By John Crewdson
 
WASHINGTON — An American Airlines non-stop flight from Boston to Los Angeles was an hour east of Denver on Thursday morning when
Michael Tighe’s heart began fibrillating wildly, no longer able to pump blood to his dying brain.

"I really don’t remember any of it. I was watching the movie and I passed out," Tighe, 62, said Friday from his bed in a Denver hospital after undergoing the airline’s first successful in-flight defibrillation.

As Tighe was being restored to life, on another American flight over central Nevada a physician was using cardiac drugs from the airline’s newly enhanced emergency medical kit to revive the dwindling heartbeat of a 73-year-old California man who had collapsed while reading a newspaper.

The two incidents, only a few minutes and perhaps 1,000 miles apart, provide a dramatic illustration of American’s pioneering efforts to treat critically ill passengers in-flight–and a telling refutation of the airline industry’s traditional maxim that it is always better to land the plane than to minister to sick passengers in the air.

Tighe and his wife, Dolores, a registered nurse, were well aware of what defibrillators can do. One of Tighe’s responsibilities, as communications director for the Boston Public Health Commission, is publicizing the city’s efforts to place automatic portable defibrillators like the one that saved his life in office buildings and hotels and on fire engines.

When they made their reservations for a trip to Los Angeles, where Dolores Tighe planned to attend a nursing conference and the couple hoped to visit one of their four daughters, the Tighes did not know American is currently the only U.S. airline that carries lifesaving defibrillators.

"It was just luck," said Dolores Tighe. "A lot of luck."

Since American began carrying the devices 18 months ago, they have been used to shock six passengers, of whom three, including Tighe, have survived. Tighe, however, is the first passenger whose life actually has been saved in-flight.

"I don’t like being that historic first," Tighe said with a chuckle. "But I’m grateful."

His wife was more than grateful. "It was a miracle," she said. "He was dead. He was dead. The fact that he’s alive is a miracle."

It was a greater miracle than she knew. Although American now has defibrillators on more than 400 of its wide-body transcontinental planes, they are still being installed on its remaining 200 narrow-body domestic jets.

According to American spokesman John Hotard, the Tighes’ plane was equipped with its defibrillator, a $3,000 Heartstream ForeRunner, only days before.

"The luck of the gods was with that man," said Dr. David McKenas, American’s medical director, who has spearheaded the airline’s upgrading of its onboard medical services.

Except for that singular coincidence, Michael Tighe would have died in the aisle of a Boeing 757 somewhere over the plains east of the Rockies.

"I had my feet on his lap," recalled Dolores Tighe. "He was watching the TV, and all of a sudden his arm swung out into the aisle, followed by his head. I knew something was wrong. I yelled at him, and he didn’t respond. I started hitting his face and calling his name, and he wasn’t answering me.

"I started screaming for help. I was hysterical. The flight attendants came, and they asked for help to get him down on the floor. Everybody was helping, passengers as well as flight attendants. It was obvious that he had stopped breathing and I couldn’t get pulse, so I started CPR."

When flight attendants arrived with the plane’s defibrillator, one of the new-generation portable machines the size of a laptop computer, Dolores Tighe didn’t recognize it at first. "All of a sudden this box appears," she said. "I had no idea what it was. They put the leads on him and shocked him. Each time he came back, and the last time he actually stayed. And then he began to respond and wake up. He kept trying to sit up. He had no idea who he was or where he was."

According to the Forerunner’s internal computer, which reads a patient’s heart rhythm and decides whether to transmit a strong burst of electrical current designed to normalize a fibrillating heart, only four minutes elapsed from the first shock to the last.

The next 30 minutes, until the plane landed in Denver, were described by Dolores Tighe as the longest of her life. "They had called for an emergency landing by that time," she said. "We just had to wait to get to an airport so we could land. It seemed like it was taking forever."

As she waited, Dr. John Roche, a surgical resident from the University of California at Davis who was en route from Sacramento to Dallas aboard American Flight 1158, was answering a call for a physician from flight attendants who had discovered an unconscious passenger in the cabin.

"He had no pulse and no blood pressure," said Roche, who connected the passenger to that plane’s defibrillator, which also contains a small cardiac monitor.

The monitor showed not a ventricular fibrillation, as it had with Michael Tighe, but a dangerously slow heart rhythm of 40 beats a minute.

No shock was advised by the machine. But Roche, viewing a picture of the man’s heart rhythm on the screen, was able to diagnose his condition as hypotensive bradycardia, a condition that also results in death if not quickly treated.

The prescribed treatment for bradycardia is a heart stimulant, atropine, which is commonly available in hospital emergency rooms but not on airplanes. Roche’s plane, however, was one of 300 on which American so far has installed enhanced emergency medical kits that contain a much wider variety of medicines and equipment, including intravenous needles and tubes, than airlines are required to carry by federal law.

"I put in an IV," Roche said, "and I gave him 1 milligram of atropine. At that point, I got his heart rate up to about 60, and he developed a blood pressure and regained consciousness."

By the time the flight made an emergency landing in Las Vegas, the passenger "was doing fine," Roche said. But without the IV equipment and the atropine, he said, "he definitely could have died."

American is so far the only U.S. airline to carry enhanced medical kits, which have been available for years on many European and Asian airlines. The kits contain drugs to treat cardiac arrest and a wide variety of other acute conditions, including diabetes, congestive heart failure, seizures, asthma, postpartum bleeding and allergic reactions.

