Emergency at altitude: exploring physicians’ knowledge, preparedness, and perspectives on in-flight medical emergencies in Saudi Arabia

doi:10.5847/wjem.j.1920-8642.2025.104

Abstract

Abstract:

BACKGROUND: In-flight medical emergencies (IMEs) present significant challenges to healthcare professionals, particularly those with limited training or experience in managing such situations. The objective of this study was to evaluate the level of knowledge, attitudes, and behaviors of licensed doctors in Saudi Arabia concerning IMEs, and to identify the demographic factors influencing their preparedness.

METHODS: A cross-sectional study was conducted with a sample of 383 licensed physicians across five regions of Saudi Arabia. Participants completed a self-administered questionnaire assessing demographics, knowledge of IMEs, attitudes towards providing assistance, and previous experience with in-flight emergencies. Data were analyzed using SPSS 26, with statistical significance set at P<0.05.

RESULTS: The results revealed a predominantly young (75.8% aged 25-34 years) and male (69.6%) participant pool. While 76.6% of respondents recognized the impact of cabin pressure on oxygen, only 45.4% correctly identified air travel risks for asthmatic patients. Although 66.8% felt confident assisting in IMEs, 20.9% cited medicolegal concerns. Moreover, area of working within Saudi Arabia (P=0.020), year of experience (P=0.041), prior experience with IMEs (P=0.021), and IMEs training (P<0.001) had a significant association with levels of knowledge.

CONCLUSION: The study highlights a critical need for enhanced training programs with a focus on the management of IMEs among healthcare practitioners in Saudi Arabia.

Key words: In-flight medical emergencies, Physicians’ knowledge, Attitudes, Confidence, Saudi Arabia, Medicolegal concerns

Abdulmajeed Almadhyan, Dhai Almuteri, Sadeem Alsenidi, Mohammed Alazmi, Raghad Rajab, Sarah Alghamdi, Samah Alkuraydis. Emergency at altitude: exploring physicians’ knowledge, preparedness, and perspectives on in-flight medical emergencies in Saudi Arabia[J]. World Journal of Emergency Medicine, 2025, 16(6): 552-558.

Figures/Tables 4

Table 1

Figure 1.

Table 2

Table 3

Attitude, practice and confidence of doctors in managing in-flight medical emergencies (n=359)

Items	No. (%)	Items	No. (%)
Offering help during medical emergencies in flight		Medical education provides sufficient skills and knowledge to deal with medical emergencies aboard
Strongly disagree	12 (3.3)	Strongly disagree	16 (4.5)
Disagree	14 (3.9)	Disagree	37 (10.3)
Neutral	93 (25.9)	Neutral	100 (27.9)
Agree	111 (30.9)	Agree	138 (38.4)
Strongly agree	129 (35.9)	Strongly agree	68 (18.9)
If another person has already stepped forward to assist, I would refrain from intervening		I have adequate awareness of the medical supplies provided on commercial flights
Strongly disagree	26 (7.2)	Strongly disagree	24 (6.7)
Disagree	71 (19.8)	Disagree	39 (10.9)
Neutral	105 (29.2)	Neutral	121 (33.7)
Agree	96 (26.7)	Agree	119 (33.1)
Strongly agree	61 (17.0)	Strongly agree	56 (15.6)
I would not interfere in medical emergencies if not confident even being the only healthcare provider on board		I have adequate awareness of the medical medications provided in commercial flights
Strongly disagree	47 (13.1)	Strongly disagree	34 (9.5)
Disagree	79 (22.0)	Disagree	72 (20.1)
Neutral	107 (29.8)	Neutral	110 (30.6)
Agree	82 (22.8)	Agree	98 (27.3)
Strongly agree	44 (12.3)	Strongly agree	45 (12.5)
Fears from medicolegal implications prevent me from giving help in flight emergency		Crew on commercial air had adequate awareness in managing medical emergencies on board
Strongly disagree	28 (7.8)	Strongly disagree	37 (10.3)
Disagree	45 (12.5)	Disagree	58 (16.2)
Neutral	100 (27.9)	Neutral	121 (33.7)
Agree	111 (30.9)	Agree	102 (28.4)
Strongly agree	75 (20.9)	Strongly agree	41 (11.4)
I need additional training to better manage medical emergencies during flights		There is a collaboration between crew, ground-based control, and onboard volunteers to help in medical emergencies on board
Strongly disagree	9 (2.5)	Strongly disagree	23 (6.4)
Disagree	13 (3.6)	Disagree	49 (13.6)
Neutral	84 (23.4)	Neutral	116 (32.3)
Agree	132 (36.8)	Agree	118 (32.9)
Strongly agree	121 (33.7)	Strongly agree	53 (14.8)
Medical training is sufficient to make me give help during medical emergencies aboard
Strongly disagree	33 (9.2)
Disagree	60 (16.7)
Neutral	94 (26.2)
Agree	125 (34.8)
Strongly agree	47 (13.1)

