A scholarly article determines what can/should be done when someone on board becomes ill. The JDA Journal is not a forum to determine what the proper medical equipment and/or techniques should be. This is, however, a good space to discuss how should the airline industry respond, on a worldwide basis, to the recommendations raised by this piece.
When the health of a passenger becomes an issue inflight, the successful resolution of that crisis involves an array of technical problems. The New England Journal of Medicine has published In-Flight Medical Emergencies during Commercial Travel written by three distinguished doctors. The authors provide a lot of useful analyses of these onboard emergencies and explain some of the technical medical issues which arise at 30,000’ (i.e. “Each plane is also supposed to have a defibrillator to shock an errant heart back into a normal rhythm, but unlike on TV, that often doesn’t work. Thus, cardiac arrest is responsible for 86 percent of in-fight events that result in death.”) The MDs can assess the value of this article, but from an aviation safety perspective, the relevant question is which of these recommendations should be incorporated into airlines’ procedures/equipment?
This is the sort of issue for which the FAA or other CAAs may not be the best policy decision makers. In the US, the Flight Surgeon and his team at CAMI may not be the best judges of complex consumer medical questions.
In any event, the decision as to what procedures and/or equipment should be included would be best served by a top level panel of experts in this specific field. Such an advisory committee could ask for and use more finite information from the airlines.
Another reason to sidetrack the usual regulatory route is the tangled process of international (ICAO) and domestic (FAA, EASA, CAAs) rule-making. These formal processes tend to take a long time from initial idea to outreach to consensus to agreed-upon text to actual implementation. The scalpel of the benefit/cost analysis, which most governments require, is sharper but cut more finely than the exercise of excellent expertise.
Perhaps a more effective and expeditious mechanism might be to convene IATA, A4A, AEA, AAPA and others to develop recommendations with strong analytical support for their choices and buy-in by the airlines. Such a choice may bring better medical help more quickly to the passengers and may save lives now, rather than years from now.
The New England Journal of Medicine should be commended for advancing the knowledge of delivering relief to airline passengers. Hopefully, the global airline industry can convert those recommendations into actions to better serve the people who fly.