You Can't Dial 911 at 35,000 Feet
After the death of a woman aboard an American Airlines flight from Haiti to New York, media coverage stoked the fears all passengers have of getting ill at 35,000 feet. But it's for exactly that reason flight attendants typically spend at least a third of their training time on first aid and other emergency skills. The Federal Aviation Administration is currently investigating how well the American crew and equipment responded to that recent call for help, but meanwhile, it's worth asking what airlines tell their crews to do if you get sick.
For some answers, I dug out a flight attendant manual for another airline that I'd picked up several years ago when I was researching airlines' flight attendant training schools for an article about how the job had evolved after 9/11. One of the main points of contention in the recent American Airlines case was whether the emergency equipment onboard the plane was in working order. But on the opening page of the "first aid" chapter, under policy, was the following line: "Flight attendants should check all emergency equipment before the initial flight of the day and anytime there is an aircraft change," and such equipment "must be checked to see if it operates properly." In fact, there were supposed to be a dozen POBS, or "portable oxygen bottles," aboard the American flight, so the odds that all would be empty or malfunctioning seem remote.
Judging from the vast array of medical situations covered in the manual--everything from childbirth to cardiac arrest, from food poisoning to ventricular fibrillation--crew members must be prepared for anything. Defibrillators, required aboard all scheduled flights since 2004, have reportedly saved more than a hundred lives in recent years. And while inflight deaths are rare--about 1 in 7.6 million passengers--MedAire, which provides advice from physicians to flight crews by phone, last year helped with more than 17,000 medical problems aloft. (Most were minor.)
But flight attendants have to walk a fine line. The book makes it clear that crew members must take pains to ensure passengers don't confuse them with medical personnel. "You are the first link in a chain of professionals who help in emergencies . . . you do NOT make a diagnosis," the manual warns, hinting at what may be the real reason for this precaution: "No statement should be made to any passenger in any way indicating that [AIRLINE X] accepts responsibility for any injury."
Here are some other nuggets from the flight attendants Bible: While the aircraft must have a well-stocked first-aid kit, flight attendants can't administer any medications directly. A DNR, or "Do not resuscitate" order, is not to be honored in flight--and crews are to "proceed with standard in-flight emergency treatment." (On most airlines, that means calling for help from medical pros aboard or calling a consultant like MedAire. Fortunately, there is almost always a trained health professional somewhere on the plane.) And what if all efforts to save a passenger fail while the plane is still hours away from its destination? While policies vary from airline to airline, it is also quite rare to pronounce a passenger dead before landing, as in the American flight. As one of my colleagues in a training class put it "no one dies on a flight, understand?"
The reason is that the decision to stay on course with a dead passenger might strike some as insensitive. In fact, some self-appointed consumer advocates have called for a new rule to require pilots to divert to the nearest airport in such cases. However, that ignores the reality that it might be better for all concerned, including the family of the deceased, for the flight to continue on to its original destination. And the Federal Aviation Administration would prefer to stay out of such decisions. "The FAA is unlikely to mandate anything that takes away from the authority of the captain to do what he or she believes is best for the remaining passengers," says FAA spokesman Les Dorr.
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As far as I know, and I'm an EMS volunteer, nobody can "pronounce"--i.e. declare someone dead--other than an MD. You can guess they're dead, you can be pretty sure they're dead, you can tell they aren't breathing, but no flight attendant or airline crewmember can actually pronounce someone dead. And if there were a doctor on the flight, there would be no need for them to voluntarily assume that responsibility.
I attend to dead people all the time--two days ago, the last one--but I can't say they're dead...
Posted by: stepwilk | March 24, 2008 at 01:52 PM
It was many years ago (~15 years) on a domestic flight and the man appeared to be a business traveler in a suit and tie. He was unmoving, had done the things that one does when passing away and the passenger next to him was agitated and wanted to move. No announcement was made. I just happened to pass by on my way to the lavatory. It was sad but the crew kept it low profile although those nearby certainly knew and I knew as I happened to be passing by at just the right time. I believe they carried him out after all the rest of the passengers deplaned. I believe they did ask whether there was a Doctor on-board and one Doctor did respond. That was the last I saw. I believe they moved him to a seat in the back that was in an otherwise unoccupied row.
Posted by: Rustum | March 27, 2008 at 01:12 PM