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By Cindy Loose

The death of a 44-year-old woman on a flight from Haiti to New York last month and the subsequent accusation of malfunctioning equipment have spotlighted the issue of emergency medical care in the air.

The FAA does not have recent statistics on how often medical emergencies occur in flight, but a study of British Airways passengers, printed in the British Medical Journal in 2000, found an average of one incident for every 11,000 passengers. The most common medical emergencies in the air: fainting or near-fainting (29 percent of cases), chest pain and cardiac problems (16 percent), asthma attacks and shortness of breath (10 percent) and allergic reactions (5 percent).

Since 1986, planes flying in the United States have been required to carry a medical kit. The FAA in 2004 ordered enhanced medical kits that contain dozens of items, including an automated defibrillator for shocking hearts, and drugs such as nitroglycerin, lidocaine and epinephrine. Even the older kits were "useful in more than 80 percent of emergencies and occasionally lifesaving," according to a year-long study published in the Journal of the American Medical Association. The study recommended only one addition: a bronchodilator, to improve air flow, since added to the kit requirements.

Crews are trained to use the equipment, but protocol also calls for them to seek medical experts on board. (Health professionals in the United States are protected from litigation in a good-Samaritan situation.) Planes are verbally linked to medical advisers on the ground; the pilot decides whether to divert the flight.

Some of the circumstances surrounding the recent death remain unclear. The New York medical examiner found that the passenger, Carine Desir of Brooklyn, had heart disease and diabetes and that those conditions caused her death, according to The Associated Press. Her cousin, who along with her brother was traveling with her, complained that a flight attendant on American Airlines had initially refused to give Desir oxygen, that the oxygen tanks subsequently brought didn't work and that the defibrillator also did not work.

Airline spokesman Tim Wagner says the woman said she was a diabetic and asked for oxygen. A flight attendant said she wasn't sure oxygen would help and stepped away to consult with another attendant, Wagner says, but oxygen was administered within three minutes of the request.

Seven medical experts on board responded to a request for help. Two doctors and a nurse worked with the patient for 45 minutes, including using a hand-pumped respirator, Wagner says. Oxygen tanks are passive mechanisms that merely enrich air and are effective only when a patient is breathing on her own. A respirator, which forces air into a patient's lungs, is needed if a patient stops breathing unaided.

An automated defibrillator does not help in a heart attack and delivers a shock in only one specific situation: sudden cardiac arrest, meaning the immediate cessation of the heart's electrical system. Victims are unconscious.

"The description of the passenger's condition and other events do not add up to a sudden cardiac arrest event and could very well explain why the [defibrillator] did not deliver a shock," says Chris Chiames, director of the Sudden Cardiac Arrest Association.

Source: The Washington Post