A couple of hours into her Delta Air Lines flight to Portugal earlier this month, Dr. Andrea Merrill heard the call to help a fellow passenger with a medical emergency. She approached the scene and was handed a red bag.
"They told me it was the medical kit, and I opened it up to see what's in there because I've never been in [an in-flight] medical emergency before," Merrill said.
What was in the kit surprised her. The blood pressure cuff, for example, was not an automatic one like those in hospitals. It was a manual one, which needed to be put together, and listening for a pulse with a less-than-optimal stethoscope.
"It's hard enough in a regular doctor's office to hear much with those stethoscopes, so you can imagine if you're 30,000 feet in the air on an airplane, it's super loud," Merrill said. "It was really impossible to hear anything and it just took some time to assemble this blood pressure cuff and then try to listen."
Merrill, who works as a surgical oncologist at Boston Medical Center, later found out that her experience wasn't an isolated one. It was one of many that other medical professionals have gone through, and highlighted long-standing calls to expand the required items in the emergency kits.
As she waited on the customs line to enter Lisbon, she turned to Twitter to give feedback to the airline about her experience. Her tweet blew up with replies.
Dear @Delta, I just assisted in a medical emergency in the air. Your medical kits need a glucometer, epi pen, and automatic blood pressure cuffs- it’s impossible to hear with a disposable stethoscope in the air. Please improve this for passenger safety!
— Dr. Andrea Merrill (@AndreaLMerrill) June 12, 2022
Long-standing push for better kits
Airlines pack the emergency medical kits following regulations from the Federal Aviation Administration (FAA). They can add more items than required, but sometimes, they fall short of what some medical professionals argue is needed.
Besides facing challenges with using a manual blood pressure cuff, Merrill was surprised to learn that there wasn't a glucometer to measure blood sugar, which she said would have been helpful in the situation.
And while there was epinephrine to treat allergic reactions – as required by the FAA – there was no Epi-Pen to make administration easier.
Other medical professionals replied to Merrill's tweet recounting similar experiences treating emergencies on air. They suggested that all kits should include naloxone, commonly known by the brand-name Narcan, to fight drug overdoses, or pulse oximeters to measure oxygen.
I also assisted with a medical emergency on @delta last summer and the patient was concerning for possible stroke sx- there was no glucometer. There was a case for one but no supplies… It was shocking how poorly stocked the “medical bag” was.
— Hannah Josephson (@HannahJosephson) June 12, 2022
Having assisted with multiple in flight emergencies over the years, I agree that ambient noise makes auscultation almost impossible. An inexpensive pulse oximeter ($20 or so) as well as an automated BP cuff would provide so much valuable clinical information for triage.
— Vidya Szymkowiak, MD (@VidyaSzym) June 12, 2022
The reaction to Merrill's tweet didn't surprise Dr. Paulo Alves, the global medical director for aviation health at MedAire.
His company provides guidance from the ground during in-flight medical emergencies, and he's treated a few emergencies himself, so he's familiar with the contents of the kits.
"The last time the kit was modified was in 2004," Alves said. "It's a long time ago, right? And of course, it is understandable that the regulation doesn't evolve in the same pace as medicine; as the medical knowledge."
A few years ago, a committee within the Aerospace Medical Association sent recommendations to the FAA to update the kits – which included adding certain drugs like naloxone, as well as an EpiPen.
In a statement, the FAA said it was "reviewing the medical kit requirements," and in the meantime has issued guidance to airlines on additional items they can include in their kits. Congress also has the power to legislate changes to the kits.
Alves said that even before those changes come, travelers can trust there's a system in place to assist in-flight medical emergencies, which are relatively rare.
There is also support available for the medical professionals who volunteer to treat those emergencies, whether they are a nurse, doctor, veterinarian or dentist.
"A message to the medical volunteer is that, 'Hey you are never alone. You know, you're a phone call away from good expert advice,'" he said.
Still, Alves asked the public to avoid traveling when feeling sick or anticipating a possible medical issue. After all, he said, even the best emergency kit or the best medical advice isn't as good as being treated at a hospital.
For her part, Merrill said that a Delta Air Lines nurse called her up a few days after she treated the emergency on the flight, as part of the company's protocol, and she took the opportunity to speak about her experience.
"We did talk about potentially having a medical kit that can be stored at the gate and then adding to their safety checklist, bringing that on," she said. "So he said that he would bring that up with them. It was a very constructive phone call."
In a statement to NPR, a Delta Air Lines spokesperson said the company was adding items to its medical kits this summer, "Including automated blood pressure cuffs, medical-grade stethoscopes and pulse oximeters."
As for the patient on that flight to Portugal, Merrill said everything turned out all right.
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