I just finished reading news that American Airlines is being sued by the family of a woman who died on board a flight from Hawaii. I won’t recount the all details here, but it seems she fell ill, a doctor on board recommended that the flight be diverted, he was overruled, the woman died, and the equipment on board was inadequate to revive her. Of course, that’s assuming she was revivable. The news account reported she died of a pulmonary embolism (PE), a blood clot traveling to the lungs. The death rate for a massive PE that requires CPR is about 75% in one study. But that is for the lawyers to debate. Reading the article prompted me to recall some of my experiences responding on airplanes as “the doctor on board.”
Flying several miles in the air with limited resources available makes responding to a medical emergency on a flight akin to practicing wilderness medicine. The airlines, I’m sure, want all of their passengers to arrive safely. The most prudent thing would be to divert every plane with a medical emergency to the nearest airport, but with roughly one in every six hundred flights having a medical emergency on board, roughly 80,000 flights a day in the United States, and an average cost per diversion of $100,000, it would cost $13,000,000 a day to divert them all. And that is discounting the cost of the inconvenience to the thousands of people who are also on those flights. So diversion is going to be a rare event. The FAA requires airlines flying in the US to have a basic medical kit that includes airway supplies, an inhaler plus seven other medications, and “basic instructions” for using the medications. Responders can advise the captain whether or not to divert, but ultimately it is the captain’s decision.
I’ve responded to three in-flight medical emergencies….
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