Controversy Over Airborne First Aid

The prognosis is not encouraging. Not that you’re actively planning such things, but try not to get very sick while flying on a U.S. airline. Chances are very good that the airline does not carry a comprehensive medical kit, and, depending upon when and where you get sick, you might be in for a very rough flight indeed.

And the airlines are not exactly rushing to correct the problem. Many of them have been lobbying against moves to require them to carry such kits.

“We’ve been opposed to it,” says Chuck Novak, spokesman for United. “After all, who would administer the treatment? And,” Novak argues, “even if a doctor was on board when a medical emergency happened, he has no medical history on the patient and the possibility of a wrong diagnosis is great.”

United isn’t alone in its opposition. Every major U.S. carrier has come out against the carrying of such kits. They argue that the kits are expensive, burdensome and could lead to misuse, or abuse.

AMA Against It, Too

The airlines aren’t the only ones opposed to the concept of improved medical equipment on airplanes. The American Medical Assn. is against it. The AMA’s Commission on Emergency Medical Services has said that only “certain minimum diagnostic and therapeutic equipment should be on board commercial aircraft.”

This includes the basics: a stethoscope, sphygmomanometer (measures blood pressure), splints, tongue blades and a flashlight.

“Aircraft technology has zoomed in recent years,” says one flight attendant who wants better medical equipment on board. “But our first-aid kits have remained the same--much too simple.”

To be sure, medical kits carried aboard U.S. jetliners have changed little from the ones put together in 1924 by Johnson & Johnson for the first round-the-world flight: bandages, gauze, ammonia, ointment and a splint.

“It’s barely minimum for a troop of Boy Scouts,” says Sen. Barry Goldwater, who has introduced a bill to force U.S. airlines to carry medical kits that would be more useful to treat heart attacks, allergic reactions, seizures, diabetic comas, choking and bleeding.

FAA Reluctant

The Goldwater bill is just one of recent moves to update medical equipment on commercial airliners.

The Federal Aviation Administration has been involved, reluctantly, in the issue since 1981. That’s the year the Public Citizen Health Research Group of Ralph Nader’s Aviation Consumer Action Project petitioned them to require airlines to carry better medical kits.

In their quest for a change in FAA rules, the consumer group charged that “every day, an unknown number of airline passengers develop serious medical problems, some of which may be life-threatening if not properly treated.”

The FAA denied the petition in 1982, citing an American Medical Assn. report that stated the addition of potent drugs and instruments could create a “possible situation of misuse by unqualified personnel.”

Nader’s group then tried unsuccessfully to appeal the FAA decision.

Although almost every major foreign airline, including carriers such as Air New Zealand, Air France and Japan Air Lines, carries substantial medical kits, U.S. lines still fight the idea.

Tough Place for Diagnosis

“It sounds like a good idea on the surface,” says Thomas Tripp, Manager of Technical Information for the Air Transport Assn. “But an airplane flying at 35,000 feet is an extremely tough place to perform an accurate diagnosis. It’s hard to even hear an accurate heartbeat with all of the wind noise outside the airplane that the stethoscope picks up.

“There’s also a problem with having drugs such as Valium and morphine on board,” says Tripp. “One half of all people are allergic to morphine. A person can die from an allergic reaction.”

But Goldwater wants medical kits on planes. So does Ralph Nader. And the Assn. of Flight Attendants is pushing hard for the kits.

“We want those medical kits,” says Noreen Koan, chairman of the National Air Safety Committee of the Assn. of Flight Attendants. “There’s a consistent need for them because quite often in an emergency a doctor is on board but he doesn’t have the proper equipment. But the airlines don’t want to spend the money.”

In a majority of cases, a passenger who gets sick on a plane and receives medical treatment after landing is essentially treated in city and state record books as if he got sick at the airport where he was ultimately treated, not in the air.

Recording Philosophy

The same recording philosophy applies if the passenger dies in flight. He or she is not officially declared dead until after the plane lands and the body is removed from the plane.

Air Canada is an exception when it comes to record keeping, and its figures seem to indicate that the incidence of passenger sickness in flight on all other airlines could be significant.

The Canadian airline carries an extensive medical kit on each of its planes and considers them a great passenger benefit. The kits cost about $500, and are locked in the cockpit and will be released by the pilot only after a physician has identified himself/herself. The kits are only used to provide treatment until the aircraft can land and the passenger can be transported to a hospital.

