What Airlines Do In The Event Of A Medical Emergency

Yesterday’s story of the death of a passenger on board an American Airlines flight continued to unfold throughout the day, and now CNN has posted an article that addresses some of the questions people were asking about in-flight emergencies in general. CNN spoke with several experts in the area where medicine overlaps with the airline industry to find out how airlines prepare for the inevitable really sick passenger.

MedAire, a private company that handles in-flight emergencies from the ground, explained how they help flight attendants.

Flight attendants with sick passengers call [MedAire’s] Good Samaritan Hospital in Phoenix, Arizona, a level-one trauma center where emergency room physicians and a service able to translate 140 languages are on call to answer questions from any of 2 million airline passengers flying at any given time, she said.

As of 1 p.m. (3 p.m. ET) Monday, MedAire had fielded 110 calls, a busy day for the company.

On average, the company gets 75 to 80 calls for an entire day, she said.

MedAire’s clients include Continental, Southwest, and British Airways; CNN says that “American has its own in-house medical team.”

If you were wondering what an airline is required to carry on board:

By law, U.S.-based commercial airlines must carry automatic external defibrillators, oxygen and medical kits. Some airlines choose to carry extra, non-mandated medications.

Here’s what American Airlines carries:

Each of the nine-pound, $250 kits includes aspirin, alcohol swabs, nitroglycerine tablets, antihistamines, IV tubing, a stethoscope, a blood-pressure gauge, a bronchodilator, syringes, gloves, saline solution, epinephrine, dextrose, a manual resuscitation bag, alcohol pads and shears.

For those who were wondering why the emergency oxygen masks weren’t used, Dr. Russell Rayman, executive director of the Aerospace Medical Association, tells CNN that it’s “not medical oxygen and would not suffice for a passenger in an in-flight medical emergency.” Flight attendants and pilots also have oxygen supplies in the event of cabin decompression, and this could be used in a medical emergency although “that’s not its purpose.”

So what about traveling when you’re feeling ill or have a fresh cast? The official cover-your-ass medical advice from the MedAire spokesperson is:

If a passenger already has breathing problems, airplane travel will only worsen the condition because cabins are typically pressurized at 8,000 feet, said Drake.

Her advice to anyone not feeling 100 percent: “Do not travel.”

Flying in a fresh cast can also prove dangerous. “Your arm could expand and it could cut off your circulation,” she said, noting that the risk is reduced with older casts, which have typically already expanded to accommodate any swelling.

Finally, the FAA doesn’t keep a master record of medical incidents across airlines. Private companies such as Medaire do—but, well, they’re private.

“There is no central repository where these things can be archived and then retrieved,” [Rayman] said.

“They don’t want to report it because it just doesn’t look good. It’s not good P.R., you could say.”

He said even an anonymous registry would serve a useful purpose.

But the FAA counters that such a project would be beyond the scope of the organization—at least that’s how we’re interpreting this:

“We’re concerned for safety on the flight,” FAA spokeswoman Alison Duquette said. “Once someone leaves the aviation system, there is no way for us to track the outcome.” (emphasis ours)

“Don’t feel great? Rethink flying, expert says” [CNN]

(Photo: rkimpeljr)

Comments

Edit Your Comment

  1. Bald_Ben says:

    I was on a Air Canada flight not too long ago when someone who had recently had heart surgery needed care. At first the flight attendants seemed a bit panicked, which kind of freaked me out, not knowing the situation at the time. A couple of minutes later and the flight attendants asked if there was a doctor or EMT on board. A couple people responded and one gentleman examined the person in question with a stethoscope Air Canada had on board. Interestingly, though, the flight attendants asked around for aspirin from passengers (turning down other pain relievers such as Tylenol). It must not have been too major of an emergency as we continued for another hour or so to our destination. Taxiing off the runway was rather swift though and we all had to remain seated as EMTs took the person off the plane.

  2. bostonmike says:

    Older casts don’t expand. The limb that’s in the cast shrinks because of lack of use, so the conclusion that an older cast is safer to fly with is correct — there’s more room in the cast. But that spokesperson is making things up.

  3. DeltaPurser says:

    I couldn’t believe my ears when I first heard of this story. There must be so much more to it… Assuming it was an Airbus 300 that flew the route (somewhat comparable to a Boeing 767), it should carry at least half a dozen oxygen bottles, in addition to other medical equipment. If two of the bottles were indeed empty, what happened to the other ones? I’d love to talk to the FA who refused to administer oxygen initially – bet s/he feels reeeeeeeeeeeeeeeeeealy bad right now!

