How to avoid passing out inflight at 35,000 feet

Fainting on planes is the most common in-flight medical emergency

fainting on flightsIf you hear a flight attendant calling for a doctor in mid-flight, chances are a passenger has fainted. The medical term is syncope. Fainting on planes is the most common in-flight medical emergency.

I know first-hand. I’ve fainted while airborne three times, most recently aboard a DC-Munich flight in December last year. Now I’m “woke” to the possibility of passing out inflight, and I’m taking it seriously.

As I sought to understand why these episodes occur, I realized that all my fainting scenarios were identical: a long-haul flight, uncomfortably warm cabin temperature, mid-flight nausea, lurching toward the galley for help, fainting en route, vomiting, confusion.

My queasiness on the Airbus 340 flight to Munich started early on

Prior to take-off, the cabin got hot as the plane was de-iced with the ventilation turned off, per regulations. Jet fuel fumes circulated in the cabin. A few hours later, feeling very ill, I struggled up the aisle, vomited and passed out as I neared the galley.

Lufthansa cabin staff clearly knew the drill. They immediately got me horizontal, elevated my feet, and cleaned me up. Soon I had two doctors at my side, an ER specialist administering oxygen, and a GP checking my vitals. Monica, the angelic GP, gave me a change of clothes from her own carry-on to replace my soaked T-shirt and tights.

“Why does this happen to me?” I asked woozily. “It’s a vasovagal episode,” said the ER doc. “You’ll be fine.” He explained a number of factors that contribute to fainting: insufficient oxygen (hypoxia) due to cabin pressure, immobility, a drop in blood pressure and possible dehydration.

With no empty seats available, I spent two hours lying on the floor by the rear exit door. The cold comfort of the galley floor was an improvement over my cramped economy seat row, where I’d been wedged in with my backpack and two large men in the adjoining seats. After I recovered, a flight attendant plied me with Coca-Cola and led me back to my seat. By the time I reached Munich, I was fine and caught a connecting flight to Poland.

Causes and frequency of in-flight fainting

Download Airplane Carry-on ChecklistBack home, I did some research and paid a visit to my doctor to figure out how to avoid fainting the next time I fly.  All my medical tests checked out normally so I turned to online searches, which reaped a heap of references and personal testimonies of passengers like myself.

One flight attendant, who was also an RN, confirmed that fainting is very common. “Basically, it occurs when you have been sitting for a long period and your blood concentrates in the lower extremities,” she wrote. “You start to feel dizzy, nauseous and so you try to head for the lav. Ninety-nine percent of fainting occurs right outside the lav. Once your body goes horizontal, blood flows equally throughout and you wake up. I’ve seen it more on long-haul flights …”

On-line publication Aviation Health notes that, “Passengers on long-haul flights seated at the rear of aircraft like the Airbus 340 and Boeing 767 seemed more likely to experience dizziness and fainting on planes. This temporary loss of consciousness through deficient blood supply to the brain can occur after a meal. It also occurs when a passenger rises after prolonged sitting. An additional factor is the oxygen deficiency of the cabin. A small drop in blood pressure may have a significant effect on cerebral function. Alcohol, too, raises the blood flow to the intestines and the heart rate.”

In-flight medical emergencies are increasing

I suspected that in-flight fainting could be a growing trend. Shrinking seat size and legroom, coupled with reduced in-flight mobility, might play a role. I searched for statistics. A study of 11,920 in-flight medical emergencies found that syncope or presyncope accounted for 37.4 percent of cases. These calls were reported by five domestic and international airlines from January 1, 2008, through October 31, 2010. The medical profession’s page on Lufthansa’s website reports that the IATA Medical Advisory Group has recorded an increase in recent years of on-board medical incidents. Lufthansa has also noted an expected increase, with a current estimate of approximately one instance per 24 intercontinental flights.

My hunch appeared to be right: in-flight emergencies, of which fainting on planes is the most frequent, are on the rise.

Are the airlines doing enough to inform and prevent fainting on long flights?

9 Tactics to Survive Denied Boarding DownloadIn the ’90s, airlines were concerned with deep venous thrombosis (blood clots). These could arise from immobility during long flights. Safety videos advised passengers to do seated exercises and walk periodically in the aisle to keep the circulation flowing. That advice, which also helps prevent fainting, has now disappeared. Today we’re told the contrary. Stay seated and don’t congregate in the aisles. On the Munich flight, we were even urged to “stay in your seat until the green light illuminates before you walk to the restroom.”

Is passenger comfort and well-being being overruled by staff convenience or security concerns? I sent an online message to Lufthansa Customer Services to find out why preventive health information is lacking in the pre-departure instructions. After a year, I still await their reply.

Effective prevention

Keeping the cabin cool is a known preventive strategy. ASTM International studied the link between cabin pressure, temperature, and fainting and found that warm temperature is a contributing factor. In order to curb the number of incidents, airlines decided to make their cabins chilly after take-off.

Flight attendants are good sources of solid first-hand advice. In the article Arrive in Better Shape, Woody Watkins, American Airlines purser, calls the ‘Coke fix” a tried and tested method to prevent fainting in flight. “As soon as passengers complain of being hot and giddy, I get a Coca-Cola down them as fast as possible.”

Here are some other tips to keep from fainting on planes:

  • Stay well hydrated before and during the flight. Avoid caffeinated drinks and alcohol.
  • Sit in an aisle seat whenever possible. Stand periodically, walk a few paces in the aisle and stretch your legs and feet.
  • Do seated exercises to keep the blood in your lower limbs circulating. Do heel-toe raises, foot rotations, and plenty of tense-and-release isometrics in the hips and legs.
  • Dress lightly in layers. Warm air temperatures on-board may lead to fainting. Adjust the ventilation if possible to stay cool, or alert cabin staff if it’s excessively warm.
  • At the first sign of feeling ill, hit the call button and get a Coke.

The bottom line: to lessen the odds of fainting on your next long-haul flight — stay cool, stay hydrated, and move!

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Editor’s note: This post originally published in the spring of 2020 has been updated where necessary. Unfortunately, airlines’ preflight instructions about fainting on planes remain unchanged. Infectious passenger rules don’t exist to prevent the spread of contagious diseases such as pneumonia, the flu, or even tuberculosis. After this current pandemic, Travelers United’s work with Congress, the DOT, and the airlines for effective infectious passenger rules continues.