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Original Research

Open Access

The knowledge, confidence and attitudes of medical students in managing in-flight medical emergencies

  • Loui Alsulimani1,*,
  • Taha Masri1
  • Aroob Abdulhalim2
  • Lama Maksood3
  • Saif Dahlawi3
  • Ahad Babkier3
  • Aseel Bati4

1Disaster Medicine Section, Department of Emergency Medicine, King Abdulaziz University Faculty of Medicine, 80215 Jeddah, Kingdom of Saudi Arabia

2Critical Care Medicine, King Faisal specialist Hospital & Research Centre, 21499 Jeddah, Kingdom of Saudi Arabia

3Faculty of Medicine, Umm Al-Qura University, 21955 Makkah, Kingdom of Saudi Arabia

4Emergency Medicine, King Fahad Armed Force Hospital, 21159 Jeddah, Kingdom of Saudi Arabia

DOI: 10.22514/sv.2024.022 Vol.20,Issue 4,April 2024 pp.59-67

Submitted: 09 September 2023 Accepted: 30 October 2023

Published: 08 April 2024

*Corresponding Author(s): Loui Alsulimani E-mail:


In-flight medical emergencies (IMEs) are common during commercial airline flights. These events occur once every 100 to 1000 flights with pressurization corresponding to an altitude of 5000 to 8000 feet during the flight, low oxygen partial pressures and low humidity. This study was designed to evaluate the knowledge, confidence and attitudes of medical students in Saudi Arabia with regards to managing in-flight medical emergencies. A cross-sectional study targeting all medical students in Saudi Arabia was conducted using an online questionnaire. In total, we analyzed 378 medical students and interns; only 18% possessed an adequate perception of knowledge relating to IMEs; 36.8% felt assured in their IME response, 36.5% believed they could provide competent care, and only 34.5% considered their medical education was adequate for the treatment of IMEs. Our analyses showed that medical students in Saudi Arabia have inadequate confidence and knowledge in managing IMEs. Consequently, there is a significant gap in current medical school curricula in the Kingdom of Saudi Arabia that could be filled by implementing focused training on the management of IMEs.


Emergency medicine; Medical emergencies; Medical students; Curricula

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Loui Alsulimani,Taha Masri,Aroob Abdulhalim,Lama Maksood,Saif Dahlawi,Ahad Babkier,Aseel Bati. The knowledge, confidence and attitudes of medical students in managing in-flight medical emergencies. Signa Vitae. 2024. 20(4);59-67.


[1] Martin-Gill C, Doyle TJ, Yealy DM. In-flight medical emergencies: a review. JAMA. 2018; 320: 2580–2590.

[2] Sul C, Badawy SM. A systematic review of pediatric and adult in-flight medical emergencies. International Journal of Pediatrics. 2018; 2018: 6596490.

[3] Katzer R, Duong D, Weber M, Memmer A, Buchanan I. Management of in-flight medical emergencies: are senior medical students prepared to respond to this community need? Western Journal of Emergency Medicine. 2014; 15: 925–929.

[4] Ruskin K, Hernandez K, Barash P, Riou B. Management of in-flight medical emergencies. Anesthesiology. 2008; 108: 749–755.

[5] Katzer RJ, Frumin E, Silverman D, Koenig KL, Schultz CH. In-flight medical emergencies: creation of a novel simulation based medical student curriculum. Medical Teacher. 2013; 35: 874.

[6] Bagshaw M, Illig P. The aircraft cabin environment. Travel Medicine. 2019; 16: 429–436.

[7] Holthof K, Bridevaux P, Frésard I. Underlying lung disease and exposure to terrestrial moderate and high altitude: personalised risk assessment. BMC Pulmonary Medicine. 2022; 22: 187.

[8] AlShamlan NA, AlOmar RS, Alrayes MM, Alkhaldi SK, Alomar AH, Alghamdi AA, et al. “Is there a doctor on board?”: willingness and confidence of physicians in the Kingdom of Saudi Arabia in assisting with in-flight medical emergencies. BMC Emergency Medicine. 2021; 21: 54.

[9] Ceyhan MA, Menekşe İE. In-flight medical emergencies during commercial travel. Journal of Travel Medicine. 2021; 28: taab094.

[10] Krishnegowda AB, Dahiya M, Rastogi P, Murthy HK. Analysis of medical emergencies in commercial flights and utility of medical resources onboard. Indian Journal of Aerospace Medicine. 2022; 66: 27–31.

[11] Chandra A, Conry S. In-flight medical emergencies. Western Journal of Emergency Medicine. 2013; 14: 499–504.

[12] Hinkelbein J, Böhm L, Braunecker S, Genzwürker HV, Kalina S, Cirillo F, et al. In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM). Internal and Emergency Medicine. 2018; 13: 1305–1322.

[13] Forti A, van Veelen MJ, Scquizzato T, Dal Cappello T, Palma M, Strapazzon G. Mechanical cardiopulmonary resuscitation in microgravity and hypergravity conditions: a manikin study during parabolic flight. The American Journal of Emergency Medicine. 2022; 53: 54–58.

[14] Bashir T. Patients crash more than airlines: a medical emergency at 35,000 ft. Journal of Community Hospital Internal Medicine Perspectives. 2014; 4: 24730.

[15] Padaki A, Redha W, Clark T, Nichols T, Jacoby L, Slivka R, et al. Simulation training for in-flight medical emergencies improves provider knowledge and confidence. Aerospace Medicine and Human Performance. 2018; 89: 1076–1079.

[16] Garneau WM, Harris DM, Viera AJ. Cross-sectional survey of Good Samaritan behaviour by physicians in North Carolina. BMJ Open. 2016; 6: e010720.

[17] Ng W, Abdullah N. Knowledge, confidence and attitude of primary care doctors in managing in-flight medical emergencies: a cross-sectional survey. Singapore Medical Journal. 2020; 61: 81–85.

[18] Sayuti M, Hawari MA, Syahriza M, Millizia A. The impact of basic life support training on the knowledge and skills amongst medical students in faculty of medicine, Universitas Malikussaleh: a pre-experimental study. Bali Medical Journal. 2021; 10: 499–502.

[19] Kommor MB, Miller KN, Powell TL, King AM, San Miguel CE, Delamare Fauvel A, et al. A first-class simulation: in-situ in-flight medical emergencies curriculum for emergency medicine residents aboard a commercial airliner. Cureus. 2023; 15: e37562.

[20] Kingsley T, Kirchoff R, Newman JS, Chaudhary R. Demystifying airline syncope. World Journal of Cardiology. 2020; 12: 107–109.

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