 How often have you been on a plane and wondered what would happen if you, or your travelling companions, had a medical emergency? Does your heart skip a beat whenever you hear the "Is there a doctor on board?" question? "In some years heart attacks in the sky are more frequent than deaths or injuries in crashes," according to the website of Dr. Perry Hookman. Well, some hope for us worried folk came in the news this week. Remote Diagnostic Technologies, of Lyeway Lane, Ropley, near Alresford in Britain is installing a new on-board medical device in Virgin Atlantic Air planes. The device seems to offer significant extension of the ability of plane crews to deal with medical emergencies, thanks, in part, to our new capability to communicate with the ground using satellite phones. Dated May 18th, the story came to my screen from the PS-Inform service of positivespace.com, and this story points to a longer May 17th news release by Reuters.
According to a British newspaper story, Remote Diagnostic Technologies has already won an award for the Tempus 2000 device. "Tempus 2000 [gives] immediate access to expert medical advice and clinical information--even if they are over the ocean at 35,000 feet. It uses a built-in modem to send data to ground-based doctors, providing them with information on temperature, pulse rate, blood oxygen level and blood pressure. Depending on the results, it can then be used to run an electrocardiogram--cardiac incidents being the most common justification for diverting an aircraft. The unit can also monitor signs of lung illnesses. Graham Murphy, managing-director of RDT and the man behind Tempus 2000, explained: ' Importantly, in addition to monitoring a passenger's condition, the unit has an integrated, hands-free voice communication system, so the patient can answer the vital follow-up questions--just as if he or she were in a hospital. There is no need for separate telephone calls and, if necessary, it can also transmit pictures of the patient to medical centres. We believe that it has significant potential for airlines, because it can be used by their crews after very little training.' " The May 17th Reuters story states that Virgin Atlantic will begin using Tempus 2000 on flights in August. The Reuters story adds that " Tempus 2000 is the first device that measures vital signs such as pulse rate, blood oxygen levels and blood pressure and transmits them in real time by satellite phones on the back of Virgin's seats, he added. Doctors at the medical center will also be able to receive a still image of the patient, so they can give a diagnosis, guidance and advice on whether to divert the plane, Murphy said." HOW OFTEN DO WE NEED SUCH A BREAKTHROUGH? What is the frequency of medical emergencies in the air? One official is quoted to the effect that "American has to divert a plane for medical reasons about 150 times a year, Mr. Hotard said, or about one flight in 5,400. The Air Transport Association study found 557 emergency landings for medical reasons in 1996, of which 183, or about a third, were for cardiovascular problems. Other reasons included neurological problems, seizures, respiratory problems, gastrointestinal problems and "other". . . . Among other reasons for landing: in-flight trauma, pregnancy, allergy to food, unruly passenger and death." (This quote from Dr. Hookman's web site.) These data indicate that we are dealing with rare events -- in the context of the total number of passenger-miles in the air, you are quite unlikely to be involved in this kind of emergency. Nevertheless, if you have bet your money at the horse races, you will have learned by now that probabilities, as we now measure them, do not apply to unique events. Every event has its own specific sequence of causal forces (like your favourite horse with a great finishing kick being boxed in on that last turn before the final stretch run to the pole). So you still have to wonder whether 'tomorrow your turn, or some family member's turn, comes up'!
