What happens if you have a medical emergency aboard a private jet? Here’s what you need to know before you take off.
American Express President Ed Gilligan was just 55 in 2015 when he had an inflight medical emergency flying aboard a company private jet.
According to American Banker, he had suffered an embolism and subsequent heart attack.
The University of Pennsylvania states the most common cause of a pulmonary embolism is a breaking off of a blood clot in your leg’s deep veins, known as deep vein thrombosis.
The CDC says DVT can be a severe risk to some long-distance travelers, typically flights over four hours.
Flight attendants performed cardiopulmonary resuscitation, according to reports.
Gilligan’s flight, en route from Tokyo to New York, made an emergency landing in Green Bay, Wisconsin; however, he died.
The topic inflight medical emergencies aboard private jets came center stage recently on the HBO drama Succession.
Media baron Logan Roy falls ill while flying across the Atlantic Ocean. A flight attendant feverishly tries to resuscitate him. However, he dies before the airplane can land.
Billionaire media baron Logan Roy succumbs aboard his private jet flight on the HBO series Succession.
The CEO of a large private charter company with a managed fleet says, “That scenario – over the middle of the ocean – is the worst possible one.”
While new private jets cost tens of millions to buy and millions of dollars to operate, the medical equipment required may shock you.
It’s significantly different from what you will find on the Part 121 airlines, which is ironic.
Part 121 covers American Airlines and Delta Air Lines and discount carriers like Spirit and Allegiant.
You get nickeled and dimed everywhere you turn.
However, the government’s rules on what type of equipment they need to have and the kind of training flight crews need for inflight medical emergencies are first-class compared to what is required on private jets.
A spokesperson for the Federal Aviation Administration tells Private Jet Card Comparisons, “The FAA requires specific medical training for flight attendants on Part 121 flights, and a Part 121 flight cannot take off without a complete, sealed Emergency Medical Kit.”
For Part 121, flight attendants must train on the “proper use of automated external defibrillators (AEDs) and in cardiopulmonary resuscitation at least once every 24 months.”
Mandatory equipment includes AEDs, approved first-aid kits in airplanes for which a flight attendant is required, and an approved emergency medical kit.
The FAA spokesperson continues, “These requirements do not apply to flights conducted under Parts 91 or 135.”
In the world of business jets, Part 91 covers private jets used for non-commercial use, typical of UHNWs like Elon Musk and Kim Kardashian, and corporate flight departments like American Express.
Part 135 is charter operators covering jet cards, membership, and on-demand charter flights.
Operators with managed fleets typically fly under both Part 91 and Part 135
There’s also Part 91K which covers fractional operators like NetJets and Flexjet.
The FAA only requires first aid kits for Part 91 and 135 aircraft with 19 or more passenger seats or with a certain payload capacity.
|In-Flight Medical Support||What is it?||Cost||FAA Part 135/91k Requirements|
|First Air Kit||Bandages, splints, antiseptic swabs, scissors, ammonia inhalants, protective gloves||Under $500||Only Part 135 aircraft with 19 + passenger seats; 91k fractional operators|
|Emergency Medical Kit||Prescription items to initially stabilize the most serious conditions; Non-prescription items to begin treatment of common illnesses affecting the traveler; Assessment: digital blood pressure cuff and monitor, digital thermometer, reading glasses; Prescriptions: heart attacks, vomiting, and nausea, infections, and allergic reactions; Non-prescriptions: aches and pains, dehydration, motion sickness, coughs, diarrhea; Dental: address toothaches, lost crowns, fillings; First-aid: dressings, antibiotic ointment, antiseptic scrubs, bandages, splint; Respiratory: bronchial inhaler, oxygen tubing, CPR pocket mask with oxygen inlet||$500 to $1,500||Not required|
|Automated External Defibrillator (AED)||An AED, or automated external defibrillator, is used to help those experiencing sudden cardiac arrest. It’s a sophisticated yet easy-to-use medical device that can analyze the heart’s rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.||Up to $3,000||Not required|
|Digital Assessment Kit (DAK)||The DAK includes a digital blood pressure monitor, compact digital glucometer, pulse oximeter, and contactless thermometer, ensuring rapid and accurate assessment. It provides enough information for a doctor to accurately assess the condition of the heart.||$10,000 and up||Not required|
|Ground-to-Air Inflight Medical Support||Links fight and cabin crew directly to doctors on the ground who can advise treatment and identify and contact the closest appropriate medical facilities if an emergency landing is needed.||Varies||Not required|
For airplanes where a flight attendant is required and with a maximum payload capacity of more than 7,500 pounds, an approved automated external defibrillator is also required.
