Artificial Intelligence and telemedicine integration in managing in-flight medical emergencies: Current evidence, clinical applications and future directions

In-flight medical emergencies (IFMEs) represent a significant challenge in commercial aviation due to limited onboard medical resources, delayed access to definitive healthcare, and the operational consequences of emergency flight diversions. With global air travel exceeding billions of passenger journeys annually, the frequency of onboard medical events continues to increase, particularly among older adults and travelers with chronic diseases. Telemedicine has emerged as an effective strategy for connecting cabin crews with ground-based physicians, facilitating real-time clinical decision-making during medical incidents. More recently, advances in artificial intelligence (AI) have introduced opportunities to enhance emergency recognition, triage, monitoring, and treatment recommendations. AI-powered systems can analyze physiological data, identify clinical deterioration, support diagnostic decision-making, and optimize resource allocation during emergencies. This review examines the epidemiology of in-flight medical emergencies, current telemedicine infrastructure in aviation medicine, emerging AI applications, clinical and operational benefits, ethical and legal considerations, and future innovations. Evidence suggests that AI-assisted telemedicine may improve passenger safety, reduce unnecessary flight diversions, enhance diagnostic accuracy, and strengthen emergency response capabilities. However, challenges related to cybersecurity, data privacy, regulatory oversight, and implementation costs remain significant barriers. Continued collaboration among airlines, healthcare institutions, technology developers, and regulatory authorities will be essential to ensure safe and effective adoption of AI-enabled aviation healthcare systems.