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During in-flight emergencies, airline medical kits sometimes fall short

A passenger who was trained as a desert first responder, Seth Coley, came into action and found that the woman was unresponsive and had a weak pulse. Coley dug into the plane’s medical kit but failed to find an oropharyngeal cannula, an instrument that must have been there and that he needed to help the woman breathe. Instead, she cleared her airways by manipulating her neck.

Next, Coley sent a message to Denver-based Frontier Airlines via an online customer service form: “I saved someone’s life on one of your flights,” she wrote. “I would like to talk about the med kit you have on your flights. You are missing some very precious and simple things. She almost died.”

Americans are flying to levels reaching pre-pandemic numbers. While COVID-19 has ushered in new sanitation and cleaning protocols designed to make air travel safer, incidents like Coley’s raise questions about airlines’ readiness for medical emergencies due to incomplete or insufficient medical kits and staff training. flight crews, who often rely on other passengers in emergencies.

Frontier did not respond to KHN’s requests for comment on that incident or its emergency kits. But Coley’s experience illustrates the risks travelers take every time they board a flight. For every 20,000 passengers who take a flight with a US-based airline, there is a medical event, defined as any health-related incident, not just an emergency, according to estimates by the airline medical services company MedAire.

The Federal Aviation Administration requires commercial aircraft to carry at least one sealed emergency medical kit containing a minimum of 25 specified tools and drugs, as well as first aid kits and automatic external defibrillators. But the FAA doesn’t track data on the use of these kits during in-flight medical emergencies. Instead, the agency leaves it up to the airlines to inspect the kits and replace them if the seals are broken.

“Ensuring that complete, sealed emergency medical kits are in place is part of the cabin crew’s pre-flight inspection,” FAA spokesman Ian Gregor said in a statement.

Commercial airplanes are required to carry sealed emergency medical kits, like the one pictured, which contain specific equipment and medications. But healthcare workers who have volunteered to help in in-flight emergencies say the kits can be inadequate and sometimes lack the necessary items.MedAire

But, as Coley and other passengers who responded to an in-flight emergency discovered, sometimes a required item can be missing from a medical kit. Some items not required by the FAA, such as the overdose reversal drug, naloxone, are carried voluntarily by some airlines. The agency has issued guidance suggesting items to add to the kits, but they are not yet mandatory.

Gregor said the FAA investigates all reports of problems with medical kits and ensures any problems are addressed. He did not respond to a KHN request for details on the number of reports investigated, their outcomes, or whether the emergencies described in this article were among those investigated.

In June, Boston surgeon Dr. Andrea Merrill was aboard a Delta Airlines flight when he assisted in a medical emergency and found the kit was not up to what he needed.

He needs “a blood glucose meter, an Epi pen, and automatic blood pressure cuffs—it’s impossible to hear with a disposable stethoscope in the air,” Merrill he tweeted to Delta after the accident. “Please improve this for passenger safety!”

After Merrill’s tweet went viral, Delta followed with her, saying it will switch to automatic blood pressure cuffs and “real” stethoscopes, as well as consider glucose meters at the gates. Merrill declined a request for an interview.

KHN has asked US airlines to detail their emergency medical protocols and the contents of their medical kits. Seven responded with limited information: Alaska, Allegiant, Hawaiian, JetBlue, Southwest, Sun Country and United. All said their kits meet or exceed FAA requirements and that they train their personnel to respond to medical emergencies. Many airlines also contract with a MedAire service called MedLink connecting flight crews with a medical professional on the ground in the event of an in-flight emergency.

Allegiant officials said passengers with medical conditions shouldn’t assume their planes will have everything they need in an emergency. “Although our crews are trained to respond to a broad range of unplanned medical emergencies, we want to remind readers who have anticipated medical needs to bring their own medical supplies in their carry-on bags and not to rely on the emergency equipment of the airplane,” said Andrew, a spokesperson for Allegiant. Porrello said in a statement.

Delta, along with American, Frontier and Spirit, did not respond to requests for comment. A 2019 article on the Delta website it said its flight attendants receive training in first aid and cardiopulmonary resuscitation. Additionally, Delta wrote that its medical equipment exceeds FAA requirements. The airline said it uses STAT-MD, a service that allows flight crews to consult with personnel trained at the University of Pittsburgh Medical Center.

The FAA requires flight attendants to receive specific medical trainingbut medical professionals who have responded as passengers during an in-flight emergency said the crew aren’t always ready to respond.

“Passengers believe there are probably more protections in place than there actually are,” said Dr. Comilla Sasson, a Denver-area emergency physician and clinical associate professor at the University of Colorado.

Sasson was on a United Airlines flight in 2018 when a passenger passed out. When she volunteered to help, crew members demanded proof that he was a doctor as he mobilized to check the passenger’s vital signs. Sasson questioned the extent to which crew members are trained to help with medical emergencies, saying other health care workers have told her of their own experiences helping a passenger in need as flight crew stepped aside.

“It’s interesting to me that airlines really depend on the kindness of strangers in many ways, much more than I would think,” Sasson said.

The goodwill of a fellow traveler is something Bay Area resident Meera Mani is grateful for after a 2011 experience. She was on a United flight from Toronto to San Francisco when her now deceased father, then in his 80s, began to show worrying symptoms: the right side of the face and the arm fell. Worried that her father was having a stroke, Mani screamed for help but she was frustrated by the slow response from the flight attendants.

“And finally, I said, ‘Is there a doctor on the flight?’” Mani said.

There was. The doctor used a defibrillator to stabilize his father.

“It was very clear to me that the [flight] the staff were completely baffled,” Mani said. “They had the equipment, they took it off, they gave it to him, but the doctor took care of it.”

United helped arrange for an ambulance to meet Mani and her father on the ground at the San Francisco airport and later called to see if her father was okay. Eventually he was diagnosed with a condition that could lead to fainting.

MedAire, which operates the MedLink advisory service, said it covers about 70% of the US market, but declined to specify airlines. Dr Paulo Alves, global medical director of aviation health at MedAire, said 98% of medical events are handled onboard and are not life-threatening, while 2% are serious cases that could divert a flight.

Alves said his company also provides medical consultations before passengers board a flight.

“A plane, even though I love aviation, is never the best place to hold a medical event,” Alves said. “The first line of prevention is actually preflighting.”

Alves also defended the contents of airline medical kits. Medically trained volunteers who step in to help other passengers in an emergency can expect resources available in a hospital, but “the plane is not a hospital. You can’t carry everything,” he said.

Mani said he would like to see airlines reveal what medical emergencies they are trained to deal with, potentially on flight safety papers. Sasson said it would help if airlines clearly shared information about what medical supplies are available on board.

“I think the general public doesn’t realize what a crap shot it is when I’m in the air that someone with some sort of medical training is going to know what to do, if something were to happen,” Sasson said.

KHN extension (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs of KFF extension (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.