Accident & Injury Advice

In-Flight Medical Emergencies Spell Trouble

by Tom Stilwell on February 25, 2020

In-Flight Medical Emergencies often require ground consultants

WHAT HAPPENS WHEN THERE IS A MEDICAL EMERGENCY ONBOARD AN AIRLINE FLIGHT?

A medical emergency during an airline flight create difficult situations for passengers and flight crews. The flight crew possesses limited medical training and limited emergency supplies. While passenger health and safety should come first, the costs of diverting an aircraft cause airlines to try to avoid emergency landings.

HOW OFTEN DO IN-FLIGHT MEDICAL EMERGENCIES OCCUR?

In one interview, a FAA spokesperson admitted that the FAA learns of in-flight medical emergencies every day.  However, the true number of in-flight medical emergencies experienced by airlines is difficult to determine.  There is no consensus on what defines an in-flight “emergency.” Additionally, the FAA has not established a regulatory mandate for airlines to collect or report these events.

According to an article published by the American Medical Association, in-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 medical emergencies per 1 million passengers. A study published in the Western Journal of Emergency Medicine noted that MedAire, a medical assistance company that supports several commercial airlines in the United States, responds to an average of 17,000 cases per year.

Suffice to say that in-flight medical emergencies occur frequently enough that airlines should have the training and equipment present to deal with the most common occurrences.

DOES FLYING CONTRIBUTE TO MEDICAL EMERGENCIES?

Flying does increase stressors on the physiology of a person that can contribute to medical complications.  While airlines pressurize their cabins, the cabins are not pressurized to “sea level.”  Rather, the airlines actually pressurize their cabins to the equivalent of 6,000 to 8,000 feet elevation, roughly the equivalent of Aspen, Colorado.  Additionally, the circulated air system on an airline contains less humidy (the air is dryer) than typical at ground level.  Thus, it is not surprising that some passengers experience symptoms of altitude changes when flying.

Fainting, light headedness, gastro-intestinal upset, respiratory symptoms, chest pains, and cardiovascular events are among the most widely reported in-flight medical emergencies.

Passengers with underlying issues, such as respiratory issues, cardiovascular issues, are at an increased risk for developing an in-flight medical event.  The Western Journal of Emergency Medicine reports that conditions such as “congenital and valvular heart diseases, symptomatic coronary heart disease, decompensated heart failure, sickle cell disease, and obstructive sleep apnea” may be exacerbated by the high-altitude cabin conditions on an airplane.

WHAT MEDICINE DO AIRLINES CARRY FOR MEDICAL EMERGENCIES?

Commercial flights are required to carry potentially life-saving medical equipment, but that does not necessarily mean that flight attendants or other crew can provide serious medical care.  The FAA requires aircraft (those weighing 7,500 pounds or more passengers with at least one flight attendant) to possess an automated external defibrillator (AED) and an enhanced medical emergency kit. The FAA considers the AED and the medical kit “no-go” items, meaning that a flight is not allowed to depart without them.

Iin-flight medical emergency kit


The emergency medical kit includes medications such as antihistamines, epinephrine, analgesics, first-aid supplies and other medical equipment including stethoscopes and syringes.  Notably, the medical kits are not required to possess equipment for obstetrical or pediatric emergencies.  Nonetheless, the Airlines have the flexibility to enhance the contents as they see fit.

Non-US airlines have different minimum requirements, and individual airlines vary widely in the contents of their emergency medical kits. European airlines are not currently required to carry AEDs onboard.

WHAT MEDICAL TRAINING DOES THE FLIGHT CREW RECEIVE?

Airline medical emergency training often concentrates on recognizing and reacting to serious medical issues. During an in-flight medical emergency, a flight attendant often becomes the person who solicits help either from the pilots and flight crew, from other passengers who are flying, or from medical professional consultants on the ground.

