We fly more than ever, but the health risk is also at the historic maximum. Here’s who should avoid the plane, what to do to prevent thrombosis and ailarks, and why there is not always a doctor (nor the tools) on board.
Summer: the airports are transformed into human rivers that flow under the boards of departures and arrivals. Never in history the amount of passengers of 2025 has been reached: Based on the projections of Eurocontrol, from June to September in Europe alone, up to 37 thousand planes per day will be raised, with a number of travelers who at the end of the season will reach almost 2 billion. Record ever, and so far everything is fine for the economy of the continent: but with an average age of the population increasingly higher and with the right expectations of the older ones who do not give up travel of pleasure, the possibility, at a certain point of our flight, is also growing, to hear the speechless announcement at the speaker: “Is there a doctor on board?”.
The thrill at high altitude
The thrill along the back: someone is sick, in a “tube” of metal that flies to 10 thousand meters in height. A study by the New England Journal of Medicine a few years ago, calculated that it runs into a medical emergency once every 640 flights: they are therefore dozens and dozens of health problems per day, now certainly increased in light of the fact that the European population is now composed for 35 percent of chronic patients. According to statistics, these alarms are almost always of minor, and in nine cases the flight continues his journey. In the remaining 10 percent, however, you are forced to rapid landing.
Thrombosis, not heart
But what are the most common problems? Who should avoid the plane at all costs and what precautions can we take if we are forced to undertake particularly long trips? “Let’s start by saying that it is not true that the plane hurts the heart”, immediately points out Giulio Pompilio, scientific director of the Monzino Cardiological Center in Milan. “This is a hard myth to die, a hoax. A heart disease, if its condition is stable, can easily fly. Obviously things change if it has had a limited heart attack, or has just been operated on the heart: in that case a medical evaluation is needed ». In fact, the real enemy in flight is not so much altitude (which can still cause discomfort) but the immobility in uncomfortable seats and with little space for the legs. “The major problem is called deep venous thrombosis, the” economic class syndrome “” continues Pompilio. «A clot is formed in the deep veins of the legs, which can detach and migrate towards the lungs, causing potentially fatal hembolia. It is a real risk, which increases after the first four hours of travel. And that concerns everyone: cardiopathic, hypertensive, but also healthy people ».
The error of the aspirin
And the famous advice to take on a “cardioaspirina” before take -off? “Nothing more wrong,” concludes Pompilio. “There is no proof that aspirin protects from immobility thrombosis. Indeed, it can increase the risk of bleeding ». So if we find ourselves with a red, swollen or painful leg, you must immediately ask for help, and refer to the famous “doctor on board”, because with trombosis you don’t joke. Easy to say: because it is not said that the doctor on board is there, that it is clear and that you find everything you need for rescue available.
Minimum equipment, different rules
In the various countries, in fact, the rules vary substantially, and therefore the level of the treatments that are received in flight depend a lot on the route and the “sensitivity” of the airline. If, just to give an example, Emirates is experimenting with a new “telemedicine station” on board – with the possibility of remote evaluation of passengers and 12 -derivative echocardiograms – which includes digital stetooscopes, pulse oximeters, pressure measures and other tools that transmit vital signs in real time to the medical team of earth, not all companies have so high standards. On the contrary. “The obligations vary a lot, depending on the country, of the length of the flight and the policy of the vectors,” tells us a commander of a European low cost, who prefers to remain anonymous. “The EASA, that is, the European Air Security Agency requires the presence on board an emergency room kit for every 100 passengers, and the obligation for the staff to follow first assistance courses. But in this kit there are no equipment such as loser or flebo, and also the few medicines present (such as tachipirine, analgesics or anti -emitics) cannot be administered by the crew, but only by the doctor who possibly makes himself available to do so. The defibrillator on board is not mandatory throughout Europe, but strongly recommended on flights that last more than 2 hours ».
Syncope, gastroenteritis and air sickness
Fortunately, cardiac arrest does not happen frequently, on the contrary it happens only in 0.3 percent of emergencies. The statistics tell us that the most widespread problem is that of syncope – the classic fainting – which alone concerns 37 percent of cases, followed by gastrointestinal disorders, which in flight can constitute a significant problem: in 2023 a flight was forced to the emergency landing for “biological risk”, due to a passenger with the gastroenteritis that had made all the toilets of the plane unusable. Then follow the respiratory and cardiovascular problems in the standings, also because the altitude is not always easy to “metabolize”.
High altitude as a high mountain
«In general, planes are pressurized as if we were 1,800-2,400 meters above sea level. We do not notice it, but for our body it is equivalent to being in the high mountains: less oxygen, dry air, and a leap of atmospheric pressure »explains Alberto Benetti, director of internal medicine -alto complexity of the Niguarda hospital in Milan. «This change can also have effects on those who are in good health. The most widespread problem is barotrauma, which can give pain to the ears, even very strong dizziness and annoyance to the paranasal sinuses. Those who have colds or sinusitis can suffer a lot. In that case it is necessary to chew tires or candies and swallow often ».
Water, movement, luck
Then there are the problems of dehydration, so you must always remember to drink a lot. «But be careful: not wine, spirits or coffee. Only water »continues Benetti. «The air in the cabin is very dry and dehydration promotes blood coagulation. And then you have to move regularly: get up every two hours, take four steps in the corridor. And if you can’t, perform seeds of ankles extension and feet rotation exercises. Simple but effective exercises ».
And it doesn’t hurt to rely on the blindfolded goddess: Because if there is no instrumentation, we just have to hope for the presence on board, perhaps, of an emergency doctor. “I rescued a person during a flight from Italy to Berlin” says Mario Guarino, Vice President Simeu (Italian Society of Emergency Medicine and Urgency). “The patient had had a syncope, we made him lie down in the corridor, but on board there was not even the loser to measure the pressure: I found it unacceptable, given that the plane is in itself a” hostile “environment, because of pressurization and restricted spaces. Making the passenger resumed was not easy, but in the end everything went well. Now I think about it every time I get on a plane ».
Also because the ethical duty is very clear: if you need, we intervene. Despite all shortcomings, anxiety and hostile environment. Because, at 10 thousand meters, even a single doctor who gets up to help those who are sick can make a difference.