Air Canada has kept close tabs on the effectiveness of the kits. In 1984, 900 people declared themselves sick. Medical kits were used in 250 of those cases. Perhaps most significant, the airline has determined that in about 90% of the cases where the life of a passenger was in danger, a physician happened to be on board the aircraft who could, and did, use the medical kit.

FAA rules generally require a first-aid kit, oxygen and adequate first-aid training for flight crews. The first-aid kits vary little between domestic airlines. A typical kit on Republic Airlines contains adhesive and gauze bandages, two types of bandage compresses, Merthiolate swabs, adhesive tape, scissors, ammonia inhalant, burn compound and wire splints.

Two Kits on Japanese Planes

By comparison, Japan Air Lines planes all have at least two kits per plane containing oxygen, rescue tube, 15 kinds of bandages, stethoscope, cold packs, adhesive plaster, splints, thermometers, gauze, scissors and vinyl sheets. Medications for colds, airsickness, stomach convulsions, digestive problems, diarrhea, enemas, heart attacks, hypertension, eye irritation, earaches, abrasions and sprains are also included. Specific instructions as to when to use what and in what quantity, and the possible reactions for all medications are provided.

First-aid training between airline personnel varies a little more. At Republic, flight attendants must complete a Minnesota state-approved first-aid course. “We look upon our flight attendants as being first-aid qualified as opposed to medically trained,” says Republic spokesman Bob Gibbons.

But first-aid training is often meaningless without equipment to treat the patient.

“Our first-aid kits are a joke,” says one airline steward who declined to be identified. “If we had a real medical emergency,” he insists, “chances are that all we could really do is move passengers away from the victim and watch while we diverted to a nearby airport, if there was one.”

Pan Am’s rule in the event of a medical emergency is to land at the nearest airport, wherever that may be. “If there is a medical emergency on board it’s a judgment decision,” says James Arey, speaking for Pan Am. “The classic thing is to ask if there is a doctor on board. If there is, it’s his/her decision if the plane needs to land immediately. If no doctor is on board, the decision to land is the captain’s.”

Some airlines believe that extensive medical kits are only effective if a doctor is on board to administer the drugs and use the equipment. “It shouldn’t be the flight attendants calling the shots,” says Nancy Vaughn, a spokeswoman for U.S. Air. “Our flight attendants aren’t medically qualified to determine treatment.”

“We don’t try to make doctors or nurses out of our flight attendants,” agrees Jim Ewing, a spokesman with Delta. “Years ago, flight attendants used to be registered nurses, but not any more. They ran out of RNs.”

And CPR, Too

Delta and other airlines’ flight attendants do receive general first-aid training as well as training in cardio-pulmonary rescusitation (CPR) and the Heimlich maneuver. Pan Am and Japan Air Lines personnel also are trained to assist a woman giving birth.

Then there is the argument made by airlines that don’t fly long distance routes. “We are 20 minutes from an airport at all times,” says Republic’s Gibbons. “We can land someplace and get qualified medical attention quickly and from someone with years of training.”

The ATA even reports that some in-flight deaths may have already occurred as an indirect result of extensive medical kits being carried and used on some international airlines.

According to Tripp, a passenger on a recent flight from New York to Paris “on a foreign carrier” complained of chest pains one hour out of New York. A physician on board treated the passenger, using the medical kit. The airline continued its journey across the Atlantic. The passenger died later as the plane continued to Paris.

The case is now in court, with the surviving family of the man claiming that if there had been no medical kit on board, the plane would have turned back to New York and the person might have been saved.

But this case is clearly an isolated one and many international carriers continue to keep the medical kits on board.

Regulation Mulled

There is some hope, however, for those who advocate the use of the kits on U.S. airlines. A regulation under consideration by the FAA would upgrade the medical kit requirements to include some prescription drugs (such as morphine) as well as syringes, scissors, scalpels, stethoscope, tracheal equipment, thermostat and blood pressure equipment as well as the trusty flashlight. Each kit would cost about $300.

The cost to the airlines would be an estimated $6.2 million over 10 years. Airlines would also have to keep specific records on each medical emergency.

The period for public comment on the proposal ended July 12. “We have a three-foot stack of mail on it,” says JoAnn Sloan, speaking for the FAA, “so it may be quite some time before a decision is made.”

So if you’re waiting for the FAA or Congress to take action quickly on this sensitive issue, don’t hold your breath. You could get very, very sick.