Volume 30, Issue 167, January 2026

Emergency medical transport and critical interventions in aviation medicine: A systematic review

Mazi Mohammed Alanazi¹, Bedoor khalid alshabibi², Razan Mohammad Almokri³

¹Saudi and Jordanian Board Emergency Medicine, Emergency Department, Head of Emergency Research Unit, First Health Cluster, Riyadh, Saudi Arabia
²Saudi Board Emergency Medicine Resident, Emergency Department, king Abdullah medical complex, Jeddah, Saudi Arabia
³Saudi Board Emergency Medicine Resident, Emergency Department, king Faisal specialist hospital & research center, Jeddah, Saudi Arabia

ABSTRACT

Background: In flight medical events (IMEs) and aircrew health issues pose distinctive challenges in commercial aviation. We aimed to synthesize contemporary evidence on IME epidemiology, onboard interventions and outcomes, and aircrew physiology and fitness with implications for safety policy. Methods: PRISMA aligned review of MEDLINE, Embase, Web of Science, Scopus, and CENTRAL plus regulator sources to 2025. Two reviewers screened and extracted data. SWiM guided structured narrative synthesis reporting. Results: Fifteen studies met criteria: IMEs, onboard interventions (n 6) and aircrew physiology, performance (n 9). IME incidence ranged from one per 604 flights to 16 per million passengers; syncope predominated. Diversion occurred in 7%, admission in 9%, and death in 0.3%. Automated external defibrillators enabled accurate rhythm decisions and 40% survival for ventricular fibrillation. First aid kits were opened in 15% of events; oxygen and telemedical support were common. Among pilots, annual medical incapacitation was 0.25%, increasing with age; psychiatric diagnoses had the longest suspensions. Fatigue exposure covered 10% of flying hours at elevated modeled risk, and about one quarter of duties followed less than 6 hours of sleep. Hypoxia experiments showed delayed symptom recognition and identified EEG, oxygen saturation, and heart rate markers linked to performance. Conclusions: Most IMEs are nonfatal and manageable on board with trained crews, standardized kits, AEDs, and telemedicine. Critical arrests benefit from rapid defibrillation. Aircrew safety improves with fatigue mitigation, hypoxia focused training, physiologic monitoring, and age aware fitness oversight.

Keywords: In flight medical events; aviation medicine; aircrew health; pilot incapacitation; hypoxia; telemedicine; PRISMA; systematic review

Medical Science, 2026, 30, e4ms3752

PDF

Published: 09 January 2026