Hotard said the enhanced kits so far have been opened 14 times, but until Thursday only for non-life-threatening conditions such as abdominal cramps, nausea and acute asthma attacks–conditions that can nevertheless cause distress and discomfort for passengers and which, untreated, often result in emergency landings that inconvenience passengers and cost airlines money. McKenas recalled a case last month in which a young woman aboard a flight bound for Chicago experienced a severe asthma attack.

"I was the physician on the radio," McKenas said, "and we were very close to advising the captain to divert since her vital signs were so abnormal. Luckily, that plane had an advanced kit, and I ordered that the kit be opened. She used the Ventolin inhaler, with such great improvement that a diversion was avoided."

McKenas said that the airline’s entire fleet will be fully equipped with defibrillators and enhanced medical kits by March. "This has been a huge undertaking, but with very great rewards," he said. "All it takes it one phone call to a passenger’s family who survived a cardiac arrest through these efforts to know it is more than worth it."

The enhanced medical kits cannot be opened by flight attendants without a physician present or an order from an American physician on the ground. But nearly all of American’s 24,000 flight attendants have been trained to use the defibrillators even without a physician’s order.

Last month, a 70-year-old passenger aboard another Chicago-bound plane was successfully defibrillated by an American flight attendant while the plane was waiting to take off from North Carolina’s Raleigh-Durham airport.

"It said to push that button, and that’s what I did," recalled the flight’s purser, Ray Baylis, who was among the first flight attendants trained to use the machines when they went into service in July of last year.

"It’s nothing to be afraid of," Baylis said. "It’s the best friend we’ve got on that airplane. I am so thankful American put it on board. It saved this man’s life."

News of American’s second and third successful defibrillations was quickly passed by the airline to Robert L. Giggey, who last February was headed for a Mexican vacation with his wife, Carmen, when he suffered a cardiac arrest on the runway at Dallas-Ft. Worth Airport.

"They called me and told me," said Giggey, who owns a small manufacturing company in Mebane, N.C., and recently returned to work after a quadruple heart bypass.

"I was very happy to hear that," he said. "If they had not done this with these machines, of course I would not be here either. I was the first, but the big thing is I’m alive."

Current federal regulations require airlines to carry only minimal emergency medical equipment: a stethoscope and a blood pressure cuff, two medicines for treating acute allergic reactions, nitroglycerine tablets for angina sufferers, and dextrose for diabetic passengers who accidentally take too much insulin.

American’s chief competitors, Delta and United, initially said they, too, would begin carrying defibrillators and enhanced medical kits this past summer. Both airlines now say they have delayed their plans and will begin installing the machines early next year.

A spokeswoman for Northwest Airlines, the nation’s fourth-largest commercial carrier, says that it "more likely than not" will also begin carrying defibrillators but that "we’re still evaluating the equipment."

Other airlines that have begun carrying defibrillators or have announced plans to do so include Varig, the Brazilian airline, Hong-Kong based Cathay Pacific, Air Zimbabwe, Finnair, Alaska Airlines and Hawaii’s Aloha Airlines.

Last month, Karen Henser, a British flight attendant with Emirates Airlines, used a defibrillator to save the life of a passenger on a flight from Dubai, United Arab Emirates, to Karachi, Pakistan. "I was nervous at first," Henser was later quoted as saying, "but then my training just took over and everything went smoothly."

In December 1997, flight attendants for London-based Virgin Atlantic Airways, which has carried defibrillators for years, successfully revived a 73-year-old Scottish tourist, Alex Tweedie, aboard a flight from London to Miami.

After recuperating for two weeks in Charleston, S.C., Tweedie returned home to Scotland to see his newborn granddaughter for the first time. Reached Friday at his home in Nairn on Scotland’s north coast, Tweedie, who is now 74, said: "I’m doing fine. Everything’s perfect. Just lovely.

In the last 18 months, American has deployed its defibrillators nearly 100 times, though in most instances only as a heart monitor.

According to Hotard, on 14 of those occasions, by showing a non-life-threatening heart rhythm, the monitor helped to prevent an unnecessary emergency landing. In eight other cases, he said, it helped airline medical personnel decide to divert the plane.

While defibrillators are useless in treating heart attacks, other drugs and treatments are available. But these depend on a correct diagnosis of a heart attack in progress, which can only be provided by a cardiac monitor more sophisticated than those built into the portable defibrillators.

The Australian airline Qantas, which pioneered the use of in-flight defibrillators in 1992 and has saved the lives of at least two of its passengers, recently announced it would begin carrying hospital-style cardiac monitors next year.

Because U.S. airlines have not been required to record or report in-flight medical emergencies, the paucity of data has made it impossible to know with any precision how often airline passengers get sick or die in the sky.

In April, President Clinton signed the Aviation Medical Assistance Act, which requires some 30 domestic airlines to begin reporting passenger medical emergencies to the Federal Aviation Administration. It also requires the FAA to decide by next year whether to make it mandatory for U.S. airlines to carry defibrillators.

In a 1996 report, "Code Blue: Survival in the Sky," the Tribune estimated the annual number of in-flight deaths at between 114 and 360–more deaths, on average, than result from aircraft accidents.

Although older passengers get sick more often than younger ones, cardiac arrest, which kills an estimated 350,000 to 400,000 American each year, often strikes those with no prior symptoms of heart disease, as in the case of Michael Tighe.

While her husband was being defibrillated by the flight attendants, Dolores Tighe recalled, two physicians who happened to be passengers aboard the plane started asking her questions about his medical  history. "And he really doesn’t have a medical history," she said.

"He exercises every day. He runs a lot. He takes care of himself. We  thought he was in relatively good shape."