That means even the largest dedicated private jets, like the Bombardier Global 7500, which has a maximum payload of 5,700 pounds, are exempt.
However, if an operator provided emergency equipment when FAA regulations did not require it, the crew is required to receive instruction in the location, function, and operation of emergency equipment to comply with Part 135.331 and Part 91 Subparts F and K.
So, in terms of what’s required, unless you are chartering a jet with 19 or more passenger seats, there’s not even a requirement for a basic First Aid Kit, although the good news is most jets apparently have them, even if they aren’t mandated.
Joan Garrett is the Founder and Chairman of MedAire, a leader in providing medical support for private aviation.
She says, “The FAA does not require Part 135 operators to carry enhanced Emergency Medical Kits (EMKs) or Automated External Defibrillators (referred to as AEDs),” adding, “I don’t think most operators out there fly without a First Aid Kit.”
She says while most manufacturers include a First Aid Kit, “How that is maintained is probably up to the operator.”
The FAA requires:
Garrett says that the list hasn’t changed since 2000.
In terms of training, “FAA regulations require Part 135 flight crews and certain Part 91 flight crews to be trained in using emergency equipment, including first aid kits.”
So, the good news is if there is a First Aid Kit, the crew needs to be trained to use it. However, that training is typically part of more extensive training covering evacuating the aircraft in an emergency and fighting inflight fires.
While First Aid kits have the bare minimum, Emergency Medical Kits carry whatever the customer wants, be it an aircraft owner, management company, or fleet operator.
Dr. Paulo Alves, Global Medical Director of Aviation Health for MedAire, which provides medical kits and support for operators of over 4,500 private aircraft worldwide, explains that there is a world beyond those First Aid Kits.
He says the list you see above was based on the type of injuries one might expect from turbulence.
It’s an important distinction because, unlike the dreaded announcement from a flight attendant asking if there are any qualified medical personnel on your flight, on a private jet, it’s you, your traveling companions, the pilots, and on larger jets, perhaps a flight attendant.
What’s onboard and what type of training and support your flight crew has could save your life.
According to a presentation during an NBAA conference, 78% of medical emergencies are on flights over three hours. 40% are on flights of more than six hours.
Medical events range from allergic reactions to neurological, respiratory, external injuries, dental, gastrointestinal, and cardiovascular.
Only 4% of those emergencies required a diversion.
The good news is only 2.1% required the person (passenger or crew member) to go to the hospital. Only 0.6% passed away.
However, Dr. Alves says all the statistics don’t matter when it comes to you or your traveling companions.
There are essentially four types of resources that may or may not be on your charter or fractional jet.
The First Aid Kits, as noted earlier, are basic.
The elevated Emergency Medical Kits are tailored to specific client needs, says MedAire Marketing Director Christopher Potter.
They would include a literal pharmacy of drugs cabin crew can administer with authorization from doctors on the ground.
Ground support is part of the real-time ground-to-air service agreement.
The EMKs could have anything from antibiotics to asthma and anti-nausea drugs and even auto-injectors.
That includes items to initially stabilize the most serious conditions.
There would be non-prescription items to begin treatment of common illnesses affecting the traveler.
Assessment tools include a digital blood pressure cuff and monitor, digital thermometer, and reading glasses;
Prescription drugs administered under the guidance of doctors on the grounds cover heart attacks, vomiting, nausea, infections, and allergic reactions.
There would also be non-prescriptions medicines for aches and pains, dehydration, motion sickness, coughs, and diarrhea.
