WHEN Bashkirian Airlines flight 2927 smashed into a cargo plane above southern Germany in July, the deaths of the two aircraft鈥檚 71 passengers and crew made headlines around the world. It was the nightmare every air passenger fears. But there is a less visible and largely unpublicised danger. Heart attacks, breathing difficulties, deep-vein thrombosis (DVT) and other medical conditions in mid-air cause as many deaths as plane crashes (see 鈥淚n-flight emergencies鈥�).
Yet a 快猫短视频 investigation has revealed that many airlines are failing to take simple steps that would save many of these lives. This could be done by fitting planes with medical equipment costing just a few thousand pounds.
To give passengers in trouble a fighting chance, doctors want medical kits to be standardised so each contains basic equipment such as defibrillators, electrocardiographs and pulse oximeters, which monitor the amount of oxygen in the blood. 鈥淲hen you think of all the money the industry spends on the safety of its planes, better medical equipment would be a very small outlay,鈥� says Farrol Khan, of the Aviation Health Institute, a charity based in Oxford that promotes the well-being of passengers.
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Flying can be very stressful. Passengers have to cope with heavy luggage, crowded terminals and busy check-ins, as well as the physiological changes brought on by altitude. Although aircraft are pressurised, the air pressure inside is usually lower than normal: typically the equivalent of an altitude of between 2000 and 2400 metres. 鈥淎ll these are known cardiac risk factors,鈥� says Peter Leman, an accident and emergency consultant at St Thomas鈥� Hospital in London.
One American study found that the risk of dying on a plane was 20 times the risk of dying on the ground. And if you collapse on an aeroplane, the quality of treatment you will receive remains something of a lottery.
The captain will ask if there is a doctor on the plane. The odds are roughly 50:50, but even if you are lucky, the doctor may lack relevant expertise. A specialist in dermatology may end up having to deal with their first heart attack since medical school.
Your quality of care also depends heavily on what medical equipment the plane is carrying. There is no international standard: for US airlines, standards are laid down by the Federal Aviation Administration (FAA); in Europe they are governed by the Joint Aviation Authorities, of which Britain鈥檚 Civil Aviation Authority is a member.
鈥淚 think the most important issue is the lack of harmonisation, says William Toff, a cardiologist at the University of Leicester with a special interest in aviation medicine. The concentrations and formulations of drugs in the kits is one problem. They are often poorly labelled and there is little or no guidance for doctors. 鈥淚f you are under stress it is easy to make dosage errors,鈥� Toff says.
In general, the minimum standard of equipment in America and Europe is higher than in many other countries. But one standard item in every airline鈥檚 kit, the stethoscope, doesn鈥檛 work on a plane because of the background noise. 鈥淚t is virtually useless,鈥� says Graham Cresswell, chief medical officer of the airline BMI British Midland.
Although DVT is the most widely publicised medical problem associated with flying, heart attacks and chest pains are the two most common reasons for diverting a plane. The FAA requires all American aircraft on international flights to carry automatic emergency defibrillators to treat any passenger whose heart has stopped. But they will not be required on short internal flights, such as New York to Washington, until April 2004. In Europe they are not required at all, although most of the major long-haul carriers do have them.
Lufthansa and British Airways have some of the best kits around, and BA planes started carrying defibrillators three years ago. Since then, they have been used on five passengers, says Nigel Dowdall, the company鈥檚 consultant occupational physician. Wherever a heart attack occurs it is often fatal, yet all five passengers left the aircraft alive, although three later died in hospital.
On short-haul flights, most other airlines鈥� planes in Europe do not normally carry defibrillators 鈥� and there is no immediate prospect of airlines introducing them voluntarily. That鈥檚 not good enough for Leman. 鈥淚f you have a heart attack at 10,000 feet, by the time you have diverted, it will be a good half an hour before you get help,鈥� he says. 鈥淵ou won鈥檛 survive that long.鈥�
Europe鈥檚 aviation authorities are reviewing the contents of medical kits, but Britain鈥檚 CAA says that making defibrillators compulsory is not part of that review. However, as Toff points out, planes have to carry a set of life jackets for the passengers in case they ditch in the sea. 鈥淭hey are rarely used, but no one would argue against their provision on grounds of cost,鈥� he says. 鈥淒efibrillators are likely to save more lives.鈥�
All cabin crew on planes are trained to deal with emergencies, even in the absence of a doctor. To provide a more consistent treatment, 40 of the world鈥檚 leading airlines subscribe to the MedLink service provided by MedAire, a company based in Phoenix, Arizona. MedAire has a team of doctors stationed in the emergency department of the Good Samaritan Regional Medical Center, Arizona鈥檚 largest hospital, that cabin crew can contact for advice. The team deals with nearly 12,000 mid-air emergencies a year, helping to treat patients and advising pilots on when to divert a plane.
But the system relies on information the doctors in Phoenix get from the plane. Without the appropriate kit, describing and monitoring the problem can be all but impossible.
A pulse oximeter, which slips on a finger and measures the oxygen saturation of the blood, and an electrocardiograph to monitor the heart should be essential parts of any kit, Leman says. A pulse oximeter, for example, costs less than 拢400.
But according to Dowdall, carrying more monitoring devices won鈥檛 necessarily improve patient care. Only about half the suspected heart attacks on BA planes turn out to be real, and the airline鈥檚 philosophy is to divert the plane whenever there is any doubt and treat patients on the ground.
Simon Brown, leader of Healix International, a company that specialises in repatriating Britons who fall ill abroad, says that without hard data, it is difficult to judge the seriousness of an emergency. He tells the story of a man who had chest pains shortly after take-off on a flight from Florida to Frankfurt. A doctor decided it wasn鈥檛 serious so the plane went on. Towards the end of the flight the man had a heart attack. Fortunately he survived 鈥� and lived to sue the airline for failing to turn back.
Some airlines are, however, going beyond what the regulations require to improve in-flight medical care. Since May, all BMI British Midland planes flying transatlantic routes out of Manchester carry a monitoring system called Tempus 2000. Virgin Atlantic and a Swiss business jet charter company called Private Air will soon do the same. Tempus 2000 collects data on the patient鈥檚 vital signs, such as a diagnostic ECG trace, blood pressure, blood oxygen levels and respiration. Combined, these can help to diagnose blood clots in lungs. The system incorporates a video link to MedAire, so that doctors on the ground can see the patient directly.
The airline won鈥檛 say how much the system has cost them. But Cresswell says: 鈥淚f it saves just one life then no one will give a damn about the cost.鈥�
