Every holiday season, millions of Americans hop on a plane to visit friends and family. Most people are anxious about flight delays and cancellations, but as an emergency room physician, there’s one announcement I dread the most: “Is there a doctor on board?” My reluctance isn’t due to any potential inconvenience or legal liability, but rather the fear of facing a sick passenger without the basic equipment or medications needed to help them.

In-flight medical emergencies are rare but happen more often than you might think. In contrast to a prior study that estimated they happen on approximately 1 per 604 flights, recently published analysis of data collected from 84 airlines found that medical emergencies were reported in 1 out of every 212 flights. For context, the the Federal Aviation Administration handles about 44,000 flights daily. That works out to roughly 70 to 200 medical emergencies a day over U.S. skies.

Here’s how those in-flight emergencies can play out: Flight attendants, who are trained in CPR and first aid skills, are the first to respond to an unwell passenger. They might radio a ground team that includes an on-call physician, who can guide treatment and advise whether the flight should be diverted. If a patient’s condition is more serious, crew members have discretion to request assistance from medical professionals who are passengers.

On both occasions I volunteered, I was traveling on long-haul international flights and assumed there was at least one other physician on board who would step forward. Well, I assumed wrong. One of those flights was ultimately diverted just before we left American airspace so the passenger could be transported to a hospital.

A few takeaways from those experiences: Heartbeats, unlike a crying infant, can’t be heard over a plane’s engine; starting an intravenous line is especially tricky when you’re hurtling through the sky at 500 mph; and we desperately need the FAA to expand its requirements for emergency medical kits.

The medical kits I used contained minimal supplies such as a stethoscope, manual blood pressure cuff, IV catheters, vials of epinephrine and lidocaine to treat cardiac arrest, and defibrillator. I was surprised at how bare-bones they were. It made more sense after I learned that the FAA hasn’t updated its basic requirements for emergency medical kits since 2004.

In 2024, Congress passed its reauthorization of the FAA. The bill directs the agency to review the costs and benefits of adding new medications and equipment to emergency medical kits, including whether their contents can adequately treat opioid overdose and anaphylaxis, a life-threatening allergic reaction. Hopefully the FAA is working on new regulations, but the agency hasn’t provided any indication that they’ll be arriving soon.

If the FAA moves forward with changing medical kits as suggested in the reauthorization bill, airlines will be required to carry naloxone to reverse opioid overdose and epinephrine in the appropriate dosage and route for anaphylaxis. (Current guidelines call for epinephrine in the concentration used to treat cardiac arrest; to dilute it to the correct dosage for anaphylaxis requires a medical professional making on-the-fly calculations.)

While these additions would be welcome, other basic equipment and medications should be included as the bare minimum. I don’t expect airplanes to act like makeshift ERs or flying ambulances, but a few simple, evidence-based provisions can make a major difference for unwell passengers. Here are a few items on my wish list, many of which are backed by the American Medical Association:

--Pulse oximeter to measure oxygen.

--Glucometer to measure blood sugar.

--Automated blood pressure cuff.

--Pediatric airway equipment.

--Benzodiazepine that can be injected into the muscle to treat prolonged seizures.

--Naloxone nasal spray for opioid overdose.

--Epinephrine auto-injectors for anaphylaxis, in adult and pediatric dosages.

--Oral glucose gel and glucagon for treatment of low blood sugar.

Several U.S. airlines already carry some of these items on board, including Southwest Airlines and Delta, though the exact contents of airlines’ medical kits are not readily shared online by every carrier. Official statements from several major American carriers about their medical kits have been vague. This leaves good Samaritan medical providers wondering what awaits them inside each bag. Improving transparency and standards for medical kits not only benefits passengers, but may also help prevent unplanned flight diversions, which can cost airlines$70,000 to $230,000.

While in-flight medical emergencies may be infrequent, the FAA’s mission is to prioritize safety even in the rarest of situations. Expanding the basic requirements for airline’s emergency medical supplies ensures standardization and improves passenger safety. For safe travels, it’s time for the FAA to heed Congress and update its policies for in-flight medical kits.

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Dr. Tushara Surapaneni is a board-certified emergency medicine physician and public voices fellow of The OpEd Project.

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