One of the passengers on the eVTOL air taxi flight started feeling seriously ill halfway between Newport Beach and Los Angeles International Airport. When the pilot was alone at the controls, she thought, “Now what? But then another thought came to her: “How will this play out when they are autonomous?”

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As experts in inflight medical care try to determine how the new advanced air mobility (AAM) industry will handle its passengers, this alarming scenario is exactly what they are considering. With most use cases involving relatively short flights, prospective operators are taking a different approach to addressing what response would be realistic and effective.

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With over 4,500 aircraft already supported by two-thirds of the world's top commercial airlines and corporate flight departments, MedAire is an established aviation service provider. Upon entering the AAM sector, the U.S.-based group soon realized that medical emergencies are not on the radar for new entrants.

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“One company we spoke with has signed a deal with a major airline to provide city-to-airport travel, but the eVTOL company itself admits it hasn't yet considered this issue, even though the airline is already supported by MedAire." MedAire CEO Bill Dolny said in a FutureFlight interview.

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There are some who might argue that inflight medical care is a solution looking for a problem with air taxi flights as short as 15 minutes. Every day, passengers hop into cabs on the ground without considering what would happen if they suffered a stroke while driving on a crowded freeway.

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Aircraft operators will be expected to provide a standard of care for passengers, from gridlock-busting hops across cities to sightseeing tours and short-haul regional airline services, according to Dolny. Similarly to the prospect of a fatal crash in the early days of eVTOL, which convinced some that the new mode of air transportation would damage the sector irreversibly, stories of heart attacks in flight could seriously erode public trust, especially in ridesharing situations.

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WIDER SAFETY PROBLEMS COULD RESULT FROM MEDICAL EMERGENCIES

Dolny painted a mental picture of a passenger panicking in a small cabin if the wrong type of medical event happens. As a rule, there won't be any crew members in the back, and in some cases, there won't be any crew members at all."

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MedAire has been forced to rethink how it might provide life-saving support in other types of aircraft in light of this conundrum. A newly introduced Digital Assessment Kit, as well as embedded versions of the company's customer-facing app, could provide an answer to the problem.

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In order to determine where to install microphones and cameras in cabins, the company is in dialogue with eVTOL aircraft developers. The researchers are also investigating how scaled-down medical kits can be provided to meet weight and space constraints, for example, preventing normal-sized defibrillators from being installed.

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MedAire provides easy-to-follow instructions for dealing with in-flight health emergencies for people without medical training.

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In addition to the 300-plus calls MedAire fields on average each day from its Phoenix and London facilities, its ground-based medical teams assist passengers during flights. It is possible to diagnose and provide guidance using cameras in some cases.

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MedAire's global medical director of aviation health, Dr. Paulo Alves, is leading efforts to refine how care can be delivered to meet the changing needs of an industry in flux. As a member of the National Business Aviation Association, he sits on the safety committee.

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To provide the right support, equipment, and training, the company recently updated its entire case history. Our focus is on responding most effectively to medical emergencies within a 10-minute window," Alves explained. A brainstorming session is underway about major events that might occur during flight. Clearly, these depend more on the individual than on the [type or duration of flight]. It is more or less the same percentage of cardiovascular events for long and short flights."

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MedAire's ground-based doctors deal with thousands of calls each year to support aircraft operators and their passengers.

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It is also fundamentally the same, even for new types of aircraft, to identify what is happening and take action quickly. An automatic flight-divert function, which would be particularly important in an autonomous aircraft, is being considered for inclusion in MedAire's algorithms for controlling the aircraft. "We are considering a case in which there is no pilot to help, so what we provide must be intuitive for the passengers," Alves said.

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As the regulatory requirements for inflight medical care are relatively minimal, the mission is ultimately to protect aircraft passengers to the fullest extent possible. For fixed-wing and helicopter operations, safety management systems are almost universally used to define the requirements.

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"We are looking for innovative ways to work with this [AAM] industry to create appropriate standards of care that do not overburden manufacturers and operators," Dolny said. There will be a standard of care that people expect, so operators will have to decide how they want to place their bets."

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About one third of the cases handled by MedAire assistance teams in 2022 involved direct inflight medical aid, on top of supporting crew and assessing passengers' fitness to fly. There were 17 percent of patients with ear, nose, and throat conditions, 16 percent with gastrointestinal conditions, 15 percent with neurological conditions, 9 percent with musculoskeletal conditions, and 6 percent with respiratory conditions.

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