Is there a doctor onboard?

Airplane Medical Reporting System Questioned

Frequency of medical emergencies remains largely a secret to the public

Investigative Reporter Elyce Kirchner examines what happens when medical emergencies happen at 30,000 feet and how often the public finds out about them.

Is there a doctor on board? That is something airplane passengers don't want to hear at 30,000 feet, but doctors say the number of people needing medical help on airplanes will increase as the flying population ages.

How often medical events actually happen in flight remains largely a secret to the public because the Federal Aviation Administration doesn't require airlines to report them. But the NBC Bay Area Investigative Unit discovered that medical emergencies may be happening more often than anyone knows. And now some doctors are putting pressure on the airline industry to make the data publically available.

"Before I experienced this it never occurred to me that the airlines didn't collect this kind of data," said Dr. Melissa Mattison.

The Harvard Medical School professor responded when a passenger had a seizure on her flight in January 2011. A few months later in a May issue of the Journal of the American Medical Association, Mattison and colleague, Dr. Mark Zeidel, advocated for a standardized recording system for all in-flight medical emergencies with mandatory reporting of each incident to the National Transportation Safety Board. Look in the document bin to read the article.

They also called for the debriefing of anyone directly involved with an in-flight medical event. They wrote that "collecting these records and disseminating lessons learned may help improve the care given during in-flight medical emergencies throughout the domestic airline fleet." Their call has yet to be answered.

"Anytime they ask for a medical professional on board to tend to another passenger they should be filling out a standard reporting form that should be filed in a database," Mattison said. "There are older, sicker people flying and we are not systematically addressing the problem of in-flight medical emergencies."

Seventy-four year old Southern California resident Concepcion Venegas died on an airplane after having a heart attack onboard a Southwest Airlines flight traveling from Phoenix to Ontario, Calif. in May 2005.

"She was on a trip (and) was supposed to come home the next week," said Venegas's daughter, Rosa Arencibia. "We never expected her to die."

According to the family's attorney, a retired EMT stepped up to help but was unable to revive her, and the pilot decided to continue on with 50 minutes left in flight.

Arencibia and her family sued Southwest Airlines for negligence after her mother's death and a jury found that the airline did everything possible to care for her. The airline did not want to comment on the lawsuit.

"Maybe there was a chance for her to survive," Arencibia said. "I believe they didn't do everything they possibly could to save my mother's life."

When there are medical problems in the sky, 90 percent of commercial airlines in the United States will call MedAire, a global emergency response center that provides real-time medical assistance to pilots, flight attendants

and medical professionals who may be on board. The company's headquarters is based in the Banner Good Samaritan Medical Center in Tempe, Ariz., where doctors are available 24 hours a day to field phone calls that come in from flight crews. Other airlines have in-house medical crews to deal with in-flight emergencies.

"Every major airline in this country will have some sort of ground-based service to help them in dealing with inflight medical events," said Dr. Paulo Alves, MedAire's Vice President of Aviation and Maritime Health.

In 2011, MedAire received 22,594 calls for service, which the company claims represents about one medical event for every 30,000 passengers. The company said that in the same year less than three percent of calls resulted in an unplanned landing or emergency diversion to another airport. But these figures may reflect just a fraction of the in-flight emergencies that actually occur each year. The Investigative Unit found that many airlines do track in-flight medical emergencies, but choose not to make the information available to the public.

Kelly Skyles, safety coordinator with the Association of Professional Flight Attendants and current American Airlines flight attendant told NBC Bay Area that she receives reports for every medical event that happens on board American Airlines flights-from routine events such as when a passenger gets airsick to serious life-threatening instances.

"There is a medical event that occurs every single day, seven days a week," Skyles said. "It may not be a major medical situation but it gets documented and reports go out...it gets added to the database."

NBC Bay Area tried for weeks to get the airlines to explain why they do not make data public, contacting 15 other air carriers by email and phone but all declined to comment for the record on camera.

The Investigative Unit also discovered that airlines face a number of challenges when responding to in-flight medical emergencies. NBC Bay Area obtained NASA's Aviation Safety Reporting System database where pilots and flight attendants can anonymously report problems on a voluntary basis. The database chronicles emergencies including 576 incidents where passengers needed medical attention on board since 2001. The database represents just some of the in-flight medical emergencies that happen on commercial airplanes.

According to the database, some flight attendants reported having difficulties communicating with medical ground crews such as MedAire, calling the communication "very poor." Others reported that "for medical consultants to be an effective tool in an emergency situation the flight attendants need a

direct phone connection..." Go to the link bin to take a look at the database.

Even MedAire admitted communication can be a challenge because oftentimes calls are routed through the busy cockpit.

"The level of care that we can provide and the level of handling depends heavily on the quality of the communication," Alves said.

He admitted that there is no current mandate from the FAA to improve this communication or to document the number of in-flight medical events that occur on board, but he says he supports a more transparent reporting system.

The FAA does require that flight attendants know basic life support skills such as how to administer CPR, and also mandates that airlines keep an automated external defibrillator (AED) on board. The agency also requires that airlines carry a medical kit during all flights and that they contain specific items including a stethoscope, tourniquet and certain medications. Look in the document bin for FAA regulations about medical kits.

But the Investigative Unit found out that the contents of medical kits vary because airlines often add to the FAA's list of required items.

"So what happens is an emergency medical kit on one airplane is organized differently than an emergency medical kit on another airplane," Mattison said. "It's my opinion that the kits be standardized and uniform across the board so that responders can know what is in the kits and how to find it."

Mattison believes that if airlines make in-flight medical events public, the industry would be better informed about what kinds of medical emergencies really happen. She says that would dictate what kinds of items contained in a medical kit are the most necessary, and in turn, would make airlines better equipped to respond to sick passengers.

"Are they cardiac?" Mattison asked. "Related to breathing? We could use that information to inform what we should put in the emergency medical kit and make the kits standard across the board no matter what airlines you are on. Every kit will be the same. And then we can educate physicians and others who are responding."

The FAA did collect data about airplane medical emergencies for five domestic air carriers during a 12-month period between 1996 and 1997, including how frequently air crews used medical kits. Look in the document bin to see the results.