t was May 1996, somewhere over Nebraska.
The 38-year-old woman, six months pregnant, had begun her trip in Cairo, changed planes in New York and was on her way to Los Angeles. Suddenly, she began bleeding profusely and could no longer feel her baby moving.
A doctor who happened to be on board felt she was stable enough to make it to L.A., though she had lost a lot of blood.
But the worried flight crew called MedLink, a service that provides in-flight consultation with emergency room physicians at Good Samaritan Regional Medical Center in Phoenix.
The Arizona doctor, fearing for the woman’s life and believing the baby could be saved, urged the pilot – who had to make the ultimate decision – to divert the plane to Kansas City. Within an hour of landing there, the woman had a Caesarean section, and today both she and her infant son are fine.
Not to mention lucky.
Hurtling along in a big aluminum can six or seven miles above the Earth is not exactly the ideal place to go into labor, suffer a heart attack or have a life-threatening allergic reaction to peanuts.
But it happens – a lot – and when it does, you may be in for a nasty surprise.
“You’re on your own,” says John Fitch, flight coordinator for AeroMedical Group in Hayward, Calif., a service that, like MedLink and one run by the Mayo Clinic, helps airlines deal with the growing problem of inflight emergencies.
Here’s what you’re up against:
– Flight crews are not required to learn CPR, or cardiopulmonary resuscitation, the Federal Aviation Administration says, though some carriers do provide CPR and other limited medical training.
– All domestic flights must carry both a first aid kit and a medical kit. But the first aid kits haven’t changed much since the 1920’s and consist mostly of bandages and protective gloves. The medical kits are little better, and under airline rules may be opened only by a doctor or other health professional – if there’s one on board, as there often is. Faced with mounting concern about the inadequacy of the kits, the FAA and the Air Transport Association have set up panels to re-think them.
– Nobody knows the true frequency of inflight medical emergencies – or deaths – because airlines are not required to report them. Published news reports, however, suggest that as many as 350 people a year die from in-flight medical problems. If that’s true, it’s a lot more than the number of deaths from plane crashes, which range from a handful per year to more than 250, according to the National Transportation Safety Board.
– What’s not in doubt is that more people than ever are flying. In 1986, there were 419 million “enplaned passengers,” according to the Air Transport Association, an industry trade group. Last year, there were 581 million – and that’s just on domestic flights and those that leave or enter US airports.
– So-called “good Samaritan” laws, which give legal protection to health professionals who offer emergency assistance on the ground, do not apply in the air, a potential disincentive for going to the aid of a fellow passenger.
A decade ago, the FAA conducted a two-year study that suggested there were at least three medical emergencies a day on US flights, with about 9 percent resulting in a diversion, or emergency landing.
In February, the FAA released a study based on data from two airlines and two in-flight medical care delivery companies like MedLink suggesting there are 14,000 emergencies every year on major US carriers. That’s nearly four a day.
While that number may seem small compared to the number of people flying, it’s almost certainly an underestimate, say those who have studied the issue. And medical emergencies aloft are rising not just because people are flying more, but because they’re flying older and sicker, says Joan Sullivan Garrett, a critical care flight nurse who in 1985 founded MedAire, the company that operates MedLink. She testified on in-flight emergencies last spring before a congressional subcommittee.
They are also flying with more disabilities, thanks in part to the Americans with Disabilities Act of 1990, which forbade discrimination against those with disabilities, including those medically at risk.
While many fliers have the same heart attacks, strokes or other emergencies that they might have on the ground, there is also an increased risk in flight because the reduced air pressure in the cabin – often equivalent to being at about 8,000 feet altitude – means less oxygen gets into the bloodstream than at sea level. This poses a particular problem for anyone with anemia, or cardiac and respiratory problems.
Although the government has only partial data on the growth of in-flight medical emergencies, some of those trying to bridge the gap between airborne patients and doctors on the ground have been keeping track of the surge in business.
Between 1987 and 1996, for instance, MedAire handled 2,500 in-flight emergencies, patching radio calls from flight crews through to doctors in Phoenix. This year alone, the firm, which serves 10 carriers, has handled 1,500 calls, says Garrett, the company’s head.
About one quarter involved heart problems, she adds, another quarter, fainting (which may also be triggered by cardiac troubles) and a fifth, neurological problems like seizures and strokes. These figures correlate roughly with FAA estimates.