In the 1930s, flight attendants were usually also nurses. Today, flight attendants only receive basic medical emergency training and cpr. Additionally, the flight crew is trained on the location and operation of the AED. However, the FAA does not mandate or require a standard curriculum for training of flight crews.

Flight attendants will be involved in all in-flight emergencies. They are familiar with both the aircraft and the airline emergency procedures. They are the primary contact with the cockpit, can assist in recruiting additional health care volunteers and can help create sufficient space for patient management.

AIRLINES RELY ON GROUND BASED SUPPORT.

Recognizing that an airline cannot count on a doctor or nurse being among the passengers on a flight, most airlines contract with a ground-based consultation service. Ground-based medical consulting companies, such as Stat-MD, Inc. and MedAire, Inc., support most major airlines. The primary role of these telemedicine companies is to assist in medical decision-making by advising on-board medical volunteers. They also provide guidance to pilots regarding diversion decisions and can recommend locations for diversion depending on the patient’s status.

When an in-flight medical emergency occurs on an aircraft, a flight attendant notifies the pilot in command. Next, that pilot establishes radio or satellite telephone communications with the ground-based medical support center and the airline operations center. The flight attendant relays information to and from ground-based support via the pilot or through headsets in the cabin.

WHO IS COVERED UNDER “GOOD SAMARITAN” PROTECTION?

The Aviation Medical Assistance Act of 1988 protects passengers and medical professionals who respond to and render aid during an in-flight medical emergency. So long as the passenger acts in good-faith without gross negligence, the passenger possess no liability for the consequences or results of the aid he or she provides. This same law protects the airline from liability (1) from trying to solicit assistance from medically trained passengers and (2) from the aid provided by the passenger(s) who respond.

In the United States, there is no statutory requirement that a health care provider or medically trained passenger respond to an in-flight medical emergency. That’s not necessarily true all over the world. For example, licensed health care providers traveling in the European Union do have a mandated responsibility to respond to these events.

HOW DO AIRLINES DECIDE WHEN TO PERFORM AN EMERGENCY LANDING?

Although the benefit of diversion is sometimes clear, such as for a passenger who has been resuscitated after cardiac arrest or who has new-onset stroke symptoms, some cases of diversion require balancing multiple factors including the passenger’s condition. In one study, in-flight medical emergencies that most frequently resulted in diversion included cardiac arrest, obstetric emergencies, cardiac symptoms, and suspected stroke.

The decision whether or not to land the plane in the event of a medical emergency ultimately rests with the pilot of the aircraft. Any other persons involved in an in-flight medical emergency are offering recommendations rather than making decisions about diversion. To make these decisions, the pilot relies largely on the opinion of ground-support physicians.

The passenger’s medical status is not the only factor that pilots and airline staff will consider. It costs money to conduct an emergency landing and there are operational delays involved.

Any time a flight diverts it is costly. When a 2016 Hawaiian Airlines  flight turned around due to a drunk passenger it cost the airline roughly $150,000, according to personal-finance and travel website The Points Guy. That included the cost of fuel, a new in-flight crew, ground crew, getting passengers on new flights and meal vouchers. When a diversion happens for a medical reason, the airline shoulders the cost.

WHAT SHOULD YOU DO?

Medical professionals caution that if you know you have underlying health issues, particularly if you have respiratory issues or cardiovascular issues, it’s probably a good idea to touch base with your primary care health care provider before you fly. You should ask your physician if there are any sort of strategies that can help mitigate any sort of in-flight medical events. For example, passengers were patients who need supplemental oxygen while they’re on the ground may need to increase that oxygen while they’re in flight.

Additionally, all travelers should hydrate often and eat scheduled meals and snacks during travel, especially with connecting or extended flights.

Passengers who believe they are having a medical emergency during a flight should notify flight staff immediately. Alerting the captain means that the incident will be on the record. Additionally, it can help expedite care onboard the plane from other passengers who are doctors or flight attendants.

