Reporting on Medical Emergency Preparedness of U.S. Airlines

“Journalists who can amass and interpret data can cover more of the world in a short time than reporters who just spill prose based on what they see” – Tim Berners-Lee, Inventor of the World Wide Web.

In the late 90’s John Crewdson from the Chicago Tribune took up the mammoth task of computing the medical emergency preparedness of U.S. airlines.

He compiled data on the number of airline passengers that died each year on U.S. flights despite the presence of doctors (who were passengers) because planes were not equipped with electronic defibrillators and circulatory drugs.

He computed the costs of equipping every airplane in the U.S. with defibrillators and basic medical kits would cost a total of $56 million over ten years ($4,100 per airplane) and this would mean hiking every airline ticket by two cents.

Partly because of Crewdson’s reporting, U.S. airlines are now required to have medical devices on board.

To report on cases of unpreparedness of U.S. airlines Crewdson had to look into the data by the Federal Aviation Administration (FAA). The FAA limits information on these incidents by the following means:

  • Simply Underreporting
  • Variable Data Quality
  • Inability to determine what happens to the patient-passengers when they leave the airplane

In the United States, an airline is only required to report an incident to the Federal Aviation Administration (FAA) when a passenger dies or if the plane is diverted due to a death or medical emergency.

According to a 2013 report by the New England Journal of Medicine, as many as 2.75 billion people fly on commercial airlines each year and medical emergencies occur only once in every 604 flights. This works out to 44,000 in-flight emergencies a year and nearly 50 a day in the USA alone. Fewer than 1 percent result in death, according to the retrospective look at nearly 12,000 in-flight medical cases.

Doctors who happened to be passengers on the flight handled passenger emergencies in 48% of the cases studied. Nurses provided volunteer emergency care in an additional 20% of cases.

Statistical analysis Outcomes of Medical Emergencies on Commercial Airline Flights — NEJM

Cardiac arrests or heart attacks were the most common cause of death on planes — 36 people died over the period of the study, and 31 were from cardiac arrest.

The FAA which looks into the medical supplies that airlines must have on board, last updated its regulations in a 2001 mandate, requiring majority of U.S. registered commercial aircrafts to carry automated external defibrillators. These defibrillators are used to shock the heart back into a normal rhythm, apart from this some additional medication and equipments were added to the medication kits.

The required medications include: a non-narcotic pain killer; IV fluids for dehydration or low blood pressure; an antihistamine to treat allergic reactions; an inhaler for asthma; aspirin and nitroglycerin for a heart attack; IV dextrose for low blood sugar; epinephrine for allergic reactions or asthma; and epinephrine, atropine, and lidocaine as an adjunct to CPR. The kits must also contain a stethoscope and a manual blood pressure cuff as well as some other supplies.

The size of the problem is not known and the risks involved are hard to estimate. Airlines have not been required to monitor medical incidents or notify a central register. Furthermore, there is no clear definition of an “incident” or “emergency,” and this leads to wildly inconsistent data. Does this definition include diarrhea and vomiting, or a faint? These are the most common conditions in flight for which medical help is sought (M Bagshaw, personal communication).

In sum, there is limited information on the incidence and characteristics of in-flight medical emergencies. To think of collecting data on them and computing them to report (back in the 90’s) on the lack of medical emergency supplies in U.S. airplanes is essential. Thus re-enforcing the need for integrating statistics into journalism.

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