Most of us take for granted that air travel is safe, so our preplanning typically centers on what we’ll do after we arrive at our destination. But medical emergencies can and do happen at 30,000 feet—on roughly one in every 604 flights, in fact. The most common problems—fainting or feeling faint…gastrointestinal, respiratory or cardiac symptoms…seizures, nausea or vomiting—often can be handled by the cabin crew in conjunction with a willing health professional if one is available. But life-threatening strokes and heart attacks do occur, although less frequently.

No one wants to start any trip with a medical problem, and there are steps that can help reduce your risk, says patient advocate David Sherer, MD. Especially as we get older and develop chronic medical conditions—or are simply more easily fatigued by the hassles of getting through the airport—additional preparation may be needed. The longer the flight, the more you’ll want to prepare. Medical emergencies happen less often on flights under two-and-a-half hours and more often on flights of four-and-a-half hours or more and when you fly internationally or coast to coast.

Inflight Smarts… No Matter Your Age

Pace yourself. With the hoops you have to jump through at various checkpoints, just getting to the gate can be exhausting. Allow yourself enough time before boarding to avoid raising your blood pressure.

Take airsickness medication in advance. Keep in mind, some of these medications can cause drowsiness. Take it 20 minutes before take-off.

Move every half-hour. When you sit for long stretches, you increase your risk for deep vein thrombosis (DVT), blood clots in the leg or thigh that can become even more dangerous if a clot travels to a lung (pulmonary embolism). Self-defense: Walk the length of the plane or at least flex your calf muscles regularly by squeezing them against the seat.

Have a hydration plan. The humidity of the air in a plane is 15% to 20% compared to the 60% to 70% indoor air at ground level. That explains why air travel is so drying to your skin. It also makes it hard to maintain the right levels of fluid in your body. Self-defense: Continually hydrate with water. Skip the dehydrating caffeinated coffee and alcoholic drinks. Yes, drinking a lot of water may increase the number of trips to the bathroom, but this also gives you more opportunities to stretch those legs. Reminder: Purchase your own bottled water after you have cleared security.

Watch what you eat. There’s something about going on vacation that allows us to forget about our healthy lifestyle rules, especially when it comes to food. Airline meals often are high in salt and saturated fat yet tempting when there’s no alternative. When available, order a special meal in advance, perhaps vegetarian or low-salt, to reduce the risk for indigestion. Bring snacks that are compatible with your dietary needs.

Dress for warmth and comfort. The cabin air often is cool, so stay temperate by layering clothes. Also bring a neck roll and an eye mask.

Specific Health Concerns

Take the following steps before your departure day…

Get cleared to fly by your doctor. This is important for people with conditions such as high blood pressure, heart or lung disease, or diabetes. It should be done a few weeks before your planned trip or even before you book it.

If you have a heart condition: You may need an exercise stress test or echocardiogram before you get the go-ahead from your health-care provider.

If you have high blood pressure: You may be warned not to take any decongestant beforehand and encouraged to stretch during the flight, skip salty food and take all medications on schedule.

If you have risk factors for DVT, such as heart, lung or inflammatory bowel disease: Ask your doctor whether you should take low-dose aspirin in the days before you depart to reduce the risk for clotting, and wear compression socks in flight to improve circulation.

If you have a serious lung disease such as COPD: Airplane cabins have decreased air pressure and lower ­levels of oxygen than most of us are used to. Your doctor may want to test your lung function before you fly. You may be told that you’ll need supplemental oxygen during the flight, even if you don’t use it at home. Regular oxygen tanks are not allowed onboard the plane. Instead, you’ll need an FAA-approved battery-powered ­portable oxygen concentrator (POC), more than enough batteries to keep it running (you want battery life equal to one-and-a-half times the length of the flight), and the cords and adaptors needed to recharge the POC on the ground. Ask your doctor for a note on his/her letterhead that details your condition, verifies that you’ve been cleared for air travel and that you need inflight oxygen. It also should list your required oxygen flow rate in liters per minute and the amount of time you need to use the POC.

Ask your doctor about emergency medications to take with you. Depending on your health and where you’ll be traveling, he may suggest that you bring along short courses of antibiotics or even a steroid. Also get printed copies of your usual prescriptions to carry with you in case you need an emergency refill. Your doctor may be able to recommend a physician at your destination, should you need medical attention.

Pack your medications with care. From insulin to an Epi-Pen, all your medications must go in your carry-on bag. This is not just so you’re guaranteed to have them at your destination but so you can continue taking them as needed during your flight. Carry a MedicAlert ID or ID card and the names and contact numbers of your doctors in case you need emergency treatment. If you have a stent, pacemaker or implantable defibrillator, include the manufacturer’s name and the device’s model number with your other vital information.

Get assistance from your airline. Procedures vary from one airline to another, whether it’s about carrying a POC or ordering a special meal. Check for information under “special assistance” on your airline’s website, or call as far in advance as you can. Many requests can be made when you make your airline reservation.

Don’t be embarrassed to ask for helpful accommodations, such as a wheelchair or other means of assistance to and from the gate and on and off the plane (when you return from an international flight and are in a wheelchair, you’ll be brought to the head of the immigration line, reducing delays).

Have a food allergy? Let your airline know, or order a special meal in advance.

Invest in “trusted traveler” programs. These allow you to skip long lines at the airport, making travel easier mentally and physically. Examples…

TSA PreCheck, offered by The Department of Homeland Security (DHS), provides expedited security screening at US airports.

Global Entry provides expedited US customs screening when returning from abroad (it includes TSA PreCheck as part of membership).

CLEAR, a private program, gets members through the travel-­document-check process and can be paired with TSA PreCheck or Global Entry. There are fees involved and an application procedure that may include an in-­person appointment to verify your identity.

Consider trip-cancellation insurance. This isn’t just in case you get sick while you are away from home but also if you start feeling sick right before you’re supposed to fly—your symptoms could signal the start of a mild or a serious illness, but you don’t want to find that out while you’re in the air. Amex Assurance Company and others offer trip insurance. Google “Trip and Travel Insurance” to get a list of the many companies that offer this, or go to to compare prices.

On Departure Day

Take your meds as directed. Sounds obvious, but in all the hustle and bustle of leaving for a trip, it’s easy to forget.

Wear an N95 mask to protect not only against COVID but also colds and flu.

When you land, acclimate as soon as you can to the time change. Example: If you’re going to Europe, which can be five or six hours ahead of the US, take a short nap on the day you land if needed, but wait until the night of your arrival day to go to sleep. This will help you wake up on local time. During any trip, stick to your usual sleep schedule to avoid flying home fatigued.

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