Capitol Hill Hears About the Life-Saving Benefits of Heart Defibrillators

Air Safety Week, June 26, 2000

Lawmakers appear largely supportive of the Federal Aviation Administration's (FAA)decision not to require Automated External Defibrillators (AEDs) at airports, despite compelling testimony this past week from heart attack victims and medical industry experts before the U.S. House of Representatives' Aviation Subcommittee.

"At our last presentation a few years ago, the committee heard from widows of people lost to sudden cardiac arrest on board airlines," said Dr. David McKenas of American Airlines' [AMR] Corporate Medical Department. "Today you are hearing from people saved by this program and the ever-growing concept of public access defibrillation."

The Aviation Medical Assistance Act of 1998 inspired the need for AEDs on commercial flights and in airports. On May 24, the FAA released a Notice of Proposed Rulemaking (NPRM) for the mandatory inclusion of AEDs on large passenger-carrying aircraft with crews that include at least one flight attendant . The NPRM's closing date for comments is Sept. 21. The FAA on June 6 published its decision not to require AEDs at airports (see ASW, June 19, 2000).

Dr. Jon Jordan, air surgeon with the FAA, said the agency's decision not to mandate AEDs at airports stems from a year-long investigation of 130 airports with an average of 275 or more daily enplanements. The probe found that 83 percent of airports had defibrillators and another 8.5 percent had an off- airport emergency response capability of less than 6 minutes.

"Thus 119 airports - or 91.5 percent - have the medical capability to address medical events, including those in which AEDs may be of assistance," Jordan concluded.

A number of the subcommittee members voiced strong support for the FAA's stance, citing potential liability issues and elimination of bureaucracy as reasons for backing the agency's decision. However, the members made clear that the incorporation of AEDs at all airports should be an industry initiative, a view expressed by emergency medical expert Frank Poliafico in this publicaiton last week (see ASW, June 19).

"A law, a regulation, could slow the airlines down in implementing ... (AED's at airports) rather than speed(ing) them up," Rep. John Mica (R-Fla.) said.

Ease of Use

One witness, Dr. Justin Hudson, testified that while he was checking in for an Oct. 17, 1999, flight departing from Chicago's Midway Airport (MDW), he revived another passenger, Jim Rives, using one of the airport's AEDs. He said the device, about the size of a laptop computer, had pictures to demonstrate where the two "leads" should be applied to the patient's chest. Hudson said he pressed one button to activate the machine and another for the machine to analyze Rives's heart rhythm. The AED then made a determination to adminster a "shock" to the pateient.

"These things are designed for ease of use," Hudson testified. "There are studies ... that show elementary (school) kids can use these."

Hudson noted that most heart attack victims have a 5-minute time frame in which they can be saved. Beyond this 5-minute period, the "save rate" begins to decline dramatically - about 10 percent per minute, according to Hudson. "These (AEDs) need to be publicly available for quick use," he told the subcommittee.

The AED includes a feature that enables it to determine whether to administer an electric shock to a victim in sudden cardiac arrent. The machine is programmed to make the decision based on the victim's heart pattern, former victim Rives told the panel. He said proper training of airline and airport personnel ought to limit liability. "If you don't do something because of a liability issue, then this is a waste of time," Rives said. "This is about saving lives and you need to take risks ... This committee needs to take a risk," he declared.