RoM-Oct2006

Handbook of WMA Policies
World Medical Association ½ R-2006-01-2006

WMA RESOLUTION
ON
MEDICAL ASSISTANCE IN AIR TRAVEL
Adopted by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
1. Air travel is the preferred mode of long distance transportation for people across the
world. The growing convenience and affordability of air travel has led to an increase
in the number of air passengers, including older passengers and other individuals at
increased risk for health emergencies. In addition, long-duration flights are common,
increasing the risk of in-flight medical emergencies.
2. The environment in normal passenger planes is not conducive to the provision of
quality medical care, especially in the case of medical emergencies. Noise and move-
ment of the plane, a very confined space, the presence of other passengers who may
be experiencing stress or fear as a result of the situation, the insufficiency or complete
lack of diagnostic and therapeutic materials and other factors create extremely diffi-
cult conditions for diagnosis and treatment. Even the most experienced medical pro-
fessional is likely to be challenged by these circumstances.
3. Most airlines require flight personnel to be trained in basic first aid. In addition, many
provide some degree of training beyond this minimum level and may also carry cer-
tain emergency medicines and equipment on board. Some carriers even have the capa-
city to provide remote ECG reading and medical counselling services.
4. Even well-trained flight personnel are limited in their knowledge and experience and
cannot offer the same assistance as a physician or other certified health professional.
Currently, continuing medical education courses are available to physicians to train
them specifically for in-flight emergencies.
5. Physicians are often concerned about providing assistance due to uncertainty re-
garding legal liability, especially on international flights or flights within the United
States. While numerous airlines provide some kind of liability insurance for medical
professionals and lay persons who will provide voluntary assistance during flight, this
is not always the case and even where it does exist, the terms of the insurance cannot
always be adequately explained and understood in a sudden medical crisis. The finan-
cial and professional consequences of litigation against physicians who offer assis-
tance can be very costly.
6. Some important steps have been taken to protect the life and health of airline pas-
sengers, yet the situation is far from ideal and needs improvement. Many of the major
problems could be mitigated by simple actions taken by both airlines and national le-
gislatures, ideally in cooperation with one another and with the International Air Trans-
port Association (IATA) to arrive at coordinated and consensus-based international
policies and programs.
7. National Medical Associations have an important leadership role to play in promoting
measures to improve the availability and efficacy of in-flight medical care.
R-2006-01-2006½ Pilanesberg
Air Travel

8. Therefore the World Medical Association calls on its members to encourage national
airlines providing medium and long range passenger flights to take the following ac-
tions:
a. Equip their airplanes with a sufficient and standardised set of medical emergency
materials and drugs that:
1. are packaged in a standardised and easy to identify manner;
2. are accompanied by information and instructions in English as well the main
languages of the countries of departure and arrival; and
3. include Automated External Defibrillators, which are considered essential
equipment in non-professional settings.
b. Provide stand-by medical assistance that can be contacted by radio or telephone to
help either the flight attendants or to support a volunteering health professional, if
one is on board and available to assist.
c. Develop medical emergency plans to guide personnel in responding to the medical
needs of passengers.
d. Provide sufficient medical and organisational instruction to flight personnel, be-
yond basic first aid training, to enable them to better attend to passenger needs
and to assist medical professionals who volunteer their services during emer-
gencies.
e. Provide insurance for medical professionals and assisting lay personnel to protect
them from damages and liabilities (material and non-material) resulting from in-
flight diagnosis and treatment.
9. The World Medical Association calls on its members to encourage their national avia-
tion authorities to provide yearly summarised reports of in-flight medical incidents
based on mandatory standardised incident reports for every medical incident requiring
the administration of first aid or other medical assistance and/or causing a change of
the flight.
10. The World Medical Association calls on its members to encourage their legislators to
enact legislation to provide immunity from legal action to physicians who provide
emergency assistance in in-flight medical incidents.
11. In the absence of legal immunity, the airline must accept all legal and financial conse-
quences of providing assistance by a physician.
12. The World Medical Association calls on its members to:
a. educate physicians about the problems of in-flight medical emergencies;
b. inform physicians of training opportunities or provide or promote the develop-
ment of training programs where they do not exist; and
c. encourage physicians to discuss potential problems with patients at high risk for
requiring in-flight medical attention prior to their flight.
13. The World Medical Association calls on IATA to further develop precise standards in
the following areas and, where appropriate, work with governments to implement these
standards as legal requirements:
a. medical equipment and drugs on board medium and long range flights;
b. packaging and information materials standards, including multilingual descrip-
tions and instructions in appropriate languages;
c. medical emergency organisation procedures and training programs for medical
personal.