If you or a family member experienced an in-flight medical emergency, and you have questions about the response of the airline, call the Stilwell Law Firm at 713-931-1111 for answers.  We specialize in airline aviation claims.

How to Get Wheelchair Assistance from an Airline

by Tom Stilwell on February 15, 2020

Airports are large places.  What do you do if you need assistance getting to your flight?  What do you do if you need assistance transferring from one flight at one gate, to a connecting flight at a different gate? What if you need a wheelchair due to your age, your medical conditions, or a disability? The Air Carrier Access Act imposes duties on the airlines to provide wheelchair assistance and makes them responsible for airport wheelchair injuries.

For travelers with mobility issues, it can be a daunting task to get from the airport curb to the boarding gate.  It can also be daunting to move from one flight to another, especially when the flights leave from different gates or – worse – from different terminals.

THE AIR CARRIER ACCESS ACT

The Air Carrier Access Act (“ACAA”) requires all United States airlines to provide free wheelchair access to any traveler who asks for it, without requiring a description or documentation of that need.  Airline wheelchair assistance may include the provision of a wheelchair, provision of an electronic cart for longer distances, and provision of an attendant to help push the passenger through the airport.

Travelers should note that the Air Carrier Access Act was enacted by the United States and its protections do not apply to all flights in the world. Specifically, the ACAA applies only to the following flights:

  • Any flight departing from an airport in the United States, regardless of carrier.
  • Any flight arriving to an airport in the United States, regardless of carrier.
  • Any flight operated by an air carrier registered in the United States of America – this includes flights between two international destinations. For example, a Delta Airlines flight between Tokyo and Singapore would be subject to the ACAA, because Delta Airlines is a U.S. flagged carrier.

Foreign airlines must offer the same service for passengers departing from or flying to the United States. For example, the ACAA would NOT apply to a British Airways flight between London and Barcelona, but would apply to a British Airways flight between London and Houston or vice versa.

Note that the ACAA makes the carrier who delivers you to a connecting airport responsible for assistance in making flight connections and transportation between gates.

AIRLINES ARE REQUIRED TO HAVE A CRO – COMPLAINT RESOLUTION OFFICER

If you have any problem before or during your flight, ask to speak with your airline’s Complaint Resolution Officer (CRO).  All airlines in the United States are required to have a CRO on duty in each airport either in person or via telephone.  It is their job to resolve disability related issues, especially with regards to airline wheelchair assistance.

REQUEST A WHEELCHAIR OR CART ASSISTANCE IN ADVANCE

So how does a airline passenger arrange for wheelchair or cart access?

When you book your ticket, ask the airline to have a wheelchair or cart available on your travel date.  This request will be added to your travel record and will allow the wheelchair to be available when you arrive at the airport.  If your airport has skycaps at the curb, you can request a wheelchair from them to get you through security and to the gate, but it is far better to make a wheelchair reservation in advance when you book your ticket. The documentation of your request for airline wheelchair assistance will help you if you encounter problems getting service during your travel.

After you check in at the gate, be sure to ask the desk agent make arrangements to have a cart or wheelchair available at your transfer point and/or final destination. The airline is supposed to provide your wheelchair or cart needs to all connecting flights and returning flights, but asking the gate agent to ensure it is transmitted may save you time and headaches along the way.

CONTRACT WHEELCHAIR ASSISTANCE

In this day and time, most airlines contract with companies to help travelers by offering wheelchairs to get around in an airport.  This may include helping mobility challenged travelers through a security checkpoint.  if the airline contracts with a service to provide wheelchair and mobility assistance, the airline remains responsible for the passenger’s assistance.

Larger airports usually have motorized carts available for those who can’t walk long distances or need help to get to a gate quickly to make a flight.

Tell your wheelchair attendant what you can and cannot do.  If you need to make a restroom stop, the attendant will take you.  However, attendants are not required to assist you with bathroom or medical needs.

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