Emergency medical kits on board commercial aircraft: A comparative study

doi:10.1016/j.tmaid.2010.10.008

Travel Medicine and Infectious Disease

Volume 8, Issue 6, November 2010, Pages 388-394

https://doi.org/10.1016/j.tmaid.2010.10.008 Get rights and content

Summary

Background

In cases of critical medical situations on board commercial aircraft, access to emergency medical kits can be lifesaving. Thus, this comparative study investigated acute care medication and equipment supplied in emergency medical kits on board both low-cost carriers and full-service carriers.

Methods

Thirty-two European airlines (sixteen low-cost carriers and sixteen full-service-carriers) were asked to provide anonymous data on the contents of their emergency medical kits. All emergency medical equipment and medication carried on board were subject to a descriptive analysis with regards to International Civil Aviation Organization (ICAO) standards for emergency medical kits, as well as variation and differences between low-cost carriers and full-service carriers.

Results

A total of twelve airlines (seven full-service carriers and five low-cost carriers) participated in this study. None complied with ICAO standards. Emergency medical kits from both full-service carriers and low-cost carriers exhibited a high degree of variability. Two European low-cost carriers were assessed as being insufficiently equipped for a medical emergency requiring acute care.

Conclusions

This study demonstrates the high degree of variability in the contents of emergency medical kits. Additionally, some airlines were equipped insufficiently for a critical medical situation on board their aircraft. Frequent checks of national authorities and further evaluation of acute care equipment are required to prepare for potentially life-threatening critical conditions occurring in special environments, such as in airplane during flight.

Introduction

Currently, aircraft passenger loads exceed almost 2 billion passengers per year worldwide and are steadily rising.1, 2, 3 Moreover, increased life expectancy in Western countries has resulted in a continuous increase in the average age of passengers.⁴ Medical incidents on board commercial aircraft occur on a daily basis.¹ The vast majority of medical incidents are temporary losses of consciousness, which are short-lived and self-limited, but there are also in-flight medical emergencies that can occur on board commercial aircraft. Both passengers and crew may require medical help in the closed environment of an aircraft cabin, without access to standard emergency medical services.5, 6 In a recent study, doctors and health professionals who travel as passengers on board commercial airplanes assisted in 85% of all in-flight medical emergencies (IMEs). Similar results were reported by other authors.7, 8 Furthermore, many airlines use on-line sources of medical advice (via satellite telephone). Cabin crews are trained to apply first aid and also commonly to operate AEDs in an emergency.9, 10 However, in the vast majority of in-flight medical emergencies, medical professionals provide crucial first aid and valuable advice to pilots regarding potential airplane diversions, which occur in approximately 3% of all in-flight medical emergencies. This results in roughly one diversion per week for large, national, European airlines.7, 11 These statistics show that, in critical medical situations, emergency medical equipment and medication are essential to providing lifesaving care.

The contents of emergency medical kits on board commercial European aircraft are subject to different regulations and show considerable variability, with regard to both the medications and equipment supplied.12, 13, 14 The regulations published in the Joint Aviation Requirements – Operations I (JAR), namely JAR-OPS 1.745 First-Aid Kit and 1.755 Emergency Medical Kit, require only that the emergency medical kit be carried by an airplane that has a maximum approved passenger seating configuration of more than 30 seats and if any point on the planned route is more than 60 min flying time (at normal cruising speed) from an aerodrome at which qualified medical assistance could be expected to be available. This is uncommon within continental Europe and many flights within Europe would not require an emergency medical kit under the latter regulations. The International Civil Aviation Organization (ICAO), however, has published standards that are binding on all ICAO states. They recommend that aircrafts authorized to carry more than 100 passengers, on a flight length of more than 2 h, carry an emergency medical kit, for the use of medical doctors or other qualified persons in treating in-flight medical emergencies. The details of the emergency medical kit and medication are given in Table 1, Table 2.

Limited data are available on the actual contents of emergency medical kits on board commercial aircraft. Therefore, we initiated a descriptive analysis to describe whether any differences exist in the medications and/or equipment provided on board low-cost European carriers as compared to full-service carriers and to analyze whether ICAO standards were fulfilled.

Section snippets

Materials and methods

This study was initiated at an academic university hospital and was performed in the year 2009. Prior to introduction of the study parameters, airlines were asked to categorize themselves as either low-cost carrier or full-service carrier. Low-cost carriers were defined as no-frills airlines with low operating cost structures and low fares. Full-service carriers were defined as having a regular operating cost structure and offering full service without extra charges.

A total of 32 European

Statistical analyses

Data analyses were performed using Med-Calc software (Mariakerke, Belgium). The null hypothesis was based on the assumption that there were no differences between emergency medical kit contents from low-cost carriers as compared to those from full-service carriers. Data were classified as categorical and analyzed by Fisher’s exact test, with statistical significance level set at 5% (P < 0.05).

