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Health Law Blog

Flight Risk: The Problem with In-Flight Emergency Medical Kits

September 15, 2014

Last December, while en route to a vacation destination in the Bahamas, a physician I know answered a flight attendant’s request for assistance. The doctor, along with his wife, a fellow physician, and two other doctors who were also on board, came to the aid of a fellow passenger who was having a medical emergency. The gentleman was unconscious, unresponsive and had no pulse.

The four doctors needed to diagnose the problem and fast. They called for the in-flight emergency kit but when it was brought to them, they were surprised at how lacking it was. As my friend put it, “There was not a lot of equipment in it”.

As they attempted to help the ill passenger, time and again the doctors were disappointed by what they found in the in-flight kit. There was an automated external defibrillator (AED) which allowed them to rule out that the passenger was in defib but because the device wasn’t equipped with a telemetry read out, it didn’t tell them anything else. When the doctors, who between them shared 100 years of experience, hypothesized the passenger may be hypoglycemic, the emergency kit offered no way to check blood sugar levels. (They improvised by asking if anyone on board had a Tic Tac, putting it under the ill passenger’s tongue, and seeing if it made a difference. It did.) When they felt the passenger had stabilized sufficiently to safely continue to their destination, the doctors administered oxygen but, with only four bottles in the emergency kit, they barely had enough to get through the two hours that remained in their flight; they were forced to make decisions on how to cut back the flow in order to make what they had last. (As luck would have it, a winter storm had shut down much of the eastern seaboard making an emergency landing at a closer airport difficult.)

This doctor’s experience is not unusual. According to a study in The New England Journal of Medicine, an in-flight medical emergency occurs during one out of every 604 flights. That equates to two per day from flights departing from Toronto’s Pearson Airport alone. Issues regarding equipment found in in-flight emergency medical kits have been raised before. In 2002, for example, Dr. Alan Drummond of Perth, Ontario, called attention to the matter when he published On a Wing and a Prayer: Medical Emergencies on Board Commercial Aircraft in the Canadian Journal of Emergency Medicine in 2002.

Transport Canada requires aircraft with more than 100 passenger seats to carry an emergency medical kit but the list of required items isn’t always up to the job, putting passengers and the healthcare professionals who attend them in a difficult position.

There are better alternatives however. The College of Physicians and Surgeons of Ontario, for example, provides a suggested list of emergency office equipment that would be prudent for a physician to have in his office. This set of equipment does not take up a great deal of space yet is more useful in dealing with emergencies than the one suggested by Transport Canada.

Transport Canada, the airlines, and the flying public need to address this issue and review guidelines as to what constitutes an acceptable standard for inflight emergency medical equipment. As the doctor in the above story puts it, “For a little more equipment, that situation could have been more competently dealt with.”

Testimonials

Several years ago I was fortunate enough to have been selected as a Tremayne-Lloyd Fellow here at Western Law. I used the funds to finish a book and to begin work on a new one. It dawned on me far too late that I had never thanked you for that splendid gift. The new book is to be published by Harvard Press in 2010. The TTL Fellowships provided ritual seed capital for this project, which required me to spend a good deal of time and money at The National Archive in Washington. Again, with many thanks.

R. W. Kostal Professor of Law and History

Tracey Tremayne-Lloyd Health Law