INTRODUCTION: U.S. airlines often request a healthcare professional to volunteer to assist an ill passenger. Litigation from a Good Samaritans care of an in-flight medical emergency (IME) is considered improbable. The 1998 Aviation Medical Assistance Act (AMAA) encourages health care professionals to volunteer with indemnity for standard and good medical care. It does not offer legal or financial assistance. Our review explored the legal support malpractice companies and U.S. airlines provide if litigation is initiated for IME care. Malpractice insurance policies can differ on IME coverage. We found most private practice physicians policies include IME. Medical institutions may have policies restricting their physicians coverage to the institutions location. Those without malpractice coverage will need to retain and pay for a legal defense to demonstrate no gross negligence and no willful misconduct. The physicians, airline crews, and on-ground IME documentation support should be retained by the Good Samaritan especially for a pediatric or adolescent ill passenger. U.S. airlines consider a Good Samaritan medical volunteer as a passenger and do not extend legal assistance. This contrasts with some foreign airlines that do provide liability protection. Knowledge of the malpractice policy IME coverage is essential prior to traveling by air. After completing care for an ill passenger, physicians should generate their medical documentation and request the IME documentation generated by the airline and on-ground medical expert. We also believe U.S. airlines should assume responsibility to provide legal assistance to a Good Samaritan physician in the event of IME litigation.de Caprariis PJ, Di Maio A. Medical legal implications when providing emergency care on a commercial flight. Aerosp Med Hum Perform. 2021; 92(7):588592.