MORE airline passengers are dying from heart attacks and other medical
emergencies than in plane crashes. The latest figures from the US Federal
Aviation Administration (FAA) suggest that the number of in-flight medical
emergencies has doubled in the past decade.
The FAA’s data show that there are 14 000 medical emergencies each year on
the nine major US airlines, which carry 65 per cent of all passengers flown by
American carriers. Applied across all airlines in the US, this is equivalent to
15 emergencies a day—at least five times the number found in the last FAA
study, between 1986 and 1988, which revealed an average of two to three
emergencies a day on US airlines.
While each airline has its own definition of an emergency, most cases refer
to difficulties requiring a request for help from passengers with medical
Overall, an estimated 350 passengers die each year on board planes operated
by American carriers. By comparison, an average of 118 passengers a year have
died in air crashes on US soil since 1978.
Data for carriers outside the US reveal a similar picture. In the year to
March, British Airways recorded one medical emergency for every 11 000
passengers. Australia’s Qantas Airways says that it has an average of three
emergencies a week. About five passengers a year suffer cardiac arrest and die
on Qantas’s international flights, a figure that translates into about one death
per million passengers.
Although the problem has increasingly been discussed by aviation
doctors—often behind closed doors—the FAA study has forced the issue
into the open. Last month the aviation subcommittee of the US House of
Representatives began hearings into the adequacy of in-flight medical care in
the US, where aircraft generally carry fewer emergency medical supplies than in
many other countries.
Eric Donaldson, the outgoing president of the Airline Medical Directors
Association, an international professional body, and general manager of aviation
health services at Qantas, testified before the subcommittee on the importance
of carrying heart defibrillators. Not only do they save lives, they also reduce
the number of diversions in response to medical emergencies. Qantas carries
heart defibrillators on its long-haul flights, as well as medical kits with
a range of drugs and medical tools. Its 345 chief stewards are all trained to
In the five years since they were introduced by Qantas, the defibrillators,
which send electric shocks into heart muscles that have stopped working, have
been used 109 times. On 24 occasions, passengers had their heart rhythm
“Defibrillators will not save every victim of a heart attack, but they will
give them a chance that would not otherwise be available,” Donaldson told
New Scientist. “If you are travelling at 30 000 feet and someone has a
heart attack, it would take at the very least 20 minutes to get back to the
gate. After 16 minutes, the chances of resuscitating someone who’s gone into
cardiac arrest are virtually nil.” Donaldson and cardiologist Michael O’Rourke
of the University of New South Wales in Sydney will publish their survey of the
use of defibrillators by Qantas in the journal Circulation later this
The pressure on other airlines to carry similar equipment is growing. The
death last year of a 37-year-old businessman during a United Airlines flight
from Boston to Salt Lake City triggered a series of damning newspaper articles
on airline safety. The victim, an avid sportsman, died while being tended by
three doctors, a nurse and a paramedic. They could do little without the drugs
or the defibrillator that might have saved the patient’s life.
American Airlines, which carries some 80 million passengers a year, has
decided to introduce defibrillators and enhanced medical kits from 1 July. Some
2300 of its chief stewards have been trained to use the equipment. Later this
year, the International Civil Aviation Organization, the UN body that regulates
air safety standards worldwide, will begin its own study of in-flight
The British airline Virgin Atlantic and Air Zimbabwe already carry medical
defibrillators. Hong Kong’s Cathay Pacific has recently said that it intends to
introduce defibrillators, while British Airways and Scandinavian Airlines say
they are considering such a move.
While no one knows why the in-flight death rate has soared since 1988, there
are a number of theories: most of the deaths occur on long-haul flights, and the
number of passengers taking these has doubled in the past decade. Additionally,
more elderly people are now flying. Some doctors speculate that the exertion of
carrying heavy baggage before a flight, plus the excitement of holiday travel,
may increase the risk of heart failure.