Results

Out of the initial total of 32 European airlines, 12 agreed to participate in the study, provided that confidentiality agreements were signed regarding the identification of participating airlines. Of the twelve participating airlines, seven were full-service carriers and five were low-cost carriers. The remaining 20 airlines were either unable to provide sufficient study data or unwilling to participate due to company policy.

No airline participating in this study fulfilled ICAO standards.

Discussion

In Europe, emergency medical kit contents are subject to multiple sets of regulations and standards. Joint Aviation Requirements – Operations I (JAR-OPS I) issued by the Joint Aviation Authorities (JAA) require an emergency medical kit to be carried if any point on the planned flight route is more than 60 min’ flying time (at normal cruising speed) from an aerodrome at which qualified medical assistance is expected to be available. As this is uncommon within continental Europe and the airlines

Conclusion

Although binding standards have been published for emergency medical kit contents on board aircrafts of ICAO member states, no airline in this study complies with existing standards. Two low-cost carriers from this study carried no basic emergency equipment, which the authors assess as unacceptable. Inability to provide proper medical treatment on board of an aircraft poses a potential danger in cases of medical emergencies requiring acute critical care during flight. We strongly suggest that

Conflict of interest

The authors declare that they have no conflict of interest.

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Cited by (23)

On-board emergency medical equipment of European airlines
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Citation Excerpt :
Whereas all airlines provide FAK, 82% only provide a specific kit for advanced treatment or for use by physicians. Hence, 18% do not provide Emergency-Medical-Kits and this percentage is also in congruency with the results from Sand et al. who found that 15.4% of their questioned airlines were low-equipped [12]. Congruently to Europe, Martin-Gill et al. found in their review of literature between January 1, 1990, and June 2, 2018, that the content of Emergency-Medical-Kits in the US varies, but is sufficient for treatment of most IFME [25,26].
Medical emergencies frequently occur in commercial airline flights, but valid data on causes and consequences are rare. Therefore, optimal extent of onboard emergency medical equipment remains largely unknown. Whereas a minimum standard is defined in regulations, additional material is not standardized and may vary significantly between airlines.
European airlines operating aircrafts with at least 30 seats were selected and interviewed with a 5-page written questionnaire including 81 items. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted up to three times by email and/or phone. Descriptive analysis was used for data interpretation.
From a total of 305 European airlines, 253 were excluded from analysis (e.g., no passenger transport). 52 airlines were contacted and data of 22 airlines were available for analysis (one airline was excluded due to insufficient data). A first aid kit is available on all airlines. 82% of airlines (18/22) reported to have a “doctor's kit” (DK) or an “Emergency Medical Kit” (EMK) onboard. 86% of airlines (19/22) provide identical equipment in all aircraft of the fleet, and 65% (14/22) airlines provide an automated external defibrillator.
Whereas minimal required material according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in availability of the additional material. The equipment of most airlines is not sufficient for treatment of specific emergencies according to published in-flight medical guidelines (e.g., for CPR or acute myocardial infarction).
Characterization of In-Flight Medical Events Involving Children on Commercial Airline Flights
2020, Annals of Emergency Medicine
Citation Excerpt :
Although each aircraft must carry at least 1 emergency medical kit and 1 first-aid kit, the actual number of first-aid kits on board is proportional to the number of passenger seats for each aircraft (eg, 0 to 50 passengers, 1 kit; >250 passengers, 4 kits). Minimum equipment and medication requirements vary widely for non-US-based airlines30 because they are determined at the country’s level. Although European airlines are not mandated to carry an automated external defibrillator, most of the large international airlines do carry one.
More than 4 billion passengers travel on commercial airline flights yearly. Although in-flight medical events involving adult passengers have been well characterized, data describing those affecting children are lacking. This study seeks to characterize pediatric in-flight medical events and their immediate outcomes, using a worldwide sample.
We reviewed the records of all in-flight medical events from January 1, 2015, to October 31, 2016, involving children younger than 19 years treated in consultation with a ground-based medical support center providing medical support to 77 commercial airlines worldwide. We characterized these in-flight medical events and determined factors associated with the need for additional care at destination or aircraft diversion.
From a total of 75,587 in-flight medical events, we identified 11,719 (15.5%) involving children. Most in-flight medical events occurred on long-haul flights (76.1%), and 14% involved lap infants. In-flight care was generally provided by crew members only (88.6%), and physician (8.7%) or nurse (2.1%) passenger volunteers. Most in-flight medical events were resolved in flight (82.9%), whereas 16.5% required additional care on landing, and 0.5% led to aircraft diversion. The most common diagnostic categories were nausea or vomiting (33.9%), fever or chills (22.2%), and acute allergic reaction (5.5%). Events involving lap infants, syncope, seizures, burns, dyspnea, blunt trauma, lacerations, or congenital heart disease; those requiring the assistance of a volunteer medical provider; or those requiring the use of oxygen were positively correlated with the need for additional care after disembarkment.