  4. shan6 says:

    I can understand from a business prospective why they wouldn’t want to keep a log of medical emergencies. But I would love to have one in place, it would sort of force airlines to better prepare themselves and their FA’s for these type of emergencies.

  5. shan6 says:

    @Shan

    In place and open to the public.

  6. Asvetic says:

    @shan6: “…it would sort of force airlines to better prepare themselves and their FA’s for these type of emergencies.”

    Hell no, I don’t want some klutzy FA sticking me with a needle. Airlines should consider an in flight EMT perhaps. Either way, it’s going to cost the customer more. Plus, this might start an outlandish requirement where the passengers would have to have physicals and medical exams with documentation prior to flying.

  7. dozerdude says:

    I wonder why the airlines are supposed to be prepared for medical emergencies. You are paying for TRANSPORTATION.

    Sure, one expects a level of safety training from the crew. But if you are very ill, stay home.

    Would this standard of care be expected on a cross-country bus trip?

  8. nursetim says:

    @DeltaPurser:
    Every time a story about a surly FA comes up, someone always mentions that their main function is passenger safety, not serving passengers. This type of situation would fit into “passenger safety”, so I wonder how that little fact will get spun.

  9. Chols says:

    So were the tanks empty or not, or did they forget about reverse threads?

  10. Propaniac says:

    @dozerdude: Because passengers on a plane cannot simply call 911 and wait for an ambulance to help them with their emergency. They’re essentially cut off from the world.

    And I’m pretty sure you don’t really think that the only people who could have a medical emergency are those who are “seriously ill” and aware of it and decide to throw caution to the wind anyway. By that logic, we could get rid of ambulances altogether and just pass laws requiring that all seriously ill people live next door to hospitals.

  11. ColoradoShark says:

    @Bald_Ben: Aspirin makes blood “thinner” in that it does not clot as easily. Sometimes helpful for people having circulation problems. Tylenol is a pain reliever and has none of the blood thinning side affects they wanted.

  12. apotheosis says:

    There’s something deeply creepy about the idea of being trapped at 30,000 feet with an extremity swelling up inside a cast.

  13. @Asvetic: I’m frankly a little surprised they don’t already certify flight attendants as EMTs, or at least make that an option for flight attendants who could then get a slightly higher rate of pay. Basic EMT training isn’t a heckuva lot more onerous than the first aid training they already get, and it’s not THAT expensive to provide.

    @dozerdude: “Would this standard of care be expected on a cross-country bus trip?”

    Probably not, but it’s certainly expected ON A CRUISE SHIP, where you can’t get off.

    I would also tend to expect a higher standard of care (and more complete medical kit) on longer flights and larger planes.

    @Bald_Ben: “we all had to remain seated as EMTs took the person off the plane.”

    I was on a flight where an infant had a medical emergency where the absolute DINGBATS serving as flight attendants DIDN’T tell everyone to remain in their seats when we landed and then were SCREAMING at the 200 passengers on the transatlantic flight who’d all immediately popped up into the aisle on landing, eager to get off the damn plane, because the morons hadn’t thought ahead enough to say “We have an ill baby requiring immediate medical care, please remain seated upon landing so we can remove her from the plane as quickly as possible.”

    I wanted to slap everyone involved. (Frankly, if I was the parents, slappage probably would have been occurring!) And then of course it took FOREVER to get off the plane because the whole snafu slowed deplaning to a crawl.

  14. mattpr says:

    @Eyebrows McGee:

    Basic EMT training is a few months long course. You can get first aid training in an afternoon. There is a huge difference.

  15. sir_eccles says:

    “Each of the nine-pound, $250 kits includes aspirin, alcohol swabs, nitroglycerine tablets, antihistamines, IV tubing, a stethoscope, a blood-pressure gauge, a bronchodilator, syringes, gloves, saline solution, epinephrine, dextrose, a manual resuscitation bag, alcohol pads and shears.”

    OMGZ ready made terrorist hijack kit!

  16. @mattpr: Requirements vary by state from 30 to 350 hours of training for basic cert. Locally I’ve seen courses running as short as two weeks (typically local volunteer FDs who are desperate for EMTs and pay for all the training). A semester of more spaced-out classes and training is more typical locally, but highly-compressed courses are available (and on-the-job supervised training is allowed where I am).

    But fine, First Responder training then. :)

  17. tkozikow says:

    The standard EMT-B course MIGHT be useful, but what would really be needed is training at the EMT-I (Intermediate) level which would allow an FA to perform interventions such as starting an IV. As an alternative, you could probably develop a training program over 60-100 hours to teach a limited set of advanced skills, but then you need to keep up with retraining, etc.

