Medical Emergencies on a Plane

by Food and Drug Administration (FDA)

"Is there a doctor on board?" Not one, but two doctors responded to the plea when, on April 23, 1995, Benjamin Talit suffered sudden cardiac arrest in flight. Despite the medical expertise of a heart-lung surgeon and the other doctor who came forward, the 43-year-old Talit died en route to Los Angeles aboard Northwest Airlines flight 339.

Ben — "a thoughtful, loving husband of 20 years, exemplary father, valued professional, and truly good citizen" — died needlessly before reaching medical help on the ground, his wife Lynn told Congress at a May 1997 hearing about airplane medical kits, because the plane did not carry a device called a defibrillator to restart his heart. It is a "bitter irony," she said, that Ben, himself a volunteer firefighter and emergency medical technician, died "for the lack of exactly the preparedness he supported and practiced every day of his life."

Based on Federal Aviation Administration surveys, an average of 15 medical emergencies may occur daily on U.S. airlines. Medical emergencies have more than doubled in the last decade, according to FAA, which says the increase may be due at least in part to improved airline accommodations for medically-at-risk disabled and elderly passengers.

"The number of emergencies is small in the statistical sense," says Jerry Hordinsky, M.D., head of FAA's aeromedical research division. "But when an event does occur, with a person potentially dying in flight because of a lack of medical equipment, it is very dramatic and attracts a great deal of public attention."

Lynn Talit disagrees. Because airlines are not required to report medical emergencies, people underestimate their scope, she told Congress, pointing out that the number of people who die in flight each year "far exceeds" airline crash deaths.

Cardiac Care Aloft

Along with neurological problems such as strokes and seizures, heart-related problems rank among the most common types of emergencies. In sudden cardiac arrest, the heart stops pumping blood, often without warning in people like Ben Talit with no known heart problems.

According to the American Heart Association, more than 250,000 Americans die each year from sudden cardiac arrest. "And not all of them happen to suffer their cardiac emergency in a hospital waiting room," Lynn Talit says.

Fewer than 7 percent of those suffering cardiac arrest outside a hospital survive, a statistic which the association attributes to the unavailability of a defibrillator, a device that restarts the heart by delivering an electric shock.

As David McKenas, M.D., American Airlines corporate medical director testified before Congress, a person's chance of survival drops 7 to 10 percent with each passing minute. Even if someone's heart stopped right after the plane left its gate, McKenas said, it would be too late to save the person by the time the plane returned to the gate. An on-board defibrillator would offer the best chance of survival.

In September 1996, the Food and Drug Administration cleared an "automatic external defibrillator" (commonly called "AED") for in-flight use and has since cleared another. While defibrillators have been used in ambulances and other nonhospital settings since the 1960s, the unique environment of a plane in flight prompted FDA to require additional testing.

According to Carole Carey, a scientific reviewer in FDA's division of cardiovascular and respiratory devices, the maker of a defibrillator for airplane use must show FDA that:

• the defibrillator can physically withstand in-flight environmental demands, such as vibration and variations in temperature and altitude
• the device will not electronically interfere with the airplane's instruments
• the airplane's instruments will not electronically interfere with the functioning of the device.

Based on this evidence, a defibrillator's labeling was permitted to state that the device was environmentally tested for use in planes. Only after FAA added its approval could the device actually be used in flight.

In July 1997, American Airlines became the first U.S. airline to carry automatic external defibrillators and the third internationally, after Britain's Virgin Atlantic and Australia's Qantas airlines. American put defibrillators on its planes that fly over-water routes to Europe, Japan, the Caribbean, Central and South America, and some domestic destinations.

Manufactured by Seattle-based Heartstream Inc. and sold under the brand name ForeRunner, the new model purchased by American weighs about 4 pounds, half the weight of most defibrillators. And the ForeRunner has a longer-lasting battery and requires much less maintenance than older models, according to Carey.

It's also easier to use, she says, making it possible for trained flight attendants to deal with some cardiac emergencies. "Flight attendants obviously aren't physicians, nurses or paramedics. But to use this prescription device, they must receive training in emergency care and use of the defibrillator."

Flight attendants can use the ForeRunner with minimal training because, unlike most defibrillators, it comes with simple pictures and a digital voice to guide a rescuer through the steps. The rescuer simply puts two pads on the victim's chest and rib area. The device measures the heart's rhythm to check for ventricular fibrillation, which requires a shock to the heart, then directs the user to push a button if a shock is needed.

American has trained 2,300 lead flight attendants in use of the defibrillator and plans to train its other flight attendants, according to Nestor Kowalsky, M.D., American Airlines' Chicago area medical director. At least one trained person will be on each flight that carries the device, he says.

American has not decided whether to add the device to the medical kit on all its domestic aircraft. "Right now, the airline is following this first phase of the program to see how successful it is," Kowalsky says. "Then a decision will be made about expanding it to other airplanes."

Several other U.S. airlines have said they are considering carrying defibrillators on their aircraft.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.