Most pediatric in-flight medical events are resolved in flight, and very few lead to aircraft diversion, yet 1 in 6 cases requires additional care.
Cardiac arrest in the air
2018, Trends in Anaesthesia and Critical Care
Citation Excerpt :
The US Federal Aviation Authority (FAA) does issue statutory basic requirements, but airlines can enhance these as they see fit [24]. Commercial aircraft carry both first aid and emergency medical kits (EMKs), the contents of which vary widely from airline to airline [25–27]. EMKs may only be opened on the authority of the captain and are only for use by suitably-qualified persons.
Data on which to base guidelines on the management of in-flight medical emergencies are severely limited by the lack of uniform national and international reporting. In-flight cardiac arrest is rare during commercial passenger flights, but where the initial rhythm is shockable, survival rate to hospital is around 23%.
With minor adjustments (for lack of space, noisy environment, limited medical facilities, etc.), standard CPR and use of an AED are appropriate. The ability to perform advanced life support procedures is very limited.
Diversion of an aircraft is costly, and may incur risks to safety as well as inconvenience to passengers. It is mainly justified if a victim regains a circulation or remains in a shockable rhythm.
Voluntary attendance by healthcare professionals at in-flight cardiac arrests is common, but may have little effect on survival of the patient.
The legal position of healthcare professionals who volunteer to assist at an in-flight emergency is complicated, but successful prosecution or litigation is very rare.
Future national and international discussion and research in the field is needed. In the meantime, deliberately didactic and pragmatic advice on the management of in-flight cardiac arrest is offered. It is hoped that this will stimulate discussion.
European Resuscitation Council Guidelines for Resuscitation 2015. Section 4. Cardiac arrest in special circumstances
2015, Resuscitation
Citation Excerpt :
On every commercial aircraft registered in Europe, there must be a first-aid kit that all cabin crewmembers are trained to use. Aircraft with at least 30 seats must also carry an advanced medical kit, which can be used by competent personnel, although the contents vary significantly and may be inadequate for all but the most basic of emergencies.504,517,520 Although most large European airlines carry AEDs, some of them only do so for intercontinental flights, but some do not even provide any equipment for CPR.517
Emergencies in the sky: In-flight medical emergencies during commercial air transport
2013, Trends in Anaesthesia and Critical Care
Citation Excerpt :
Unfortunately, the contents of these additional kits vary significantly throughout Europe. Sand et al. also stated that medical flight kits currently vary extensively in European aircraft.5,27 Since data on in-flight emergencies is scarce,1,2,5 it is not possible to adequately assess the usefulness of the material provided.
In 2012, approximately 2.5 billion people worldwide traveled by commercial airline transport. Therefore, medical issues concerning the air travel of passengers have gained increasing publicity over the last few years. Although in-flight medical emergencies frequently occur in commercial airline operations, detailed data about the incidence, causes and consequences still remains limited. The aim of this review was to gather and analyze the data of published reports concerning incidence, causes, and consequences of in-flight medical emergencies during commercial airline travel.
To retrieve published data on in-flight medical emergencies of different previously published studies, a MEDLINE^® search (http://www.pubmed.com) was performed using all combinations of the keywords (“in-flight” or “inflight”) and (“emergency” or “emergencies”) and (“airline travel” or “air travel”) and (“medical” or “medicine”). Two specialists for Anesthesiology with expertise in aviation medicine as well as emergency medicine categorized the retrieved studies independently.
A total of 207 studies were retrieved by using the presented search terms in the MEDLINE^® database. Subsequently 15 studies (1989–2012) provided data on the incidence, causes, and consequences of in-flight medical emergencies and were therefore used for analysis. Most authors report one in-flight medical emergency incident in the range of 10,000 to 40,000 passengers transported and the rate of an in-flight death ranges between one in 3 to one in 10 million passengers. Cardiac problems as well as syncope have the highest occurrence rate (50.3%) of emergencies during commercial airline travel. Less frequent are infectious diseases (27%) and neurological problems (23.4%). For minor problems, nausea and vomiting had the highest occurrence rate.
Data on in-flight medical emergencies is scarcely published. However, neither a national nor European/international database on in-flight medical emergencies currently exists. For this purpose, a standardized, international database on in-flight medical emergencies is warranted in order to improve preventive strategies by assisting pre-flight medical assessment.
Medical Events on Board Aircraft: Reducing Confusion and Misinterpretation in the Scientific Literature
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Emergency medical kits on board commercial aircraft: A comparative study

Summary

Background

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Statistical analyses

Results

Discussion

Conclusion

Conflict of interest

Lancet

Lancet

Lancet

Oxygen supplementation for chronic obstructive pulmonary disease patients during air travel

Curr Opin Pulm Med

Notfallmedizin im Flugzeug: Erste Hilfe über den Wolken

Dtsch Arztebl

Management of in-flight medical emergencies

Anesthesiology

Clinical aspects of inflight incapacitations in commercial aviation

Aviat Space Environ Med

Surgical and medical emergencies on board European aircraft: a retrospective study of 10189 cases

Crit Care