First-aid support includes dressings, antibiotic ointment, antiseptic scrubs, bandages, and splints.
For respiratory emergencies, there could be a bronchial inhaler, oxygen tubing, or CPR pocket mask with an oxygen inlet.
Again, each EMK is customized based on the customer.
The AEDs are used for somebody experiencing sudden cardiac arrest. Alves says it is the first three minutes that are the most critical.
An AED, or automated external defibrillator, is used to help those experiencing sudden cardiac arrest.
It’s a sophisticated yet easy-to-use medical device that can analyze the heart’s rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.
If there isn’t an AED, one would need to perform cardiopulmonary resuscitation, or CPR, manually.
The Digital Assessment Kits send a stream of information from the patient back to the ground. That includes blood pressure, oxygen saturation, blood sugar, and other vital signs.
The DAK includes a digital blood pressure monitor, compact digital glucometer, pulse oximeter, and contactless thermometer. It ensures rapid and accurate assessment. It provides enough information for a doctor to accurately assess the condition of the heart.
However, the EMKs have less fancy equipment to relay vital information as well.
The ground-to-air real-time assistance goes beyond just talking the crew through what to do. They also look for the nearest airport with the most proximate hospital based on the type of emergency.
They arrange to have the airplane met by medical professionals. In other words, they help shave possibly lifesaving minutes off the response time.
Potter says each client has different solutions. They are based on a myriad of factors, from costs to storage space. There is also the size of airplanes and the types of missions they are flying.
On light and very jets and turboprops, the wisdom is they are mostly on shorter flights. You are going to be able to land quickly, so extra equipment isn’t needed.
In other words, both pilots need to be back in the cockpit, getting the airplane on the ground as fast as possible.
Potter says you find some operators that have differing levels of equipment on different size jets.
While fleet operators typically would standardize what they have, at least by aircraft type, management companies are another story.
The owner of a managed private jet pays the bills. However, some management companies require AEDs on the airplanes they manage, be it Part 91 or 135k.
But the key is anything above the FAA’s minimal requirements is optional.
It also means refurbishing the kits, something Part 121 airlines must do after they are opened. The airplane can fly one more leg before restocking the used kit.
In the world of private jets, how quickly the kits need to be refurbished is not regulated by the FAA. It would be based on if that operator has specified it as part of their own operating procedures they file with the FAA.
Potter says MedAire works with clients to refurbish used kits.
However, the cost is not a one-off type of thing. Potter says the EMKs have to be replaced annually, and AEDs and DAKs also need to be refurbished ongoing.
He says ongoing costs represent 50-75% of the original price.
“Just like you have a checklist to respond to an inflight mechanical problem, business aircraft operators need to have a standard operating procedure for an inflight [medical] emergency,” says Dr. Clayton Cowl, Chair, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic told Business Aviation Insider for an article titled, “Flight Crews: Managing an Inflight Medical Emergency.”
“It’s not like a commercial airline flight, where you often have multiple cabin crewmembers to assist or may have a nurse or a doctor among the passengers,” says Lesley Revuelto, a flight attendant with nearly 30 years of experience in Part 91, 91k, 121, and 135 operations in the same article.
They say operators should have regular training covering the different types of aircraft so flight crews know where resources are located.
Revuelto says, “The first time we ran through scenarios as a department, we noticed a lot of inconsistencies in checklists. You see the disconnects when you run procedures and do drills, and then you can close the gaps before an emergency occurs.”
Karl Kamps, VP of Aircare International, noted, “For example, the oxygen port might be behind the divan. It’s important to pull out the medical equipment routinely and become familiar with it.”
You may need to play a role in an inflight medical emergency.
Kamps says flight crews should identify a lead passenger on each flight and provide that passenger with basic instructions on the location and use of onboard medical equipment.
Beyond saying there are 4,500 private aircraft out there that have some level of services from Medaire, Potter says the company’s client list of clients is confidential.
According to Amstat, the current active fleet is 23,539 jets worldwide and 15,862 in North America.
Potter says the bigger the jet, the more likely it will be subscribed to a portion of MedAire’s services.
