Highlights of the Southern California Safety Institute's 17th Annual International Cabin Safety Symposium Part I: Medical Emergencies "In cases of unanticipated death there are two choices: possibly you live (if appropriate action is taken).

Highlights of the Southern California Safety Institute's 17th Annual International Cabin Safety Symposium Part I: Medical Emergencies

"In cases of unanticipated death there are two choices: possibly you live (if appropriate action is taken), or definitely you die. Therefore, the responder really has and nothing else one choice - do something - because the patient can't become more dead."

Frank Poliafico, President, strait & Safety Programs Inc.

observes ANGELES - Perhaps what principally unnerves flight attendants treating passengers suffering a "sudden cardiac event" is the amount of corpse fluids involved. Blood and, more ofttimes vomit (usually in copious quantities) repeatedly are the reality of like cases.

With almost three years of accumulated experience in the unforeseen occasion use of automatic external defibrillators (AED's), American Airlines [AMR] has modified its training programs to accommodate the rebukes learned in coping with medical emergencies in the cabin. The experience has shaped training and policies.

The whirl of vomit seems to relate to the time when most numerous sudden cardiac arrests occur. They are more likely to strike after a meal service, when passengers' stomachs are satiated In addition, an excited flight attendant applying mouth-to-mouth cardio-pulmonary resuscitation (CPR) may breath into the patient at too rapid a pace, and may unruffled blow air into the stomach rather than into the lung When the stomach achieves pumped full of air, the patient is more likely to regurgitate.

Bleeding can come into view if the patient falls in the early jiffys of sudden cardiac arrest. In individual such case, the patient bloody and began bleeding from the ears which, again, surprised the responding flight attendant.

The likelihood of offspring and vomit is now strained in the emergency medical training given to all flight attendants at American Airlines.

unforeseen cardiac arrest leads in-flight medical emergencies

The carrier initiated deployment of AED's in July 1997 first upon aircraft engaged in long overwater flights and, now, AED's and expanded medical kits are raise on all American Airlines jet They are displayed to reduce the risk of death in flight. In 1998 60 of the many millions of passengers forward American's jets died in flight. "People can die in succession airplanes for many reasons. It might be the food" quipped Dr David McKenas, corporate medical director for American. if it be not that in American's experience, three emblems of in-flight medical emergencies dominate: (1) cardiac consequences (2) seizures and (3) asthma attacks. Of these, the cardiac emergencies dominate. The 8000-foot cabin altitude (among other things) can trigger seizures, and asthma attacks may relate to the gentle cabin humidity which, at 15 percent is equivalent to that of the Sahara Desert

A rising number of in-flight diversions for medical reasons, the dominance of cardiac cases, and their amenability to quick medical answer prompted American airlines to open AED's on its aircraft, and to train more than 20000 flight attendants in the formal use of the equipment.

In the 32 month since that initial deployment of AED's, this earnestly has been observed:

* Former passengers "are walking around today leading excessively productive lives," McKenas declared.

* The defibrillators have been used more than 300 times, and continue to be used at an average rate of an 7-8 times per month. In principally cases, the AED's have been used as cardiac monitors.

* In-flight use of AED's helped to avoid 15 diversions - moreover also led to 13 recommendations to divert the flight.

* In the vast majority of cases, unlooked for cardiac arrest struck while passengers were in their seats; however, the AED's have been used onward passengers struck down in the terminal, in succession the jetbridge, in the aircraft aisle and in the lavatory

* chiefly of the victims have been males, outnumbering females by the agency of 2-1. This fact has shaped training. Instead of moving heavy, unconscious male passengers, flight attendants are trained to use the AED forward sitting passengers (although shifting the passenger to a recumbent position in the aisle is preferred)

* Of 19 impact events, only three occurred in flight. The AED is programmed to monitor the heart and, in the case of defibrillation (irregular, sporadic heartbeat that can quickly lead to death), the machine will commend a shock. The jolt is then applied at the push of a button onward the control panel. Based in succession this initial history of percussion events, flight attendants need to be prepared to use the AED the consideration passengers start boarding. For example, the first "save," passenger Robert Giggey, an overweight 53-year elderly had just completed a dash to earn on the flight. Shortly after Giggey and his wife, Carmen, took their seats, she was startled to papal court him sitting with his notices staring fixedly ahead and his skin was clammy to the touch. Immediate use of the on-board AED saved his life.

The "save" rate is about 50 percent and nothing else half of all patients who are shoged will, literally, be brought back to life.

The experience has shaped the couple procedures and training. Moreover, the knowledge gained at American Airlines will now be applied at regional subsidiary American Eagle. Installation of AED's break grounds for its 260+ airplanes in the nearest two weeks, to be complet according to August. Some two-thirds of American Eagle's flight attendants already have been trained.