Since 2005 Flight Attendant and Airline News: Humorous, Entertaining Prose With a Dose of Insanity
Tuesday, January 22, 2013
What Happens If You Become Seriously Ill During a Flight?
Marc Weber Tobias, Contributor 1/22/2013 @ 1:52PM
I am an investigative attorney and physical security specialist.
If you fly on commercial airlines in the United States and have ever
wondered what would happen in the event of a medical emergency, especially if
the carrier works in conjunction with physicians on the ground, you should feel
more reassured after learning what I found from one airline.
I fly about
150,000 miles a year, primarily on Delta Air Lines, and had a chance to visit
with a number of senior crewmembers and pilots, and read the relevant sections
about in-flight medical emergencies. I learned about what they do when a
passenger becomes ill or suffer a heart attack or other life-threatening event
while flying.I wrote an article last year about an oxygen system failure
aboard a Delta flight I was on, and briefly touched upon the role of flight
attendants during an emergency. After reading the Delta procedures for
crewmembers, there is no question that the primary job of a
flight attendant is all about safety and helping passengers in a medical crisis.
Their other tasks are secondary.
I shared some of the
information I learned from Delta Air Lines with Dr. Tom Stys, Director of the
Sanford Cardiovascular Institute in Sioux Falls. What I found was actually quite
amazing and encouraging for all passengers that fly this airline. Delta’s
procedures are similar to those in effect by all other U.S.
Delta Air Lines, as well as many other carriers, contract with
the University of Pittsburgh Medical Center for their STAT-MD program for
immediate medical consultation when they have a problem during a flight. UPMC
offers the same kind of service to the airline industry as does another major
These providers insure that medical events are properly
analyzed while they are occurring so that passengers have the best chance of
survival, should the emergency be life-threatening. More passengers are
flying, which means more medical emergencies onboard that can result in serious
ramifications, including death.
It is estimated the almost six million
people travel onboard commercial aircraft every day throughout the world.
Passengers are living longer, which equates to having a higher likelihood of
recurring medical conditions which can manifest themselves during a journey.
Longer flights, larger capacity aircraft and more passengers with underlying
health issues all contribute to a growing problem for airline
Unexpected, but planned-for medical emergencies include heart
attacks, strokes, choking, diabetic reactions, seizures, and other maladies.
Real incidents do happen, and more often than you would think, as reported in
the New York Times in May, 2011.
Passengers And Medical
Problems Passengers can be classified in three groups in the context of
medical events: those that have unknown conditions; predisposed conditions which
are triggered as the result of travel; and known conditions which include those
passengers that became ill at their destination and are trying to return home,
are securing more appropriate or less expensive treatment, or are literally
flying home to die.
There is a technical communications problem when
Delta or other carriers communicate with the UPMC STAT-MD or other ground-based
doctors during an emergency. There is no direct link between a flight attendant
or physician onboard in the cabin and the hospital because evidently it is too
complicated to tie the intercom system on the aircraft with the internal company
radio system or satellite phone onboard so that instructions do not have to be
relayed from the flight crew to the one that is treating the passenger. A
spokesman for Delta confirmed this issue but said it has not posed any problems
Security concerns in the U.S. prevent direct communications
between a doctor onboard and the airline dispatch facility and medical staff
because nobody can enter the flight deck to speak directly to the ground. There
is also a new security directive that prevents the Captain from leaving the
cockpit to assist a patient or flight attendants because of the potential to
create a medical emergency as a diversion for hijackers.
The Doctors On
The Ground That Can Help You
I interviewed Dr. Paulo Alves, Medical
Director of MedAire, about what they do and his extensive experience in the
specialty of aeronautical medicine. His company has been in business for twenty
five years and is one of the leading providers of remote medical consultation
and care for flights, whether the passengers or crew are on the ground or in the
They provide an integrated system with airline crews to make sure
that everyone is on the same page as to the latest technology, techniques,
medical trends and regulations. The company oversees training, and equipment
provisioning to sixty airlines throughout the world. They have a Global Response
and Dispatch center in Phoenix that handled 22,000 cases last year, and assisted
with 12,000 medical fit-to-fly assessments of passengers at the boarding gate,
and 5,000 cases of airline crew members that had medical issues during
The company works with airlines to help protect passengers and
crew in case of two different scenarios: a medical event, or a potentially
life-threatening emergency. The University of Pittsburgh STAT-MD program is
similar to MedAire, but was initially designed to serve Western Pennsylvania to
support emergency medical services. UPMC has one of the finest emergency
medicine curriculums in the country, so it is natural that airlines also utilize
Telemedicine And The Airline Industry In The
U.S. According to MedAire the U.S. carriers do not have telemedicine
capabilities as yet, while five different carriers in Europe do. Even though
many aircraft now have WiFi they don’t use it for medical emergencies, but they
all have voice links via satellite phones, company frequencies, or Airinc, which
is a national aeronautical radio link for air transport. Technology really
has not caught up with the airline industry. While the FDA just approved a
cardiac monitor for use with an iPhone last week, such technology is not
available on aircraft even thought it could be.