Currently, to find out who has the service and equipment they have on board and which aircraft types, one would need to contact operators individually to ask.
While a number of the large operators I spoke with have higher than required packages, for example, AEDs, that isn’t necessarily an iron-clad assurance.
In some cases, it’s only on larger aircraft.
But, then, there’s still the question about on-fleet versus off-fleet.
Even for those operator programs with AEDs on the entire fleet, EMKs, and real-time ground-to-air emergency assistance, they sometimes go off-fleet when they don’t have the capacity to fly customers or the aircraft in their fleet scheduled to fly you has a mechanical.
In other words, as best I could find, even if you wanted to choose a provider based on how they outfit their airplanes and the ground support they engage, you could find up you are flying with another operator with a lower level of support.
One large operator said they plan to discuss making EMKs, AEDs, and ground-to-air support part of their sourcing standards.
The challenge is it won’t be easy.
Brokers for both on-demand charters and jet cards, as well as operators going off-fleet, use online directories like Avinode and FlyEasy to find available private aircraft.
They can search for features such as WiFi or fully enclosed lavatories, something not all light jets, VLJs, or turboprops have.
There is no search function to find what type of medical equipment is aboard and what services like Medaire are subscribed to.
“Avinode provides users the ability to search for Ambulance aircraft. However, we currently do not have the option for more in-depth searches regarding medical equipment, such as first aid kits. If specific equipment is required on a flight, it is always possible to add this as a request when submitting a quote,” according to an Avinode spokesperson.
Greg Johnson, CEO of FlyEasy parent Tuvoli, says the company is currently looking at providing free-form search.
That would be based on information operators upload to the profiles of each aircraft they have on the charter market.
Johnson says the reason for this seeming white space is simply a lack of demand.
“If brokers were requesting it as a feature, we would have it,” he says.
That probably reflects that since the Ed Gilligan tragedy until the fictional Logan Roy, there haven’t been any other profile deaths from heart attacks and such aboard private jets.
Still, if you want to know about how many flight hours your pilot and co-pilot have, how many they have in your aircraft type, and if their certifications are up-to-date, Argus and Wyvern allow you to run pre-flight audit reports, something many brokers use.
They don’t cover what type of training pilots have, such as CPR, and again, there isn’t one place where this information can be readily found – what equipment is on the airplane and if there is a subscription for ground-to-air assistance.
For Private Jet Card Comparisons, I’ve been updating our comparison data on the subject. Compared to data about whether or not there’s WiFi, pricing policies, and policies on pets, It has been slow going.
This is a very unsatisfying story to write; as for charter operators and fractional flights (if you end up off-fleet), there doesn’t seem to be any foolproof ways to ensure your flight will have an AED, real-time assistance from medical professionals on the ground, an EMK, or for that matter, even a First Aid Kit.
That brings us to the most important advice you can take away from this report.
MedAire’s Alves says Part 121, 135, 91K, or 91, if you don’t feel well, don’t fly.
He says, “40,000 feet is not the place you want to have a medical event.”
In other words, don’t be like Logan Roy.
The Succession protagonist, who had previously suffered a stroke while aboard one of his helicopters, apparently felt that he was the only one who could get the job done, and so he took off on his fateful and final flight.
Alves says it’s important to listen to your body.
One broker says don’t confuse private jets for air ambulances.
“If you have medical conditions, including underlying conditions, there are air ambulances,” he says, adding, “They can fly with nurses and doctors and other medical equipment.”
So, what’s the bottom line?
As part of the comparisons database, I am trying to beef up the data on in-flight medical support, but I’m not sure of the value.
While major operators may have AEDs and elevated medical kits and subscribe to services such as MedAire, the nature of the industry means you could be flying with another operator.
There are other players besides MedAire, so it’s hard to say what portion of the worldwide fleet does have more than a First Aid kit since there’s no single source to find out what airplanes have what assets.
If you want a silver lining, none of the operators or flight providers I spoke with say they have had serious medical emergencies, even if they are prepared.
In other words, it seems like most of you have the good sense not to be like Logan Roy.