    I really wonder how many of the 75-100 calls per day are serious medical emergencies which require the skills of a Level I ER. An asthma attack is an emergency, but you should have an inhaler with you and the airlines appear to have a bronchodialator in their emergency kit. Same with allergic reactions to food since you would expect someone to be carrying their EpiPen. Cardiac problems are the condition which would concern me most and an AED is only of value in specific situations. Beyond that, you need drugs and a more advanced monitor to evaluate and treat the patient/passenger.

  18. @mattpr: BTW, I did say not a heckuva lot more onerous than the first aid training THEY, they flight attendants, already get — which is typically far more substantial than a day-long Red Cross session. (More like a specialized First-Responder course that focuses on emergencies in the air.)

  19. drdom says:

    Making flight attendants could pose a slight logistics problem, although I’m sure it could be worked out.
    EMT’s are licensed by individual states, and their scope of practice differs from state to state. There is a National Registry of EMT’s, but by law an EMT basic can do some things in one state that they can’t do in another.
    In our state we have a 240 hour curriculum for EMT basic, plus additional hours and certification from a medical director for advanced skills, such as EPI administration, defib, airway insertion and nebulizer treatment. Other states do not allow an EMT Basic to administer breathing treatments, insert airways or administer any injectables.

  20. The Porkchop Express says:

    @drdom: Would FAs not be employed under federal regulations?
    I would think that since they do take some time training them for other emergencies, they could give them a bit more than “first aid” training.
    Or maybe they could require an EMT on each flight and one less FA. Just rain the EMT on some of the FA stuff.

  21. ohiomensch says:

    I was on a flight once that had to be turned around because someone had a heart attack. The pilot had to make a decision because we were almost directly in the middle between the nearest airport and our destination. So spend an hour backtracking, or an hour and 15 mins to our destination.

    The plane was turned around. The flight attendants were a bit panicked, and you could tell they were scared, but they kept it together. They made an announcement asking for medical help and the plane was virtually packed with medical professionals willing to help, 5 emt’s 2 nurses, and a doctor, and once the guy was being helped, things seemed to calm down. We were told that the plane was making an emergency landing, that we were all to stay in our seats, that all drink service was being suspended, all drinks that were out were being collected, and the guy sitting next to me was quite miffed that his vodka tonic was being ripped from his hands, even tho he got a coupon for a free one later.

    I don’t know what the chances of that happening again are, but I would think that in most flights, odds are there is at least one person with somekind of medical training.

    Back in the day, “stewardesses” were also registered nurses, but it was found that it wasnt really needed.

    I do however think that basic first aid and cpr should be required of flight personnel. But I have also been on airplanes where they didn’t have band-aids. I always carry a little mini first aid kit in my carry on just in case.

  22. doughnutman says:

    My dad had a heart attack on a continental flight to Argentina from Houston. On the flight a flight attendant recognized that something was wrong with him and asked if their was a doctor on board. Thankfully, there was a doctor on board who recognized that he was having a heart attack. The plane made an emergency landing in Panama and the flight attendant drove him to the hospital. My dad is alive because of the amazing work that the airline employees did. Hopefully airlines will take the necessary steps that saving people’s lives can happen to anyone in the sky.

  23. Hogan1 says:

    In all seriousness, do you really want to have to pay the extra cost the airlines would add to tickets if Flight Attendants were required to be trained as EMT’s? All the talk from the people who think the airlines are responsible for people dying on flights due to lack of equipment or medical personal is simply absurd. As a commenter said before, you are paying for transportation, not for the services of an EMT standing at your side. If you feel you must have this, go charter a plane with a medical crew and fly away to your hearts content.

  24. JustIcedCoffee says:

    One word LIABILITY
    FA are not trained extensively because they would be held to a higher standard of care, and that would allow for greater liability for the airline — The standard of care is what any layperson would be expected to do, training them for EMT or nursing would hold them to a higher standard, and cost airline more money as the inevitable mistakes start to happen.

  25. What? No, sphygmomanometers? ;-)

    In a perfect world, I think an in-flight EMT, or at least an attendant with some EMT training, would be prudent because you can’t just call 911 from 30,000 feet. On a bus or train, you can force the bus to pull over or get help at the next stop. But I know that’s NEVER going to happen.

    Or, the airline could release a disclosure about preexisting conditions, with a clause that says “we will do our best to help you, but we have limited medical supplies on board, so you are taking you chances”. That would waive their liability in case of a medical emergency.

