Airlines find solution for cardiac arrest during flights

Most carriers now use automated defibrillators

February 28, 2003 | The Business Journal of Milwaukee
By Adam Kirby

There is no such thing as a good place to experience sudden cardiac arrest.

Still, few places are worse than aboard an airplane while in flight.

When the heart stops pumping, every second is crucial. The odds of resuscitation drop significantly each minute that goes by without electric shocks survival is unlikely after four minutes and nearly impossible after 10. But emergency landings can take as long as 25 minutes to coordinate and execute.

Cardiac arrest kills approximately 300,000 Americans each year, making it the leading cause of death in the United States. However, health industry experts believe the advent of automated external defibrillators and their rapidly increasing accessibility will help shrink that figure.

Federal Aviation Administration guidelines require airlines to have automated external defibrillators, or AEDs, present on all flights by April 2004. The devices, which can be operated without training by laypersons, have been credited with saving the lives of dozens of air travelers since airlines began installing them in the mid-1990s.

Nearly all major commercial carriers, covering approximately 80 percent of the traveling public, are now in compliance with the FAA mandate, said Massachusetts attorney Ron Kidd, an advocate of AEDs.

Such was not the case as recently as three years ago. On a Dec. 31, 1999, Northwest Airlines flight from Los Angeles to Milwaukee, Sushil Malhotra experienced cardiac arrest. No defibrillators were on board; instead, flight attendants merely placed an oxygen mask over Malhotra's face, according to a lawsuit filed by Malhotra's daughter. Malhotra, who lived in Waukesha, died two days later.

The lawsuit, filed by Milwaukee resident Abha Malhotra, claims Northwest was negligent by failing to have AEDs available particularly since high-profile competitors like United Airlines and American Airlines had already equipped their respective fleets.

The family's attorney, Paul Weinberg, said the lawsuit is as much about increasing AED awareness as it is about winning wrongful death damages.

"We've been called gold diggers I beg to differ," Weinberg said. "These cases are what, unfortunately, make industries change their practices."

A Northwest spokeswoman declined to comment on the lawsuit. In court documents, the airline denied any wrongdoing. A preliminary hearing is expected in April. Northwest installed AEDs in early 2001.

United spokesman Joe Hopkins said about a half-dozen passengers' lives have been saved since his company deployed AEDs in 1999, "so they have proven their value." American Airlines, the first carrier to put AEDs on flights, credits the devices with saving more than 15 people's lives.

"The argument against defibrillators was, we can't turn airplanes into flying emergency rooms," Kidd said. "We've always agreed with that, but sudden cardiac arrest was the major cause of death (on flights).

"I don't think it's realistic to say you've got to have a doctor on board. The genius of defibrillators is, they can be activated by lay first responders."

Appleton-based Air Wisconsin Airlines Corp. does not yet have AEDs on any of its 380 daily flights but expects to meet the FAA deadline, said spokeswoman Christine Mangi.

Oak Creek-based Midwest Airlines deployed AEDs on each of its 34 planes in January 2001 at a cost of $3,500 per unit, plus flight attendant training. The AEDs have never been used, said spokeswoman Suzette Broennimann.

David Danowski, co-owner of an Oregon-based defibrillator wholesaler called Defib World, said the airline industry was actually one of the leaders in purchasing AEDs. Other industries have been relatively slow to catch up, he said.

"Airlines have been big into the thing real early," Danowski said. "Businesses have only been picking up in the last 18 to 24 months."

AEDs now cost between $1,200 and $3,200 each and require no training to use. As a result, units have been popping up in a variety of public places, including airports and hotels. General Mitchell International Airport has 10 AEDs located throughout the concourse, while Chicago's O'Hare International Airport has units about every 100 feet.

"Now we see them hanging on the wall like fire extinguishers (so) that anyone can just grab it off the wall and use it," said Bill Locke, emergency medical technician trainer at Fond du Lac's Moraine Park Technical College. "These things are so foolproof, anyone can use one."

Hotels are also logical places for AEDs because of their role as gathering places, Kidd said. Two types of hotels high-rise structures and hotels in crowded downtown areas have a particularly keen interest in AEDs since emergency response times can be hindered, Locke said.

"They're quite important, especially if you have big events," Kidd said.

Danowski, however, said Defib World has not had much business with the hotel industry.

Milwaukee-based Marcus Hotels & Resorts has had AEDs in each of its 11 hotels for two years, though they have not been used yet.

The Food & Drug Administration recently approved AEDs for home use; Locke said the devices could become staple household appliances for at-risk families in the near future.

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