by Kathleen Doheny
July 25, 1999 At a press conference two years ago during a cardiologists’ convention in Anaheim, officials from Qantas Airways demonstrated how a portable defibrillator the size of a laptop computer could deliver an electrical shock to restore a heart’s normal rhythm after cardiac arrest. The officials from the Australian airline predicted that American carriers would soon follow their lead in putting defibrillators on board.
The forecast is becoming reality.
American Airlines was the first major U.S. carrier to begin stocking AEDs (automatic external defibrillators) and is now fully equipped, as is Delta Air Lines’ fleet. United Airlines plans to begin stocking the devices on all flights soon. US Airways hopes to be fully equipped by the end of this year. Representatives of Continental and Southwest say those airlines are still researching the question.
In May, Chicago’s O’Hare International and Midway airports became the first in the country to make AEDs available for emergency public use in their terminals. Thirty-three AEDs have been installed on the walls in public areas at O’Hare and seven at Midway, says Monique Bond, an O’Hare spokeswoman. As of last week, none had been used.
One reason for the quick spread of the battery-operated devices is a decline in their cost, say spokeswomen for two leading manufacturers, Hewlett-Packard Heart-stream, which makes the Forerunner, and Medtronic Physio-Control, which sells the Lifepak 500 AED. A unit typically costs about $3,000, but large orders usually get a substantial discount.
Soon airlines and airports may have no choice about whether to buy the devices. The Federal Aviation Administration is under a congressional mandate to decide whether the AEDs should be mandatory on air carriers and at airports. The decision, due in November, will be based on the FAA’s collection of data on how many passengers die aloft each year and from what causes.
Cardiac arrest occurs when the heart experiences fibrillation, a chaotic electrical activity. To operate the AED, the user places the electrode pads on the victim’s bare chest and lets the unit analyze the rhythm, says Margaret Annabel, a spokeswoman for Hewlett-Packard. "It will alert you whether to give a shock," she says.
While the AEDs are simple to operate, the airlines and airports put their employees through training. The American Heart Assn. and the American Red Cross now include AED training as part of, or in addition to, their CPR classes, which are open to the public.
Putting the devices on every plane is no small undertaking for an air carrier. United Airlines will spend about $12 million on the project, including training of its flight attendants.
So how common are in-flight medical problems?
In a survey released last year, the Air Transport Assn., the trade organization of major airlines, looked at the 1996 trip reports of nine leading carriers and found that only one in 58,000 passengers had a medical problem. Of the 10,471 "medical events" reported in the survey, chest pain, heart attack and dizziness were among the more common.
According to the American Heart Assn., about 250,000 people a year in the U.S. die from sudden cardiac arrest, and about 50,000 could behave with expanded availability of defibrillators. For cardiac arrest that happens outside a hospital, the survival rate is 5% or less, according to the heart association.
"For every minute of cardiac arrest, a person’s chances of survival go down by 10%," says the association’s Berna Creel. "The first three or four minutes is the real window of opportunity."
AEDs aloft are "long overdue," says Hal Salfen, director of consumer affairs for the International Airline Passengers Assn., an organization of frequent fliers.
Since American Airlines first began to equip its planes with AEDs, the devices have been brought out about 130 times, according to John Hotard, an airline spokesman. That includes hookups for other purposes, such as getting an electrocardiogram readout. Of eight American Airlines passengers who were given shocks to restart their hearts, six survived; the two others died en route to the hospital.
Liability issues are a concern. Under the Aviation Medical Assistance Act of 1998, a "medically qualified individual," such as a physician or paramedic, who assists during in-flight medical emergencies, cannot be held liable for damages in civil courts unless he or she is found guilty of gross negligence or willful misconduct.
On the ground, the issue of liability for those who try to help in emergencies varies from state to state. Many states have "Good Samaritan" laws, which relieve the helper of responsibility for damage if he or she acts in good faith. In California, a bill passed by the legislature and sent to the governor earlier this month extends Good Samaritan protections to those who use an AED in an emergency if they have completed a basic certified CPR and AED course.
Healthy Traveler appears on the second and fourth Sundays of the month.