I confirmed with Delta
Air Lines that at present they do not have any remote monitoring capabilities
onboard any of their aircraft. Delta and other carriers will implement
international Internet access, which means that in the future they may offer
enhanced services in order to more effectively communicate with medical
personnel on the ground.
Delta Air Lines And Your Care Onboard
Delta carries several different medical kits on board, called Enhanced
Emergency Medical Kits (EEMK) and Expanded Medical Kit (XMK). As Dr. Stys
explained, there is essentially everything onboard that he has in his emergency
room for treating heart patients as far as the basics. There are a number of
drugs carried for emergency treatment including Atropine, Diphenhydramine,
Dextrose, epinephrine and Lidocaine. Aspirin, Acetaminophen, and Nitroglycerine
tablets, as well as inhalants and surgical instrument are
Medical equipment includes a variety of needles and syringes,
trauma shears, tourniquets, gloves, tape, alcohol, normal saline solutions, I.V.
sets and I.V. catheters. Airways, masks and resuscitation equipment are
standard, as well as one-way CPR valves and oxygen supplies. Blood pressure
monitors and stethoscope are also included in the XMK kit, as are the American
Heart Association ACLS (Advanced Cardiac Life Support) book, splints and related
Flight crews even have protective gowns, face shields and
gloves, as well as hazard bags, digital thermometers, and digital
There are definite procedures for flight crews to follow on
all airlines. If you fly on Delta and you suffer a heart attack, stroke,
blood-sugar reaction or other illness, the Flight Attendants are trained and
re-certified every year to act instantly.
The critical task for airline
crews is to stabilize, rather than treat a passenger that is experiencing
There are specific procedures that are detailed for
flight crews to treat cardiac arrest, stroke, smoke inhalation, chest pain, and
I wanted to know if the medical equipment, training and
procedures for Delta crews would meet medical standards that are recognized by
Dr. Tom Stys, the Director of the Sanford Cardiovascular Institute in Sioux
Falls. After my discussion with the Director of MedAire I felt that a cardiac
emergency was probably the most life-threatening and of concern for most
passengers. See my interview with Dr. Stys after we reviewed information I had
gathered from Delta Air Lines. He was quite surprised at the level of care that
could be afforded for passengers and crew as a result of the medicine and
equipment that is standard on all Delta aircraft.
The Last Alternative:
Diversion Of Aircraft
While most medical problems onboard are not serious
or constitute a life-threatening emergency, some are and diversion of aircraft
or death can be the result. In 2010, 442 of the 19,000 cases that MedAire
handled resulted in aircraft being diverted from their final destination. Ninety
four people died onboard of the cases they managed.
A pilot has the
ultimate responsibility to make the decision whether to divert the aircraft to
the nearest airport to get a passenger or crewmember proper medical treatment.
This must be based upon a sound understanding of the actual medical situation
that is occurring and several factors go into this decision. These include
alternatives to mitigate the risk to the patient, the time required to get to
the destination in comparison with the flight time required to land at the
nearest suitable airport, and the condition of the patient.
is even more complex because if a diversion is contemplated there has to be an
airport within range that has the proper medical facilities to handle the type
of emergency. MedAire and UPMC both have an extensive data base of medical
facilities in proximity to every airport so if their team is consulted they can
advise the pilot as to their opinion whether the passenger or crewmember can be
stabilized until reaching the planned destination or if it is a life-threatening
event that requires immediate action.
According to MedAire and UPMC, the
airlines are quite responsive to protecting their passengers, even if a
diversion is expensive and very inconvenient for all passengers onboard. When I
spoke with corporate-level representatives of Delta they confirmed that their
primary concern was for passenger safety and health and that cost was not
factored into the equation. They indicated that the procedure for determining
when to divert for a medical situation is with primary guidance from
With enhanced air-to-ground communication capabilities that include
the availability of broadband Internet connection and the introduction of
specifically designed aviation medical devices, passengers will benefit from
upgraded technology and telemedicine in the future.
For the latest in
airline industry information, the updated Air Transport Association website is
an excellent reference.