Given this reality, it seemed useful to explore the general issue of airline preparedness for on-board medical emergencies. I've gone to over 12 web sites to be educated on the topic, and what turns up from this research is indeed mighty educational. (A number of these sites are listed at the end of the article.) There is a range of related topics on which
travellers might well be better informed; because it turns out
that a substantial part of the margin for coping with emergencies
lies in our own travellers' hands! These topics include your
normal risk of being subject to some sort of health emergency,
the extent to which the air cabin environment (especially air
quality) helps or hinders disease transmission, the variety of
medical devises and other aids actually on your flight, and the
quality of relevant training provided to airline crews. All of
these topics are touched briefly in this story, based on the
research done. ANOTHER IMPORTANT MEDICAL DEVICE NOW WIDELY USED The research brought us some useful information about another important device, made by Heartstream Inc. a Seattle company, that is already installed on a large number of airlines. The web site of Dr. Perry Hookman, refers to the device, named "Forerunner", as "a $3,000 battery-powered device [that] can be used with very little training. . . . [It] is a combination heart monitor and defibrillator - that is, a device that produces an EKG, and one that shocks the heart back into normal rhythm if necessary. The device is already credited with saving one passenger's life, on a flight from Dallas to Mexico City on Feb 18, and has helped many other times to determine whether a stricken passenger was, in fact, having a heart attack. . . . After paddles are applied to a patient's chest, the device senses electrical currents from the heart and decides whether a heart attack is, in fact, in progress, and whether defibrillation is needed. " Based on a text at the manufacturer's web site, it seems that the Forerunner is an "automatic external defibrillator (AED). . . . The AED automatically interprets the patient's heart rhythm, identifies ventricular fibrillation, and advises the operator whether or not a shock is appropriate. This advance greatly decreased the amount of training required to use a defibrillator; responders using defibrillator no longer needed to be physicians or highly trained paramedics. As a result, an increasing number of people could potentially use a defibrillator to save a person experiencing sudden cardiac arrest. Indeed, lay people and even children have successfully saved lives by using AEDs." Heartstream Inc. has won awards for the Forerunner. According to the May 17th Reuters story, "Roughly half of the world's commercial airlines currently carry defibrillator, which can revive passengers after cardiac arrest . . . ." Also, some 27 airlines make use of "an emergency telemedicine center which offers 24-hour advice by certified physicians to passengers and crew in flight." Dr. Hookman's text says that "Congress has directed the Federal Aviation Administration to study whether all airlines should be required to carry more medical equipment. " One way we travellers can get into this act is to make a point of calling our airline to ask what devices are going to be on your particular flight. Enough calls to the laggard companies might help prod them into action. The situation at American Airlines has been represented as follows: "With the diagnostic tool on board, American has also beefed up the medical kits on its planes . . . These kits, separate from the first-aid kits kept in the cabin, are in the cockpit and can be released only by the captain; they contain prescription drugs that can be used to treat cardiac arrest, epileptic seizure, asthma, bronchitis, psychosis, nausea, vomiting and other disorders. The drugs could be administered by a physician who happened to be on board, or on the orders of an airline physician on the ground, contacted by radio. " (Quote from the website of Dr. Perry Hookman.)
ARE FLIGHT CREWS ADEQUATELY TRAINED TO HELP IN MEDICAL EMERGENCIES? To be optimally useful, though, the medical diagnostic tools have to be backed up by things to be given to people in trouble, and competent advice on what to give and how much. Does your favourite airline train its flight attendants enough to ensure that there is the capability to use on-board medical devices and aids properly? A 1999 story from Australia states as follows: "The present regulations on the safety training required for flight attendants are minimal and lacking in detail. Anecdotal evidence suggests that considerable differences exist between the various flight attendant training courses run by the regional airline operators." What is the situation in the USA and other major bases for airline operations? The story from Australia points out that "A number of aviation safety bodies such as the US National Transportation Safety Board (NTSB), Transport Canada and the International Civil Aviation Organisation (ICAO), have addressed the upgrading of flight attendant standards." It continues as follows: "The NTSB conducted a special investigation on flight attendant training and performance during emergency situations. The study revealed that some flight attendants did not demonstrate adequate knowledge of exit operations, use and location of equipment, or use of checklists during an emergency, and that some were unable to follow established or standard operating procedures. Crew communication was also cited as being deficient in some cases. At the conclusion of the report, the NTSB stated: 'Identification of these deficiencies indicates that flight attendants' safety training has been seriously neglected.' The Safety Board strongly believes that the ability of flight attendants to perform their duties successfully during emergency situations is directly related to the quality of their emergency training. (NTSB/SIR-92/02 Washington DC 'Flight Attendant Training and Performance During Emergency Situations')." Notice that none of that commentary specifically refers to training of attendants to deal with medical devices. Hence the following $64 question: Which airlines are systematically providing cabin crew with serious training on the handling of on-board medical devices, and related communications with doctors on the ground? IS AIR CABIN AIR QUALITY A HELP OR A HEALTH HAZARD? Bad air quality in a plane during a long flight may rarely create a medical emergency; but if you are subject to a wide variety of health conditions air-plane air quality is something about which you might wish to be informed. The subject was the focus of a 1997 speech given in Washington by speech by Patricia A. Friend, International President Association of Flight Attendants, AFL-CIO. She stated that "AFA is pushing