First-Aid Kits Must Be Fuller

Chances of surviving heart attacks or some other medical problems on U.S. airlines will increase due to a Federal Aviation Administration ruling requiring carriers to carry upgraded medical kits as of Aug. 1, 1986.

The new regulation applies to all aircraft carrying 30 or more passengers.

Under the new rule, the carriers will have kits aboard containing equipment and prescription drugs for treating such emergencies as heart attacks, insulin shock and acute allergic reactions. The airlines will also have to continue carrying the standard first-aid kits (which have been called primitive, Boy Scout kits and other less complimentary terms), which include things such as bandages, burn dressings and ammonia inhalants.

Upgraded First-Aid Items

Among the items in the new kit are blood pressure cuff, stethoscope, nitroglycerin, dextrose, Adrenalin, an instrument to clear the airway passage and syringes and needles in sizes necessary to administer the drugs.

However, the upgraded kit isn’t as comprehensive as originally proposed. Scalpels and surgical items, as well as morphine and some other drugs and controlled substances were left out. The question of security, of particular concern to the carriers, was a major factor in such deletions.

The issue of liability in the use of these kits also remains unresolved. “We don’t have the jurisdiction to legislate liability, which is up to Congress,” an FAA spokesperson said.

Good Samaritan bills, which would relieve users of such kits (doctors as well as airline employees) from liability for treating passengers during flights, are still bouncing around Congress.

Who Can Use Kits?

Consequently, while airlines are required to familiarize their personnel with the contents of the upgraded kits, the FAA has left it up to the carriers as to who can use the kits.

“We anticipate that airlines will only provide these kits to doctors on the flights, and restrict their staff from using them,” said Matt Finucane, safety coordinator of the 22,000-member Assn. of Flight Attendants.

Judging from the comments from both American and TWA, that would seem to be the pattern.

“We will require that only qualified physicians have access to these kits, as they will contain controlled substances that only doctors are allowed to dispense,” said Dr. R. W. Wick Jr., corporate medical director for American Airlines.

A similar policy was stated by Dann Oldani, a TWA spokesman: “Our staff will be familiarized with the contents of the kits, but their use will be for qualified medical personnel.”

Meanwhile, Finucane said, “We’re still lobbying Congress for passage of a Good Samaritan act.”

As for the kit, Finucane added: “We’re favorably impressed, even though some items were eliminated, and the new kits should help save some lives. It’s certainly a step in the right direction.”

Foreign Airlines Ahead

ACAP (Aviation Consumer Action Project), which has been lobbying for such an upgraded kit since 1979, also expressed basic satisfaction: “We’re satisfied that the kits will help handle some emergency situations, though we would have preferred additional equipment and drugs, since these items are carried by foreign airlines and there doesn’t seem to be any problem with those carriers,” said Con Hitchcock, legal director, ACAP.

“The arguments about security and pilferage are bogus,” Hitchcock added, “and the liability issue is also specious. I don’t know of any foreign airline that has been hauled into court due to its use of their medical kits. The foreign airlines are really ahead of U.S. carriers, who have been in the dark ages for decades in this matter, which is why it took seven years to get a better kit.”

Hitchcock cited, as an example, Air Canada, which indemnifies doctors who use its in-flight medical kits from any suits that might be filed by passengers treated aloft by these physicians.

As an example of what one foreign carrier has aboard its jets, SAS carries emergency first-aid kits and medical service kits, both of which can be used by flight attendants. In addition, a doctor’s bag is kept under lock and key and can only be used by doctors or nurses who establish their credentials.

This latter bag contains, among other elements, respirators, stethoscope, three thermometers, catheters and a blood pressure manometer as well as prescription drugs to treat angina, asthma, severe allergic reactions, motion sickness and other illnesses. A written report has to be filed for each use of this doctor’s bag.

Doctors Willing

As far as the willingness of doctors to treat passengers, Hitchcock maintained that statistics indicate nine out of 10 doctors provide assistance. “But they have complained about the lack of equipment. The odds are good that a doctor will be aboard most flights of more than two hours.”

From a medical perspective, Dr. U. A. Sexton, regional flight surgeon for the FAA, observed: “This kit seems designed to have drugs that can help passengers with some major problems. But these drugs would have to be greatly over-administered, which is very unlikely, to do any harm.

“The list of potential elements of the kit was chopped down. For example, I was surprised to see a drug like lidocaine, used for irregular heart beat, left out. But I can understand why, as lidocaine can damage someone if improperly given.

“Overall,” Sexton added, “this new kit is adequate for domestic flights. I wouldn’t feel safe using other drugs without knowing more of the passenger’s medical history, which the person may not be in a position to give. The passenger may be on certain medications already, which would indicate what treatment to give. It’s unrealistic to expect heroic measures, inasmuch as there is still minimal equipment and space as well as a medical history.”

The new FAA rule also requires the airlines to report all medical emergencies annually for two years, describing how the medical kit was used, by whom and the outcome of the emergency.