COLUMN ONE : Calling for Better Care in the Air : Airlines say preparing for every emergency is impossible, but critics claim more can be done. New technology offers hope. Until then, ailing passengers often rely on the ingenuity of good Samaritans.

Roland Koenig felt fine when he got on the plane in Los Angeles. But an hour into the flight an asthma attack became so bad it shut down his heart.

“I went to the john and came back and knew I was in trouble. I couldn’t breathe at all,” said the 73-year-old Texan. “Everything went blank and I felt myself being lifted out of the seat.”

Two doctors and four medical aid workers came to his rescue when cabin attendants put out a call for help. The key to saving his life, however, was three zaps from a portable defibrillator.

“When I awoke the next morning . . . a couple of [hospital] attendants came in and said, ‘Here’s the miracle man.’ ”

Maybe it wasn’t a miracle. But it was very good luck for Koenig that he was heading to Australia last December on Qantas, one of the few airlines whose planes carry defibrillators--machines used to administer electric shocks to heart attack sufferers.

More often, if an airline passenger becomes seriously ill, aside from the expertise of whoever happens to be on board, most planes can offer only an emergency medical kit stocked with basic items like a stethoscope, syringes and nitroglycerin tablets.

Airlines say there are limits to what they can do to prepare for in-flight medical emergencies. Equipment that can be carried is limited by space and cost effectiveness, they say, citing the relatively low numbers of incidents that occur each year.

Others argue that although airlines can’t prepare for every emergency, more could be done. Although the number of incidents may be low, they say, you can’t put a price tag on a life and the large number of people who fly--airlines carried about 1 billion passengers last year--makes medical care in the air a concern for everyone.

An average of 72 passengers die each year on airlines worldwide, according to a 1988 study, the last one conducted.

More recently, American Airlines reported that on its 873,097 flights last year, there were 165 medical emergencies that required a plane to divert to the nearest airport.

Given those numbers, airlines balk at having to make costly improvements. Said a Delta spokesman: “We are an airline, not a hospital.”

Doctors who have endured the frustration of trying to save lives at 30,000 feet, however, say they would settle for a few more pieces of basic equipment and life-saving drugs.

“All you have to do is go through one of these cardiac arrests on a plane and you are convinced,” said Richard Kerber, a University of Iowa cardiologist who managed to resuscitate a passenger on a flight to California.

That’s what made a believer out of Canyon Country pediatrician Rochelle Feldman. She said she has been called upon to aid several sick passengers, including one instance when she used a tampon to quell the severe nosebleed of a passenger on blood-thinning medication.

Her greatest in-flight challenge came last April when she tried to save Benjamin Talit, 43, of West Hartford, Conn. He was found unconscious in a lavatory aboard a Northwest Airlines flight from Detroit to Los Angeles.

Like many stricken passengers, Talit had apparently staggered to the lavatory in an attempt to shake off a wave of discomfort that swept over him before he went into cardiac arrest. A flight attendant found him slumped inside.

Feldman, one of two doctors who answered the flight crew’s call for help, said Talit still had a faint, quick pulse when she checked him.

She said it wasn’t just lack of a defibrillator that caused Talit to slip away. The medical kit didn’t have drugs or equipment--oxygen, tubing, Lidocaine--that Feldman said she needed. “It killed me. It killed me because we had him alive,” she said.

The plane made an unscheduled landing in Las Vegas, about 45 minutes after the emergency occurred. By then, the ambulance at the gate was no longer needed; the coroner was called instead.

A Northwest spokesman said the company’s airlines are equipped with more medical supplies than the FAA requires, but he added: “Unless you’re traveling on Air Force One, you’re limited to what you can carry on board.”

However, Feldman concluded that an airplane “is a pretty lousy place to get sick.”

Reviewing Standards

Airlines and the government are looking at ways to improve a difficult situation.

Right now, the FAA requires that airlines teach flight attendants how to handle routine passenger illness or ailments such as fainting or epileptic seizures, but does not specify training other than familiarization with the emergency medical kit.

