Airlines Put Defibrillators On Board

November 03, 1997

DALLAS, Nov. 4 -- Putting portable defibrillators in commercial airliners and at airports would save both lives and money for the airlines, according to a study published in today's Circulation, an American Heart Association journal.

The portable semiautomatic external defibrillator devices (AEDs) shock the heart and correct the irregular heartbeat called ventricular fibrillation, the most common cause of sudden death.

Researchers at Australia's University of New South Wales studied a program at Qantas Airways in which AEDs were on board all of its Boeing 747 and 767 jets and were available at its terminals in Sydney and Melbourne.

Survival from cardiac arrest in the air or in air terminals can equal survival rates from the most effective ambulance services when the right equipment is available and crews are trained properly, says Michael O'Rourke, M.D., professor of the University of South Wales. He is the senior author of the paper. In return, the airlines avoid making diversions to the nearest airport because the machines also tell flight crews when resuscitation is futile.

In the 65-month study of the airline Qantas, 27 passengers went into cardiac arrest and were treated with the AED on board the aircraft. Sixteen of those had a sudden loss of consciousness; eight of the 16 could not be aroused from sleep. Six of those who collapsed went into fibrillation. The defibrillator worked in five of the six, reports O'Rourke. Two of them survived, apparently saved by the defibrillators.

Nineteen cases of cardiac arrest were reported at the airports; 17 of those patients went into ventricular fibrillation. Defibrillation worked on all 17. The Qantas crews could get the AEDs working within a minute after the device was taken from the kits, the researchers found, with an average time of 38 seconds. "Initiation of the Qantas cardiac arrest program resulted from a combination of circumstances," the researchers say, "good luck, and experience with defibrillation in other situations." Australia is particularly good with heart attack victims, according to the researchers. All of the 740 ambulances in New South Wales, for instance, carry defibrillators and highly trained paramedics. In an editorial accompanying the article, Robert A. O'Rourke, M.D. (no relation to the Australian physician) of the University of Texas Health Center in San Antonio, says the success in airline terminals makes "a strong case for requiring the presence of an AED and other medical equipment necessary for successful cardiopulmonary resuscitation in all major airline terminals."

More people die of cardiac arrest on airliners -- estimated to be around 1,000 a year -- than die in plane crashes. The standard procedure in the industry is to apply cardiopulmonary resuscitation to the passenger having a cardiac arrest and redirect the flight to the nearest airport. In virtually every case, the passenger is dead by the time the plane arrives. With defibrillators on board, Australian scientists found that some of those passengers can make it to a hospital.

Television audiences watching the television program "ER" may know AEDs as the electrical pads emergency room doctors put on patients' chests. Time is crucial. Few individuals ever survive more than 10 minutes after the initial attack unless CPR is given and the heart is shocked into regular contractions. It takes a modern airliner at least 20 minutes to get down to a nearby airport from cruising altitude -- if one is nearby. It could take 15 to 20 minutes for a plane on a takeoff runway to get back to the terminal.

Qantas was an especially good airline for the test because many of its routes are over water, says O'Rourke. If a person went into cardiac arrest, Qantas jets could be over the Pacific Ocean hours from the nearest airport, he adds. The AEDs are part of an extensive medical kit carried on the planes since 1991, mostly for use by doctors volunteering to assist an ailing fellow passenger. If a doctor on board volunteers, the kit contains numerous drugs to help. The airline trained 380 flight service directors, the chief pursers on the planes, to use the defibrillators on the airliners and registered nurses stood by at airports.

When a passenger collapses, the Qantas crews are trained to notify the purser, who immediately gets the medical kit, while the other crew members move the victim to a doorway where there is more room. A call is put out on the plane's public address system to determine whether there is a doctor on board, while the purser gets the AED out of the kit and working. The crew cuts off the victim's clothing and the purser applies the pads.

So far, besides Qantas, the only airlines planning to have AEDs on some of their planes are Virgin Atlantic, Air Zimbabwe, Cathay Pacific of Hong Kong and American Airlines.

O'Rourke, in his editorial, points out that the Federal Aviation Administration estimated that the American Airlines AED program need save only one or two lives over the next five years to justify the cost of installing and maintaining the AEDs and providing the expanded medical kits. The added cost to each passenger would be minuscule, he says.

Co-authors are Eric Donaldson, M.B, and John Geddes, M.D.

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American Heart Association

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