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Most U.S. airlines carry little more than the medical equipment currently required by FAA: one to four first-aid kits, depending on the number of passengers, and one medical kit per aircraft.

Each first-aid kit must be accessible to the flight attendants and include:

• bandages
• compresses for applying pressure, moisture, heat, or cold
• antiseptic swabs
• arm and leg splints
• tape
• scissors.

An airplane's medical kit must be accessible to the flight crew, but is for use only by medical professionals. It must include:

• blood pressure cuff
• stethoscope
• plastic airways to deliver oxygen to help with breathing
• nitroglycerin tablets for chest pain
• dextrose solution for hypoglycemia
• epinephrine for asthma or allergic reactions
• injectable diphenhydramine HCl for serious allergic reactions
• hypodermic needles
• protective latex gloves.

The goal during serious in-flight medical emergencies is to stabilize the patient while further emergency care is sought. The pilot may decide to make an emergency landing, called "diverting" the plane, depending on factors such as the passenger's apparent medical condition, weather conditions, turbulence, air traffic, and the distance from adequate ground medical facilities.

To help with medical decisions, most airlines have 24-hour access to a physician on the ground. In the future, airlines may decide to use a computerized system developed by a Michigan surgeon for air-to-ground transmission of passengers' vital signs.

But "there is nothing the people on the ground could tell the doctor on board if the right equipment doesn't exist," says Talit, who wants Congress to require enhanced medical kits that would include defibrillators.

One airline voluntarily carrying defibrillators on its overseas flights is not enough, according to Talit. The automated defibrillator, she says, "should be as commonplace as fire extinguishers, and as accessible in case of emergency. Not every public building catches fire — few do — but do we not have a fire extinguisher in these public places?"

Joan Sullivan Garrett, who is president of MedAire Inc., a firm that provides emergency medical guidance to commercial airlines, is also in favor of updating the federal regulations. "Emergency physicians and flight crews," she told Congress, "are using first-aid kits circa 1924 to deal with 1997 realities."

In addition to the automated defibrillator, her recommendations include an automated blood pressure cuff and stethoscope so laypersons can check a person's pulse and an albuterol metered-dose inhaler in case someone suffers an asthmatic attack.

At press time, Congress was still exploring whether to require additional on-board medical equipment, including defibrillators. FAA is working with the airline industry to evaluate the costs and health benefits of additional medical tools on board. But, Hordinsky says, until FAA gets more information, the agency cannot impose additional rules.

So, for now, it is up to the airlines if they want to upgrade their medical kits beyond legal requirements. Regardless of what medical equipment is on board, people with medical conditions that put them at risk should consult their doctors before flying. They should also bring their own medications on board. Even the best-equipped airlines have limited medical capabilities. As MedAire's Garrett testified at the congressional hearing, "It's important to remember that an aircraft cannot be a flying hospital."

Sick at Sea

More than 4 million passengers took a cruise in 1996, according to the Cruise Line Industry Association. The organization estimates that by the year 2000, cruises will attract as many as 7 million passengers each year.

Based on the sheer volume of travelers, some are bound to get sick. "In addition to seasickness and sunburn, which are the big leaders, we see all the things you would normally see in an emergency department on land," says Theodore Harrison, M.D., who heads the cruise ship and maritime medicine section of the American College of Emergency Physicians.

While Coast Guard regulations cover the safe navigation and design of a cruise ship, the government does not regulate the quality of on-board medical treatment. In 1996, the American College of Emergency Physicians and a major industry group, the International Council of Cruise Lines, developed the first meaningful standards for cruise ship medical facilities.

Under the ICCL guidelines, a ship should have:

• licensed medical staff qualified to administer cardiac care and life support, who are fluent in the language spoken by most of the passengers and crew
• adequate infirmary space based on the ship's size
• wheelchairs, stretchers, cardiac monitor, portable defibrillator, and other important equipment and emergency medications.

Harrison says that most cruise ships already meet the voluntary guidelines, and he expects that virtually all the ships will meet them in time. "Before the guidelines, everybody was pretty much on their own in determining what medical capabilities were needed. The guidelines leveled the playing field for everybody."

The guidelines may help cruise medical staff address the day-to-day medical needs of passengers, but for complicated cases, many cruise lines are associated with a hospital that can provide emergency consultation 24 hours a day. "We help the ship's medical staff make a decision when they call us about an unusual condition," says Abdul Memon, M.D., the associate director of the emergency department of Florida's Jackson Memorial Hospital, which provides medical emergency advice to Royal Caribbean Cruise Lines.

"The medical care will be pretty good on most cruise ships, under the circumstances," Harrison says. But he cautions travelers to not expect the level of medical care they could get in a New York City hospital. "A cruise ship is just a one or two thousand person little town out there. And people should expect the same medical care as they would expect in a little town in the middle of nowhere."

To help ensure a safe cruise, passengers may want to take some precautions. If you have medical concerns and are considering going on a cruise, Memon recommends:

• discussing your travel plans with a doctor
• carrying adequate supplies of medications you may need
• calling the cruise line's medical department to make sure the ship can accommodate your special medical needs.

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.