Airline Responsibility for Inflight Medical Emergencies
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.
