But no matter how knowledgeable the doctor, the medical care is limited by distance.
"We're often getting the story told to us from the passenger, maybe to the flight attendant, maybe to us," said David Claypool, a medical director at the Mayo Clinic Medical Transport, which advises Northwest Airlines and other clients. "We're working on experience and gestalt."
Perhaps better medical judgment can be deployed before the plane takes off. For instance, if gate agents notice that a passenger in the boarding area is in distress, coughing uncontrollably or writhing in pain, they can alert their airline and consult with on-call medical professionals to determine whether the passenger poses a risk. A passenger with full-blown chicken pox, for example, may be denied boarding.
But there is a flip side to empowering flight crews to play the role of public health officials. Discrimination lawsuits, for example, have been threatened against airlines that ejected passengers with HIV.
It's also generally up to the crew to make the difficult decision about what to do with a body in the event of a death onboard. Last year, a first-class passenger on a British Airways flight from New Delhi to London woke up to find himself sitting near a corpse. The airline later said that an elderly woman from the economy section had died after takeoff, and the body was moved to first class, where there was more space for family members of the deceased to grieve with more privacy.
Some airlines offer more training and carry more medical equipment onboard than others. American, for example, has offered defibrillators onboard since 1997, long before the government required airlines to carry them.
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