Emergencies arising during commercial airline flights may have serious consequences. We report the experience of the Paris Emergency Medical Service (SAMU) in providing in-flight assistance to Air France between 1989 and 1999. During this period medical advice was sought 380 times during the carriage of about 350 million passengers. Analysis of the patient files suggests that serious emergencies were rare and that cardiopulmonary resuscitation was required only exceptionally. However the relative frequency of cardiac and neurological emergencies in our analysis supports the necessity of carrying adequate medical equipment and of having direct access to expert medical advice. The results suggest the requirement for a rigorous prospective epidemiological study of in-flight emergencies to evaluate the effectiveness of current practice and possible modifications of equipment and protocols for patient management.