When a New York woman died aboard an American Airlines flight returning from Haiti last month, her death raised concerns among passengers about the level of medical treatment available at 9,000m.
An inquiry is still under way in the death of Carine Desir, 44, aboard American's Flight 896 on Feb. 22, but it has already prompted airlines and passengers to review the current protocol.
What happens if a passenger has a heart attack onboard? How well-equipped is the plane? What kind of training does the flight crew have?
Medical emergencies happen on planes more often than you might think. MedAire, a Phoenix company that provides cabin crews with medical advice, received 17,084 in-flight calls last year. Most were minor in nature, involving fainting or an upset stomach.
But 649 planes were diverted for medical reasons and 97 people died onboard, according to the company, which advises 74 commercial carriers, including Continental, JetBlue and Virgin America.
"We fly more than a quarter-million people a day on average, which would easily fit a medium-size city," said Tim Smith, a spokesman for American. "Just about anything that can happen on the ground can and will happen on an aircraft."
So how prepared are the airlines for medical emergencies? It depends on the carrier. The Federal Aviation Administration's rules are pretty thin: Planes are required to be equipped with a first-aid kit, a defibrillator and, for all but the smallest planes, an emergency medical kit that includes a stethoscope, needles, epinephrine and an intravenous set.
But beyond being trained in basic CPR, and being drilled every 24 months on how to use a defibrillator, flight crews aren't required to know much more than where the medical equipment is kept. A 2006 FAA advisory states, "Flight attendants should not be expected to administer medications or to start IVs."
Candace Kolander, a flight attendant and the health coordinator at the Association of Flight Attendants, said: "Although we have the equipment onboard, the reality is we aren't trained as medical hospital personnel. In reality, it's minimal first aid."
Attendants can open a first-aid kit to dole out bandages, and they can administer oxygen and use the defibrillator. But they are not supposed to use the stethoscope and syringes, or even administer aspirin without the direction of a medical professional. Rather, they are typically instructed to call upon medically trained volunteers from the cabin.
So, in the event that a medical crisis strikes in the sky, passengers are generally at the mercy of who happens to be onboard.
"People think they have the same resources in the air as they do when they call 911, and it's just not that way," said Joan Sullivan Garrett, the founder of MedAire. "They're ignorant of the fact that there are many challenges of flying outside of their control."
What happens, for example, if a passenger experiences cardiac arrest? Getting the passenger to a hospital may seem like the obvious priority, but which hospital and how are tough questions: Should the plane be diverted to the nearest airport? Is that runway long enough? Is it faster to proceed to the planned destination? How urgent is the condition?
These weighty decisions are ultimately left up to the pilot.
Although the FAA doesn't require it, most US airlines contract with companies like MedAire or medical institutions like the Mayo Clinic for medical counsel from doctors on the ground for flight attendants and pilots - albeit remotely. Some go further: American has its own in-house doctors who provide medical direction to flight crews.
But no matter how knowledgeable the doctor, the medical care is limited by distance.
"We're often getting the story told to us from the passenger, maybe to the flight attendant, maybe to us," said David Claypool, a medical director at the Mayo Clinic Medical Transport, which advises Northwest Airlines and other clients. "We're working on experience and gestalt."
Perhaps better medical judgment can be deployed before the plane takes off. For instance, if gate agents notice that a passenger in the boarding area is in distress, coughing uncontrollably or writhing in pain, they can alert their airline and consult with on-call medical professionals to determine whether the passenger poses a risk. A passenger with full-blown chicken pox, for example, may be denied boarding.
But there is a flip side to empowering flight crews to play the role of public health officials. Discrimination lawsuits, for example, have been threatened against airlines that ejected passengers with HIV.
It's also generally up to the crew to make the difficult decision about what to do with a body in the event of a death onboard. Last year, a first-class passenger on a British Airways flight from New Delhi to London woke up to find himself sitting near a corpse. The airline later said that an elderly woman from the economy section had died after takeoff, and the body was moved to first class, where there was more space for family members of the deceased to grieve with more privacy.
Some airlines offer more training and carry more medical equipment onboard than others. American, for example, has offered defibrillators onboard since 1997, long before the government required airlines to carry them.
On April 26, The Lancet published a letter from two doctors at Taichung-based China Medical University Hospital (CMUH) warning that “Taiwan’s Health Care System is on the Brink of Collapse.” The authors said that “Years of policy inaction and mismanagement of resources have led to the National Health Insurance system operating under unsustainable conditions.” The pushback was immediate. Errors in the paper were quickly identified and publicized, to discredit the authors (the hospital apologized). CNA reported that CMUH said the letter described Taiwan in 2021 as having 62 nurses per 10,000 people, when the correct number was 78 nurses per 10,000
As we live longer, our risk of cognitive impairment is increasing. How can we delay the onset of symptoms? Do we have to give up every indulgence or can small changes make a difference? We asked neurologists for tips on how to keep our brains healthy for life. TAKE CARE OF YOUR HEALTH “All of the sensible things that apply to bodily health apply to brain health,” says Suzanne O’Sullivan, a consultant in neurology at the National Hospital for Neurology and Neurosurgery in London, and the author of The Age of Diagnosis. “When you’re 20, you can get away with absolute
May 5 to May 11 What started out as friction between Taiwanese students at Taichung First High School and a Japanese head cook escalated dramatically over the first two weeks of May 1927. It began on April 30 when the cook’s wife knew that lotus starch used in that night’s dinner had rat feces in it, but failed to inform staff until the meal was already prepared. The students believed that her silence was intentional, and filed a complaint. The school’s Japanese administrators sided with the cook’s family, dismissing the students as troublemakers and clamping down on their freedoms — with
As Donald Trump’s executive order in March led to the shuttering of Voice of America (VOA) — the global broadcaster whose roots date back to the fight against Nazi propaganda — he quickly attracted support from figures not used to aligning themselves with any US administration. Trump had ordered the US Agency for Global Media, the federal agency that funds VOA and other groups promoting independent journalism overseas, to be “eliminated to the maximum extent consistent with applicable law.” The decision suddenly halted programming in 49 languages to more than 425 million people. In Moscow, Margarita Simonyan, the hardline editor-in-chief of the
RSS