The plane, the plane HEART ATTACK
at 30,000 feet

By Aaron Howard, RN
Illustrations by Malcolm Garris/PhotoDisc
April 3, 1998

An airline passenger with sudden cardiac arrest is the stuff of great television drama. In real life, the window of opportunity to save a person with a life-threatening cardiac dysrhythmia is measured in minutes. The Air Transport Association of America recorded at least 183 cardiovascular inflight emergencies in 1996, with 42 fatalities.

The odds of surviving a heart attack in the sky have improved—at least on some airlines—thanks to the introduction of automatic external defibrillators (AEDs). At present, American Airlines has equipped 242 of its aircraft with AEDs and plans to install defibrillators on all of its 640 planes by November. Three other carriers—United, Delta, and Alaska—have also announced plans to put defibrillators on board.

Easy to use

Advances in biomedical technology could mean defibrillators will become as standard as fire extinguishers on aircraft. The new generation of external defibrillators weigh as little as 4 pounds and are the size of a hard-cover novel. Instead of using rechargeable batteries, these AEDs are powered by long-life battery packs. The battery pack automatically performs a comprehensive self-test of the equipment’s readiness every eight hours. The device alerts the flight crew with visual and audible indicators when a fresh battery pack is needed.

Should You Volunteer to Help?

What if a passenger has an inflight cardiac arrest and a health professional volunteers to render aid? At present, any volunteer potentially could be sued because there’s no Good Samaritan law that covers airlines.

Various state laws provide liability protection for licensed nurses and other health professionals who stop at the scene of an accident to render aid. But airlines fly above any one state jurisdiction. And a health professional who acted in good faith could find himself or herself the target of a malpractice or liability claim months later.

Rep. John Duncan Jr., R-Tenn., has introduced a bill in Congress to protect airlines and individuals, including health professionals, from liability when acting in good faith during an air emergency. The airline industry supports the Duncan bill.

STATUS OF THE BILL

More important, the new generation of AEDs can be used by those without medical training. When attached to a passenger by electrodes, the AED senses cardiac electrical patterns and uses a computerized algorithm to interpret and make therapy decisions. The computer can discriminate between life-threatening ventricular dysrhythmias that should be shocked and other ECG patterns which do not require action. The Federal Aviation Administration (FAA) approved the use of biphasic external defibrillators in November 1996, and the Air Transport Association of America then consulted with physicians to evaluate the devices also.

"You don’t need to be an ICU nurse to use them," said David A. Fuscus, spokesperson for the Air Transport Association of America. "You hook the person up to the machine, and if they .

don’t need a shock, the machine won’t let you shock them."

Still up in the air

Individual airlines are currently evaluating AEDs. According to Continental spokesperson Karla Villalon, one concern is the cost of AEDs, $3,000 to $4,000. Another problem is legal liability. "We live in a litigious society where people get sued for everything," Villalon said. "There’s a liability question associated with having a defibrillator on board."

Airlines are watching the outcome of a suit against United in Boston federal court. The widow of a 37-year-old man who died of cardiac arrest during a United flight sued the airline for negligence because it didn’t have a defibrillator on board.

The airline industry doesn’t want aircraft to become emergency rooms. An airplane’s purpose is to provide safe transportation, not to be a flying hospital, according to American spokesperson Chris Chiames.

Training the crew

Under the current minimum standards, set by the FAA 12 years ago, flight attendants receive yearly CPR instruction as part of their continuing training. Airlines are also required to carry first-aid kits. However, these kits lack even the most rudimentary equipment for emergencies, such as resuscitation bags and IV equipment.

American is the first airline to commit to carrying AEDs on all its aircraft. Chiames says he expects all 20,000 American flight attendants to be trained on using the Heartstream ForeRunner AED by November.

"This type of defibrillator is essentially self-taught, user friendly, and doesn’t require a lot of technical or medical expertise to use," said Chiames. "Our flight crew pursers and lead attendants have already been put through the training, and we’ve received very positive response. One of the primary responsibilities of our flight attendants is passenger safety. They’ve seen how it can help in passenger problems."

American crews have used the on board AEDs to monitor passengers 39 or 40 times, Chiames said. And in February, an American flight attendant and a passenger who was a paramedic used the Heartstream ForeRunner to save a life. A 53-year-old passenger suffered cardiac arrest during boarding at Dallas/Fort Worth Airport. The defibrillator was used to deliver one shock, which cardioverted the passenger. The man was taken to a local hospital, where he later underwent a triple bypass. He is back home in North Carolina and doing well, Chiames said.

"We’re pleased we had the equipment available to help with the outcomes," Chiames said