor to Air Canada while also working as an emergency physician at Vancouver General Hospital. She is founder and course co-director of the Onboard Medical Emergencies course (www.onboardme.com).

When not on shift, she is often planning her next vacation flight.

Episode Overview

At 36,000 feet, the environment changes everything.

Cabin pressure, hypoxia, limited equipment, cramped spaces, and hundreds of anxious onlookers create one of the most unique prehospital environments imaginable.

Dr. Carvalho walks us through:

• The physiology of flight (why everyone is mildly hypoxic at altitude)

• Why your SpO₂ of 92–93% is normal in-flight

• The impact of cabin pressure on cardiac demand, alcohol effects, and chronic illness

• Why DVT risk starts at 4 hours, not 8

• And what actually happens when you volunteer to help

The Big Four In-Flight Emergencies

The most common categories:

1. Neurologic

2. Cardiac

3. Respiratory

4. GI

With increasing numbers of older passengers and travelers with chronic disease, in-flight events are becoming more common — approximately:

• 1 in every 600 flights

• 1 in every 7,000 passengers

What’s in the Emergency Medical Kit?

Most major aircraft carry:

• AED (stored separately)

• Oxygen & BVM

• Oral airways

• IV supplies + limited fluids

• Epinephrine

• Ventolin

• Antihistamines

• Steroids

• Benzodiazepines (PO/IM/IV)

• Glucose ± glucagon

• Naloxone (on some airlines)

• Basic documentation & indemnity forms

Some airlines carry intubation equipment — many do not.

Who Can Volunteer?

If you have medical training — physician, nurse, paramedic, student, allied health — you are valuable.

You don’t need to run a code solo.

You will:

• Identify yourself

• Show credentials if available

• Work alongside trained flight crew

• Connect with ground-based physicians who guide treatment

• Document care

And importantly:

You will not be the one deciding whether the plane diverts.

Legal Protection & Good Samaritan Law

A major concern for responders is liability.

Dr. Carvalho reassures listeners:

• The Good Samaritan principles apply

• You are protected when acting in good faith, within scope, without gross negligence

• No volunteer has ever been successfully sued for assisting in-flight

Airlines also provide indemnity documentation inside the kit.

Cardiac Arrest at 36,000 Feet

Yes, it happens.

Management includes:

• Moving the passenger to floor space (galley/bulkhead/business class)

• AED use

• CPR with crew/volunteer support

• Early ground consultation

Resuscitation attempts are typically performed for ~30 minutes or until exhaustion if far from diversion.

If a death occurs in-flight:

• The flight does not divert

• Resuscitation may be ceased

• The passenger remains secured until landing

Diversion Decisions

Diversions are complex and involve:

• Captain

• Ground-based physician

• Aircraft range/fuel

• Airport capability

• Passenger impact

Volunteers may recommend — but do not decide.

Key Takeaways

• You already know how to respond.

• The environment is different — but your fundamentals apply.

• Most in-flight diagnoses are correct.

• Most patients improve with basic stabilization.

• Your presence matters.

If you hear the call overhead — consider stepping up.

Listen now to gain confidence for one of the most unique clinical environments you may ever encounter.