In-Flight Medical Kits: Unresolved Issues

Editorial, by Jon L. Jordan, MD, JD

If you haven't noticed, media journalists have reported on the occurrence of medical events on board air carrier aircraft and the controversy over how these events should be managed and by whom. This is not a new issue. This is one that has been debated within the aviation medical community for years.

For over a year, the Office of Aerospace Medicine has been gathering information on the occurrence of medical events on board aircraft1. The intent in gathering this information is to determine whether some adjustments need to be made in the required training of flight crewmembers or the types of medical equipment and medications that must be carried on board air carrier aircraft.

The current required medical kit contains only a limited number of medications, set more than ten years ago following recommendations from the medical community. While the initial proposal was for a much more comprehensive kit, the agency was convinced that the contents should be limited. This was partially based on concern expressed by several medical organizations that possible misuse of potent medications outweighed the potential benefits of including them in the kits.

While the kits seem to have been proven satisfactory over the years, medical kits carried by many foreign air carriers are much more extensive than those carried by US air carriers, a comparison that has provided fuel for controversy.

More recently, the question of whether cardiac defibrillators should be required has added a great deal of "spice" to the issue. Quantas and Virgin Atlantic Airways carry defibrillators, and American Airlines has announced a plan to do likewise.

Taking into consideration the costs, benefits, and possible drawbacks associated with a more extensive medical kit and such medical equipment as defibrillators,

  • should the Federal Aviation Administration move aggressively to modify the requirements?
  • would the presence and use of more sophisticated medical equipment and medications by volunteer medical personnel tempt the flight crew to continue the flight and not divert the aircraft to the nearest airport (in life-threatening cases), as is now the typical practice in the US?
  • where does the responsibility for misuse of the medical kit or equipment reside — with the air carrier or the medical personnel who voluntarily assist in a medical emergency?
While we all may have our own personal beliefs and opinions on this issue, these and many other questions will have to be considered before this complex matter can be resolved. We don't have all the answers yet, so all I can say is, "Please stay tuned."