  26. StevieD says:

    As a teen I had the opportunity to fly on an Air Force Med Evac jet several times as a stretcher patient. There is a limit of what can and can not be done on a plane, and given the tight quarters of a commercial jet there is even less room to perform medical proceedures and those proceedures would be performed by somebody that does not perform the proceedure on a daily/hourly basis like the average big city paramedic.

    In addition, most domestic passenger jets are within 30 minutes of landing at a city with a major trauma center or teaching hospital. Granted landing at a remote airport is not the same as landing AT the trauma center, but it does get you on the ground with a with higher level of access.

    Bottom line, commercial airlines should only be handling the most time critical emergencies, such as having a bronchodilator and epinephrine for asthma and allergic reactions. Beyond an allergic reaction, just land the plane at a nearby city.

    Over the water is entirely different issue, but guess what, the passenger CHOOSE to fly on that particular flight.

  27. chas_TN says:

    Anyone else find it odd that instead of diverting to the nearest airport. They moved her to the first class cabin, covered her with a blanket and continued the flight!

    Are the fees for being on time really THAT IMPORTANT?

  28. emt888 says:

    I am an EMT and I was flying home from studying in Korea. My flying journey went from Inchon to Tokyo, and then from Tokyo to Detroit. While on the 19 hour leg from Tokyo to Detroit, there were two medical emergencies. In both cases the flight attendants came over the loudspeaker and asked for anyone with medical training and they directed us to the seat number. I responded along with a doctor. In both cases they asked to see and wrote down our medical license numbers before they would let us near the person. Thankfully, both emergencies were not severe and it only required an hour of our time for each one.

    As a thanks to us, Northwest offered each of us a whole 5,000 frequent flyer miles (total). Whoopee.

  29. LordKDp says:

    Fun fun fun…I was on an Air Canada Flight on standby and ended up with seat 31-A in the very back corner of the plane. It’s nice to know that the stewards put un-secured equipment back there on the seats they think no one will sit on. So…what happens if we hit some kind of turbulence or worse? Oh how I’d love to get hit in the head by the crap they leave un-secured back there.

    One french lady even had the nerve to give me attitude about sitting back there.
    “IS THIS YOUR SEAT?!” in French I think, I had my music on.
    “Pardon?”
    “IS THIS YOUR SEAT?! 31-A?!”
    “Yes…” Confused look on my face.
    “ARE YOU SURE?!”
    “Yes…standby mean anything?”
    “FINE” And then she rushed off to the front.
    I was tempted to say something if she or anyone else came back to do it again.

    - Lord KDp -

  30. airren says:

    Yesterday I was on a Southwest flight from New Orleans and was sitting next to a woman who cut her hand while putting her luggage away. She asked the flight attendant if she could get a bandaid but the flight attendant said that she had given the only one they had to a person earlier in the morning.

    I could not believe it. Do they don’t have first aid kits?

  31. AustinTXProgrammer says:

    @chas_TN: The passenger was from the destination and had been declared dead by a medical doctor. The airline save the family thousands by not diverting.

  32. r3c says:

    i am a flight attendant for a u.s. carrier and would like to address a few of the questions raised:

    - there probably is more to this story than has been reported. the family members of the deceased claim the tanks didn’t work, but that could be based on the fact that they didn’t see the bag (which is connected to the mask) inflate. it is stated in our safety demo that the plastic bag may not inflate. two doctors and two nurses also tried to administer oxygen, but that tank was apparently empty as well. even if the two oxygen tanks were empty, there are plenty more on that particular airplane.

    - flight attendants are trained in cpr and to use a defibrillator (or aed). the family members claimed the aed didn’t function effectively. the aed monitors a patient’s heart rhythm and decides if a shock is necessary, the user only presses the button to deliver a shock if prompted.

    - it’s true that airlines don’t want to give flight attendants more medical training because of the cost and liability. can you imagine medical malpractice lawsuits on airplanes?

    - i have seen many passengers on my flights that should not have been flying that particular day. not only do they risk aggravating their own illness, they put other people’s health at risk. my wife (who is also a flight attendant) just had a medical emergency recently where the aed was used, but did not delver a shock and oxygen was administered. after the flight diverted, the emts at the local station gave the passenger the option to continue on her flight, but the pilots refused. people are often more concerned with making their flight, rather than the risks involved.

    - in response to the “klutzy flight attendant” comment, a baby was delivered by a flight attendant on this same route a few years ago. a haitian woman gave birth prematurely and there were no doctors on the flight. it was featured on a nightly news program.