What doctors need to take care of sick airline passengers.

Health and medicine explained.
March 6 2008 11:00 AM

Is There a Glucometer on Board? How About an Oxygen Tank?

What doctors need to take care of sick airline passengers.

(Continued from Page 1)

But the organization of the plane's medical equipment proved a major barrier. Unbeknownst to the flight attendant, there was a big kit of equipment in addition to the smaller one she had given me. But the big kit was stocked elsewhere in the plane—along with a second, and full, oxygen tank. In the end, it turned out that the plane had everything we really needed—such as a glucometer and lots of medications to use in emergencies. But the flight attendants didn't figure this out until we were landing, at least an hour after the patient became sick.

At the end of the flight, the attendant confessed she'd been confused because the last time she needed to access these kinds of supplies, she had been on a different type of plane where everything she needed was stocked together. In retrospect, I too was faked out, by the way the equipment was organized: The small medical kit I was given had just enough supplies (a mix of stuff for diagnosis and treatment) to convince me that this was all there was. If I had been given a bag with, perhaps, only Band-Aids and a gauze pad, I think I would have insisted on a search for more and better equipment. The deceptive way in which the supplies were packed and stored meant that I didn't have the right tools at the right time to take care of the sick passenger.

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Efforts to improve patient safety in hospitals and other medical care settings have gained increased attention since the Institute of Medicine released its 1999 report outlining how common medical errors are. Organization of medical equipment is an important part of using the science of human-factors engineering to improve patient safety. Also called ergonomics, this science takes into account the design and organization of a particular environment to improve the way humans function within it. It borrows from aviation safety, which emphasizes standardization, checklists, cockpit design, and teamwork. I have written before about incorporating some of these processes into emergency care on ambulances. On airline flights, where medical emergencies are rarer and unexpected, the value of ergonomics may be even greater. The people using the equipment often cannot rely on their experience to overcome hurdles thrown up by poor design or organization like the ones my wife and I encountered.

Fortunately, the passenger whom I cared for improved without much help. I sat with him until we landed and an ambulance came to take him off the airplane. I suspect he fully recovered. But if he had deteriorated instead, I might not have been able to help him. The February 2008 edition of one of the airlines' in-flight magazines contains a letter from the CEO, bragging about the industry's widespread use of automated external defibrillators on airplanes. These machines can save a passenger or crew member whose heart suddenly stops beating. Stocking them is, doubtless, very important. But passenger safety depends on the next level of organization: Every plane should contain the same medical equipment, stocked in the same place, in the same way. Airline staff should, of course, be well-versed in what they have and where it all is. In addition, a card or a list, itemizing the available supplies, medications, and dosages, should be on board and automatically given to any doctor or nurse or EMT who offers to assist a sick passenger. I don't know if these rules would have saved the life of the woman on the plane from Haiti, but I have little doubt they could help many of the other passengers who get sick on airplanes every year.

Zachary F. Meisel is a practicing emergency physician, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics.

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