Airline passenger misconduct: Management implications for physicians

Objective: The history and etiology of airline passenger misconduct are discussed and relevant medico-legal and management implications reviewed. Method The medical literature was reviewed and supplemented with internet searches for relevant information. Organizations including the Federal Aviation Administration, International Air Transport Association, Transportation Safety Board of Canada, and the Canathan Transportation Agency were contacted for unpublished information. Three cases of in-flight psychiatric emergencies in which two of the authors were involved are presented along with a review of relevant literature pertaining to the etiology and medical management of passenger misconduct. Recommendations for the in-flight management of disruptive passengers are discussed. Results: Incidents of in-flight passenger misconduct represent a serious threat to passenger safety. The three cases presented highlight the difficulties involved in managing incidents of passenger misconduct in the context of limited resources and treatment options aboard aircraft. Ambiguity remains in regard to the responding physician's medico-legal obligations; (and liabilities) during the management of an unruly passenger. However, liability risks appear minimal at this time. Conclusions: Awareness of the causes of passenger misconduct is required to adequately prevent, identify, and treat in-flight cases of passenger misconduct. Although most physicians will not be obligated to respond, liability issues do not appear to be a major factor preventing the offer of medical assistance.