for a proper minimum standard for fresh air in the aircraft cabin . . . Our national office receives complaint letters about poor air quality from some passengers as well as flight attendants. " This suggests that as late as just three years ago air plane air quality was not something to feel relaxed about on all flights, to state the case mildly. She continued that "Some flights may have additional air-quality problems arising from malfunctioning equipment, jet fuel leaking into the air intakes while on the ground or carbon monoxide from incomplete combustion of fuel. Air quality problems also can arise from failure of the environmental control system to function during flight, or leaks of hydraulic fluid or oil into the ventilation system. All of these contaminants are magnified by the reduction in the amounts of fresh air being circulated on board newer aircraft. " There have been major efforts to make progress in this area, however. "AFA's early efforts to improve cabin air -- in the 1970s --focused on developing standards to limit ozone in the cabin. This was followed by the push to ban smoking during the 1980s, and then the current effort to improve air quality through better aircraft design and operation in the 1990s. This latest effort was initially directed toward the growing number of commercial aircraft that recirculate air that has already been breathed by other passengers and crew. . . . Last June, the FAA finally required an air quality standard of 10 cfm of fresh air for each person in the cabin of new aircraft." Ms. Friend comments, however, that the FAA requirement is half that recommended by her Association and it applies only to new aircraft. "In addition, the FAA six months ago reduced the maximum allowable level of carbon dioxide on aircraft [to a level that was still ] five times the standard for offices. " The ban on smoking is now known to everyone who flies domestically. Her comments about air quality recommendations in this connection are telling. "Congress approved funding in 1984 for the National Academy of Sciences to study Airliner Cabin Air Quality. The study, published in 1986, included many recommendations to the FAA on how to improve cabin air quality. But up until last year, only one of them had been implemented" -- the ban on smoking. This ban followed many congressional hearings,and letters of complaints sent to Congress. A supporting factor was the National Academy of Sciences recommendation in favour a ban on smoking on domestic flights. Smoking is not the only matter you show know about, however. Carbon dioxide levels in air planes is also an issue because higher than average levels may assist the transmission of disease during flights. "On non-smoking flights, which are most prevalent today, the average CO2 concentration was more than 1,700 parts per million. To give you a point of reference, the American Society of Heating, Refrigeration and Air Conditioning Engineers sets its standard for building air quality at not more than 1,000 parts per million," according to Ms. Friend. She goes on that "In our view, it is already clear that tougher air quality standards are needed for the aircraft environment. . . . [W]e recommend [a minimum level of] 20 cubic feet per minute of fresh air per person in the aircraft cabin. Today, passengers and flight attendants are commonly getting as little as 7 [cubic feet per minute] -- or only one-third of the amount of fresh air required for a prison cell! . . . We also advocate records of cabin pressure, carbon dioxide and carbon monoxide concentrations, temperature and relative humidity on each flight to be made available to flight attendants on request." Her association also supports the establishment of a toll-free number for use by persons to phone in complaints "about the aircraft air quality and environment". In fact, a coalition of us travellers should be easily able to support the financing of such a line by a small contribution from everyone. Indeed, the AFA might even organize the campaign, and kick it off with highly contributions from within their membership. One thing to address, though, is the potential for people to use the line to unfairly persecute certain airlines. We might recall the story (in Brill's Content, as I recall) that employees of a Certain Famous Company entered newsgroup discussions and spread bad comments about a competitor's operating system, as part of a deliberate campaign. Thus, before we have such a toll-free line some way to find independent support for complaints (at least on a sample basis) should be found. One possibility (perhaps distant, though) is for an air quality measuring device to be taken onto planes that are reported to be sources of air quality trouble, and that on a sample basis. This process could be designed in such a way as to be the basis for an estimate of the percentage of bogus complaints being lodged. Certainly complaints that focus on a specific airline, or flight, should be monitored for independent confirmation. In any event, human nature being what it is, we will probably accept the status quo as being 'a tolerable risk' until there are widespread documented problems connected with bad air plane environments, and a large number of us feel that these problems are getting just a bit 'too close to home' for comfort. At the same time, a well-designed toll-free-number system could exert pressure on airlines fairly quickly, at least by comparison with the long wait for a pile-up of letters to Congress, subsequent hearings, interest-group lobbying, etc., etc., before any enforceable regulation is passed. The system would have to be maintained by an organization with high profile and credibility, and it would have to regularly publish a score card on airline air quality performance. In response that publishing activity, the laggard airlines might feel some serious pressure to clean up their act. Thus, the bottom line here seems to be that we need to put four things together: (1) diagnostic equipment, (2) ability to communicate with medical experts on the ground, (3) suitably trained crew on the plane, and (4) supportive cabin environment. This brings up another potentially big bottom line -- the next time you are offered a dirt-cheap ticket on Your Favourite Airline to take you a long distance, you might wonder how far Your Favourite Airline has gone toward meeting all of these helpful conditions. Could your 'el cheapo ticket' be a tip-off to less than average attention to potential health hazards by Your Favourite Airline? Here are some related web sites: A serious effort has been made here to respect peoples' copyrights. Any lingering violation will be corrected promptly, as soon as someone points out where the violation takes place. Contact me at lestone@arawak.net. © 2000 Arawak Enterprises. All rights reserved. |