by Paul Levy

First posted on (Not) Running a Hospital on 02/19/2013

Paul Levy, Host of (Not) Running a Hospital

My friend and colleague Dr. Melissa Mattison writes in response tomy post below comparing airline safety and hospital safety:

Ironically, one area that the airlines could absolutely improve is the care of passengers who become ill and have an inflight medical emergency.

She and BIDMC chief of medicine Mark Zeidel wrote an article about this in JAMA in 2011, entitled “Navigating the Challenges of In-flight Emergencies.”  They make some really good points:

Available evidence suggests there is significant room to improve and standardize the care that is provided to patients during in-flight medical emergencies. Even though emergency medical kits are mandated to contain certain medications and equipment, the actual kits vary from airline to airline. The US Federal Aviation Administration (FAA) mandates that flight attendants receive training “to include performance drills, in the proper use of AEDs [automated external defibrillators] and in CPR [cardiopulmonary resuscitation] at least once every 24 months.” However, the FAA “does not require a standard curriculum or standard testing.” 

To improve the chances that passengers who become ill during air travel will do well, airlines and their regulators could take steps similar to what they have done to ensure flight safety for all flights under FAA jurisdiction including the following.

First, a standardized recording system for all in-flight medical emergencies should be adopted, with mandatory reporting of each incident to the National Transportation Safety Board, the organization responsible for reviewing safety events and recommending changes to practice. This approach should include a systematic debriefing of anyone directly involved with the in-flight medical emergency. Wherever possible, this debriefing should happen immediately; otherwise, follow-up telephone interviews should be conducted.

Second, based initially on expert recommendations and later on the results of reporting, the optimal content of the first aid kits on airplanes should be determined, with a man-date that a standard kit, with identical elements, in identical locations, be on every flight.

Third, the training of flight attendants in how to deal with medical emergencies should be enhanced and standardized.

Fourth, access of flight crews to ground-to-air medical support should be standardized. If this form of support is deemed to be effective, then it should be available to all passengers, on all flights when on-plane health care professionals are not available.

With standard emergency medical kits and standardized training of flight personnel, it will become possible to provide to physicians and nurses some rudimentary training in in-flight medical emergencies.

Because the airline industry has already developed standardized reporting and responses to many forms of in-flight emergencies, the adoption of these measures by airlines and their regulators should not add a great deal of expense, but such sensible measures have the potential to improve outcomes for airline passengers who become ill.