“It’s fairly expensive to divert an aircraft, and so a captain has to take into account a whole host of issues," said Jose Nable, an assistant professor of emergency medicine at Georgetown University Hospital and co-author of a 2017 paper on in-flight emergencies. Perry Flint, a spokesman for the International Air Transport Association airline trade group, said his organization estimates that a diversion can cost anywhere from $10,000 to $200,000.

Erin Benson Scharra, a United Airlines spokeswoman said the company is investigating Christman’s claims, but declined to speak further about medical diversions or consultants it employs.

Companies like MedAire, housed in the the emergency unit of the Banner-University Medical Center Phoenix, play a key role in diversion decisions. STAT-MD Inc., which offers a similar service and uses doctors from the University of Pittsburgh, works with around 20 national and international air carriers. It says it reduces landings that would otherwise be recommended by nervous and out-of-their-element doctors in the sky.

“They’re going to revert to divert,” said T.J. Doyle, the medical director for STAT-MD. “The medical volunteer should be a data-gatherer and a procedure-doer. They should not be a decision-maker.”

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The emergencies encountered by medical professionals on flights vary in severity. Internal medicine doctor Gina Jabbour of New York revived an elderly woman who fainted after using the bathroom. The flight continued on schedule and Jabbour was rewarded by a flight attendant with “secret cookies.”

Scott Schoifet, an orthopedic surgeon, was dozing on a flight from Japan to New York in 2006 when he was awakened to help a fellow passenger with chest pain. Flight attendants asked Schoifet whether it was safe to continue flying.

“It was stressful first because they’re looking at me like, ‘What do you want to do?”’ Schoifet said. “I can’t make this decision. There’s 350 people on the plane.”

He checked in with the woman for the rest of the flight until she disembarked at a stop in Detroit, and then the plane continued on.

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