In-flight emergencies also keep doctors busy at the Mayo Clinic, which handles inflight consultations for Northwest Airlines. In fact, the clinic averages one medical emergency a day, says Dr. Robert Orford, who handles the consultations.
Mindful of both passengers’ health and the fact that an emergency landing can cost hundreds of thousands of dollars if the plane must dump fuel to avoid landing with full tanks or has to put delayed passengers up in hotels, airlines are beginning to look for more ways to deal with in-air medical problems.
In July, American Airlines equipped its overseas fleet with automatic external defibrillators to monitor people with heart attack symptoms and deliver an electric shock when necesssary to restore normal cardiac rhythm. So far, the machines have been used 28 times, mostly as monitoring devices.
The airline also employs seven doctors, available 24 hours a day, says Dr. David McKenas, corporate medical director. And because “the FAA medical kit has very little in it,” American is adding equipment for “advanced airway management” for patients who have trouble breathing, a wider variety of medications, and other features that will “permit a physician to handle the first hour of virtually every emergency,” he says.
New technology may soon make in-flight medical consultations even better. One system, called LifeLink, was developed by a Michigan physician and Kevin Montgomery, a California software engineer.
Working in his garage when he wasn’t at his job at the NASA Ames Research Center, Montgomery hooked up a machine that monitors vital signs to a laptop computer. He then figured out a way to compress the information and transmit it over the telephones on airplane seat backs via the Internet to doctors on the ground. The system is not yet on the market.
Another remote diagnostic system called VitalLink, made by Telemedic Systems, Inc. of Redmond, Wash., will use satellite hookups to link flight crews with medical experts. That system should be on the market next year, says Ralph Schneideman, a Telemedic vice president.
But there’s a lot more that could be done to deal with emergencies aloft in an era when flight attendents are no longer required to be nurses, as they were 50 years ago.
Congress, for instance, is considering legislation to set up government standards for tracking and handling in-flight medical emergencies, extend good Samaritan laws to the air and beef up medical kits, including requiring defibrillators.
The Air Transport Association is embarking on a program to standardize reporting of medical problems by airlines, says ATA spokesman David Fuscus. And flight attendants are pushing hard for more training in handling emergencies.
“We would like much-improved training,” says Mary Kay Hanke, international vice president of the Association of Flight Attendants, which represents 42,000 members.
Still, the bottom line up there in the potentially unfriendly skies is that medical care on board is hard to come by. That means, says Marty Salfen, senior vice president of the International Airline Passengers Association, that “if you have any type of medical condition, see a doctor prior to getting on the plane.”
And if you feel sick once you’re on board, “contact the flight attendant. Don’t wait until it’s virtually too late.”
Some tips for the flyer
Health and aviation specialists offer the following tips that may help protect against in-flight medical emergencies:
- If you have a serious medical condition, ask your doctor whether it’s safe to fly and what precautions to take if you do.
- If you get short of breath on the ground – from emphysema, anemia, cancer or other condition – recognize that this may get worse when you fly. On many flights, the cabin air pressure is equal to that at the top of an 8,000-foot mountain. This means your lungs must work harder to extract the available oxygen.
- If you will need oxygen on board, tell the airline at least 48 hours before your flight. You may have to pay $ 50 to $ 75 per tank or trip. (You can’t take your own because the tanks made for home use are not certified for use in aircraft. If improperly sealed or bumped, the oxygen, under high pressure, could leak and turn the tank into a missile.)
- Pack medications, including nitroglycerin for heart problems, inhalers for asthma, and epinephrine for allergies, in your carry-on, not in your checked luggage.
- If you have serious allergies or other life-threatening conditions, wear a medical alert bracelet.
- If you are seriously ill, travel with a companion who knows your medical history, including the drugs you are taking.
- Drink plenty of fluids – a glass of water per hour – to minimize dehydration. Don’t drink alcohol or caffeinated beverages, which are dehydrating.
- Move around as much as possible and do gentle stretches in your seat to minimize the possibility of a blood clot forming.
- Try not to fly if you have a cold. If you must, take whatever antihistamine or decongestant your doctor recommends to reduce sinus swelling. And be considerate of fellow passengers and flight attendants – cover your mouth when you cough, dispose of tissues in a bag, and wash your hands often.
- Recognize that flying is stressful, both emotionally and physically, so allow enough time to park and catch your flight.