Competence and Readiness of Physicians in Saudi Arabia in Managing In-Flight Medical Emergencies: A Systematic Review

As air travel in Saudi Arabia continues to grow rapidly, ensuring that physicians are competent and ready to manage in-flight medical emergencies (IMEs) is important.Evidence regarding physicians' competence and preparedness remains limited.This review aimed to assess physicians' competence, including knowledge, awareness, attitudes, confidence, and willingness, and readiness, including awareness of aviation physiology and onboard medical resources, and to identify key gaps and predictors of performance.A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies published up to May 15, 2026.Cross-sectional studies involving licensed physicians in Saudi Arabia were included.Outcome measures included knowledge, awareness, attitudes, confidence, willingness, preparedness, and practices regarding IMEs.Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool.This systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and followed a predefined protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261328551), to ensure methodological rigor and transparency.Six cross-sectional studies from different regions of Saudi Arabia were included.Adequate knowledge of aviation physiology, onboard equipment, and emergency protocols ranged from approximately half to three-quarters of participants, and considerable variability was observed across studies.Most physicians expressed positive attitudes toward volunteering during IMEs, yet many lacked confidence due to insufficient targeted aviation medicine training, medicolegal liability concerns, and unfamiliarity with airline procedures.Physicians who had previously encountered an IME were more likely to have completed life-support training, to travel frequently, and to demonstrate higher competence and readiness to assist.Systemic barriers, including ambiguous legal frameworks and lack of formal aviation medicine training, further hindered effective emergency response.Despite a high willingness to assist during IMEs, doctors in Saudi Arabia have significant knowledge, confidence, and preparedness gaps.Establishing structured simulation-based training, enhancing legal structures, and furthering professional collaboration may help bridge these gaps.It is also recommended to develop a nationally unified framework and incorporate emergency training in medical education.