Airlines have adopted standard procedures in case of serious medical emergencies. Pilots are instructed to call medical base stations to consult with physicians and are authorized to divert the flight to the nearest airport where paramedics are standing by.

Flight attendants are told to call for help from medical professionals who are traveling on a flight. Regulators say surveys have found that help is usually available on most flights.

Airlines also screen people who appear to have serious medical problems, denying boarding passes to those who are at high risk for emergencies. But airlines will accommodate those who can fly with medical assistance, such as oxygen tanks.

When emergencies do occur, however, doctors who happen to be aboard a flight are left to improvise with the items in the standardized on-board emergency medical kit.

Feldman said she found that in trying to save Talit, the medical kit had far less of the equipment than is routinely found in the $350 emergency chest that many physicians keep in their offices.

This kind of complaint is prompting a review of the kit’s contents by a committee of the Air Transport Assn., the airline’s major industry organization. The chief medical officer of Delta Air Lines, who chairs the committee, declined to comment. The FAA is about to study the issue as well.

But adding extra items would not be easy.

“The events are so few and so unpredictable that I could stock [a jetliner] like an ambulance and still not have the right equipment for the right case,” said James M. Atkins, a professor of internal medicine at the Southwestern Medical School at the University of Texas and director of Dallas’ emergency medical services.

The one piece of equipment that seems to be drawing a lot of attention is the portable, automatic heart defibrillator.

The devices have been installed in 53 Qantas long-range jets since 1991 and have been used 50 times, 16 in cases of cardiac arrest. They have saved two people, including Koenig.

The machine that saved him is among a new generation of briefcase-sized defibrillators that are cheaper than their predecessors. They can automatically determine whether the patient needs a charge, then deliver it.

Companies are hoping to market automatic defibrillators as soon as next year that could cost about $3,500--half the cost of the cheapest models now--with the goal of a $1,000 machine not far away.

Nonetheless, given the huge cost for saving relatively few people, defibrillators on airplanes aren’t worth the cost, said Atkins.

He estimated that the cost of every life saved would be about $75 million, based on the number of incidents versus the number of planes. That amount of money could save dozens, maybe hundreds of lives if it were spent on public immunization or public health programs, Atkins said.

American Airlines, for instance, has discussed installing defibrillators, but for the present has decided against it, a spokesman said.

Airlines also fret about the legal complications of using defibrillators. At present, doctors who aid stricken passengers on airlines are protected by good Samaritan laws.

“If someone is there and tried to use it and didn’t know how, they end up hurting the person more than helping,” said Tony Molinaro, of United Airlines. “We don’t want to take that kind of chance.”

To bolster communications links to the ground, British Airways hopes to install a kit on planes equipped with its latest satellite-linked entertainment systems that transmit vital signs to the ground--and physicians’ instructions to the plane--with the help of a laptop computer.

Despite such advances, critics say the airlines need to do more. “To me, it’s a scandal. The airlines have gotten away with it for a long time,” said Richard Cummins, a medical researcher at the University of Washington who is an outspoken advocate for improved medical care in the skies.

“As a public service utility, [the airlines] have a duty to care for passengers in their hands. Their response is ‘no way.’ ”

A Life Saved

Sometimes, it all comes down to ingenuity, skill and luck.

Recently, a 39-year-old woman traveling from Hong Kong to London was saved on a British Airways jet, which carries a more complete medical kit than the ones found aboard U.S. airliners.

She had fallen off a motorbike on the way to the airport, and during the flight found the pain in her arm had worsened to the point where she could no longer breathe. Two doctors who were on board decided they would have to operate to reinflate a collapsed lung.

The plane’s medical kit contained a scalpel and local anesthetic, but not the special tube and metal rod needed for the operation. The doctors were forced to improvise with a coat hanger and plastic tubing, a urinary catheter and Courvoisier cognac. By the end of the flight, the woman was well enough to eat breakfast.