Table 3

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Demographic factors	Count	%
Age, years
25-34	272	75.8
35-45	60	16.7
> 45	27	7.5
Gender
Male	250	69.6
Female	109	30.4
Nationality
Saudi	289	80.5
Non-Saudi	70	19.5
Area of working in Saudi Arabia
Central	110	30.6
Southern	37	10.3
Northern	74	20.6
Western	93	25.9
Eastern	45	12.5
Years of practice
<5	238	66.3
5-10	67	18.7
>10	54	15.0
Experience in emergency department
No experience	35	9.7
Less than 1 year	164	45.7
1-2 years	83	23.1
More than 2 years	77	21.4
Experience in providing assistance during in-flight medical emergencies
No	236	65.7
Yes	123	34.3
Training in life support
No	14	3.9
Yes	345	96.1
Training in management of in-flight medical emergencies
No	256	71.3
Yes	103	28.7
Frequency of air travel
Never	19	5.3
Once a year or less	133	37.0
Two times per year	102	28.4
More than two times per year	105	29.2

Demographic factors	Inadequate knowledge (n=177)		Adequate knowledge (n=182)		P-value	95% CI
Demographic factors	n	%	n	%	P-value	95% CI
Age, years
25-34	143	52.6	129	47.4	0.089	0.01-1.02
35-45	23	38.3	37	61.7
> 45	11	40.7	16	59.3
Gender
Male	120	48.0	130	52.0	0.454	0.423-0.658
Female	57	52.3	52	47.7	0.454	0.423-0.658
Nationality
Saudi	144	49.8	145	50.2	0.687	0.536-0.753
Non-Saudi	33	47.1	37	52.9	0.687	0.536-0.753
Area of working in Saudi Arabia
Central	45	40.9	65	59.1	0.020	0.018-0.022
Southern	18	48.6	19	51.4
Northern	32	43.2	42	56.8
Western	59	63.4	34	36.6
Eastern	23	51.1	22	48.9
Years of practice
<5	124	52.1	114	47.9	0.322	0.132-0.421
5-10	30	44.8	37	55.2
>10	23	42.6	31	57.4
Experience in the emergency department
No experience	17	48.6	18	51.4	0.041	0.039-0.043
Less than 1 year	92	56.1	72	43.9
1-2 years	40	48.2	43	51.8
More than 2 years	28	36.4	49	63.6
Experience in providing assistance during in-flight medical emergencies
No	106	44.9	130	55.1	0.021	0.018-0.024
Yes	71	57.7	52	42.3	0.021	0.018-0.024
Training in life support
No	6	42.9	8	57.1	0.632	0.523-0.721
Yes	171	49.6	174	50.4	0.632	0.523-0.721
Training in management of in-flight medical emergencies
No	109	42.6	147	57.4	<0.001	0.0001-0.0006
Yes	68	66.0	35	34.0	<0.001	0.0001-0.0006
Frequency of air travel
Never	10	52.6	9	47.4	0.524	0.432-0.621
Once a year or less	71	53.4	62	46.6
Two times yearly	50	49.0	52	51.0
More than two times yearly	46	43.8	59	56.2

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