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DOCTORS responding to in-flight medical emergencies may have to wait another year before standards regarding the provision of medical kits on planes are in place.
There is currently no Australian legislation requiring airlines to have a medical kit, or to standardise the contents of the kits. Instead, individual airlines have discretion about the medical equipment they provide, according to the Civil Aviation and Safety Authority (CASA).
Proposed regulation of mile-high medical kits has been under way for more than 3 years, but industry consultation is ongoing and implementation is not expected until 2012.
Under the new rules, there will be mandatory requirements for planes to carry first aid kits and emergency medical kits, with inclusions recommended by CASA. However, the specific contents will not be legislated due to the speed of medical advances and the difficulty in changing regulations.
A CASA spokesman said the new medical kit rules were a small part of a large piece of regulatory reform, which had been delayed due to the huge consultative process and legislative drafting issues.
“But we understand that the better the equipment on board, the better the doctors can do what they need to do,” he said.
JAMA has raised concerns about the quality of in-flight medical care and equipment, with the release of a four-step proposal to improve in-flight medical care, written by two American doctors. (1)
Doctors in America who responded to in-flight emergencies faced challenges such as inconsistent or ill-equipped medical kits, inadequate support from flight attendants and cramped physical conditions, the authors said.
The proposal calls for mandatory reporting of all in-flight medical emergencies and systematic debriefing of anyone involved in the incident. “Collecting these records and disseminating lessons learned may help improve the care given”, they said.
A standardised first aid kit should be available on all flights, the authors said. The optimal contents of this kit would be based on expert consultation and the results of the mandatory incident reporting.
The proposal also recommends standardised access to on-the-ground medical support and improved training of flight attendants. In Australia, all flight attendants are required to have first aid training.
The JAMA authors said that key concepts in the quality health care movement, such as root cause analysis, actually originated in the aviation industry and helped improve flight safety. However, these approaches had not been applied to the medical care provided to airline passengers.
– Sophie McNamara
1. JAMA 6 May 2011 (Online first)
Posted 9 May 2011
I managed to fall asleep on a singapore airlines flight (a rarity for me) only to be woken by an insistent flight attendant asking me to help some guy with a broken tooth.
As it turned out, this guy got endocarditis last time this happened – after an extensive search thru the medical kit, there were no antibiotics, so I suggested they ask passengers over the PA for some antibotics. The cabin manager refused as this would disturb the passengers! I did point out that they had no issue waking my wife and myself. No thanks, No upgrade, a waste of time – next time will probably tell them i’m on holidays so bugger off!
I responded to a call on a Qantas flight from LA to Sydney in November, 2009. I was able to insert an IV cannula, however the contents of the medical ‘kit’ definitely required upgrading. Since then I have made several attempts to contact the key person at Qantas who is responsible for medical equipment. I receive more letters of appreciation but never the reply that I want…. to whom do I talk?!
I recently looked after a woman with a bowel obstruction on Singapore Airlines, flying to London. The flight attendants had no idea what was in their kits but I found lots of equipment and drugs, and was able to put up IV fluids and give IM buscopan and maxolon. There was no analgesia other than voltaren so I wouldn’t have wanted to look after someone with renal colic. I was much appreciated and upgraded on the way home, but poor hubby had to stay back in cattle class which I thought a bit lousy given I had saved a huge cost of plane diversion.
Many years ago I helped at an in-flight medical emergency. Because of the non-existence of ANY medical equipment to help me, and the indifference of the cabin staff we returned to our departure point. When I commented in a later letter that there was no medical equipment on board, British Airways rather stuffily told me that they were in the transport business, not the health industry.
Far from getting an upgrade then or later, I heard on the Av Med grapevine that they would rather not fly me again!
I spent the next 30 years doing medevacs, and yes, my diagnosis was correct!
Individual airlines have discretion about the medical equipment they provide, according to the Civil Aviation and Safety Authority (CASA). This is a recipe for disaster. Joint Health Command for our three armed services in Australia already follow a standard recommendation for equipment in these circumstances. Adopt it quickly and provide the safety many believe already exists. If a more international approach is required the same example can be used drawing upon a similar US or UK facility.
I was called on some years back to assist on an Emirates flight between Singapore & Dubai when a young adult traveller complained of severe headache, neck pain and photophobia. They didn’t have a thermometer on board, but fortunately I was correct in my diagnosis of migraine (again thanks to a detailed history!), so avoided the emergency off load (if I had diagnosed meningitis they wanted to divert to Calcutta!). Thankfully a combo of Imigran (from a passenger)& sleep worked well. And I got a nice upgrade next time I flew with them! A great idea (& long overdue) to standardise in flight medical kits.. should have been compulsory a long time ago!
I was recently asked to assist a gentleman who had a syncopal episode and awoke with an altered conscious state on and international flight with a reputable airline (Emirates). The plane had oxygen and a sats probe (which was great) but that was it. No blood pressure cuff, blood sugar monitor and definitely no ECG/cardiac monitor to help make a diagnosis. Furthermore, no fluids, IV cannulation equipment, medication, etc, even if a diagnosis was made to treat.
Fortunately passengers in surrounding seats had a portable BP machine & glucometer in their hand baggage. The patient was hypotensive, likely secondary to his anti-HTN meds, alcohol and ‘sleeping tablets’ he had.
In the end, maybe the history was all I needed…