30,000 Feet and No Heart Monitor

May 27, 2025 - By Rebecca Handler

Fatima Rodriguez, MD, wasn’t planning to practice cardiology at 30,000 feet.

She was on her way to a cardiology conference in Atlanta when a passenger — a 60-year-old woman with multiple chronic health issues — started vomiting and sweating. “The differential diagnosis was broad,” Rodriguez recalled, meaning the cause could have been anything from food poisoning to a heart attack. But the tools available on the plane were limited.

“The blood pressure cuff didn’t inflate, and the cabin noise drowned out the stethoscope,” she said. Desperate to get basic information, she turned to her Apple Watch, using it to check the woman’s heart rhythm. That small step may have helped rule out a cardiac emergency. But the experience revealed a much bigger issue.

“Right after I landed, I joined a faculty workshop at the Stanford Center for Digital Health (CDH),” said Rodriguez, who serves as associate director at CDH and vice chair of clinical research in the Department of Medicine. “And I realized this was one practical gap that, if fixed, could really help patients.”

Dan Seung Kim, MD, PhD, had a similar realization in the air. On a different flight, he was called to assist a passenger experiencing palpitations and shortness of breath. “I was shocked at the equipment that was available,” Kim recalled. “As someone who routinely practices in a well-staffed clinical setting, it was difficult not to be able to perform the kind of evaluation we take for granted in the hospital. I ended up using my own Apple Watch to try to capture an ECG and rule out a heart attack.”

These experiences prompted Kim and Rodriguez — along with CDH colleagues, Eleni Linos, MD, DrPH, and Ewan Webster — to co-author a recent PLOS Digital Health Opinion calling for a long-overdue update to the FAA’s in-flight emergency medical kits, and arguing that wearable health technology should be part of the solution.

An In-Flight First Aid Kit from 2006

Right now, FAA regulations require commercial airlines in the U.S. to carry basic emergency medical kits, including CPR masks, IV supplies, a stethoscope, and a blood pressure cuff, and rely on bystander assistance. But these kits haven’t been updated in nearly 20 years.

“The kit is definitely helpful,” said Rodriguez. “But with the advances in wearables that can detect irregular heart rhythms, monitor glucose, and track blood pressure, there’s so much more we could be doing.”

Kim agrees. “Current emergency kits don’t take advantage of recent technology,” he said. “That means during an in-flight emergency, much of the diagnostic information a healthcare provider would typically rely on just isn’t available.”

In other words, doctors trying to help a passenger mid-air are often left guessing.

When Every Minute Counts

What’s at stake is more than convenience, it’s the ability to make the right call under pressure. “Knowing if you need to land a flight to save a patient’s life is critically important,” Kim said. “But unnecessarily diverting a plane is also costly and disruptive.”

Kim pointed to several ways wearable tech could help: for example, smartwatches and smartphone devices like KardiaMobile can record electrocardiograms (ECGs), which show the heart’s electrical activity. “Apple Watches have even been used to perform a 9-lead ECG, which can help identify certain types of heart attacks while in the air.” This could help to determine whether an emergency landing is needed.

Other scenarios are just as compelling. Say a passenger with diabetes becomes disoriented or passes out. If they’re wearing a continuous glucose monitor (CGM), a doctor can quickly check if their blood sugar is dangerously low and act before the situation worsens. “These technologies already exist,” Rodriguez said. “We just need to bring them onboard.”

You Don’t Need a Parachute Trial

Some have asked for more data before adding new devices to in-flight medical kits. Linos has questioned this idea.

“If we already have strong evidence that certain devices can detect urgent medical conditions and support accurate diagnoses on the ground, do we really need to repeat those studies in the air?”

“It reminds me of the famous ‘parachute study,’” she said, referencing a satirical article in The British Medical Journal that poked fun at the idea of requiring randomized controlled trials for things with obvious benefits — like wearing a parachute when jumping out of an airplane. “Of course, it’s important to ensure these devices are accurate and proven effective for the medical decisions doctors must make in emergencies,” Linos added.

Not Just for the Skies

While the article focuses on aviation, the authors see broader implications for wearable-driven triage. “We are at a crucial point in the evolution of medicine, where both wearable devices and large language models are now accurate, and could soon be able to provide excellent medical care, even in situations where a specialist doctor can not be present. The promise of these technologies is that they can help people when they’re not right next to a hospital or clinic,” Linos said. “That might be in the air, but it could also be in someone’s home, or in rural areas where specialist care is hard to access. The promise of remote monitoring, LLMs, telemedicine, and wearable devices has not yet been fully realised, but we are getting closer.”

What a Smart Medical Kit Should Include

So what should a modern in-flight medical kit include?

“In addition to what we have now,” Kim said, “it would be great to include a glucometer for checking blood sugar, a pulse oximeter to measure oxygen levels, and a device that can record an ECG and detect ST-elevation, which is a marker of a serious heart attack.”

None of these are futuristic inventions. They’re FDA-approved devices already in the hands of consumers and physicians alike.

For Rodriguez, it’s not a question of possibility, but of urgency. “When emergencies happen in the air, we need more than good intentions,” she said. “We need tools that work.”