An Expanding Horizon

An Expanding Horizon

MedAire's business grows as airlines realize the advantages of inflight medical emergency support

BY Monica L. Rausch, Associate Editor

July 1999

PHOENIX, AZ — A woman, 38 years old, is six months pregnant and making a long trip from Cairo to Los Angeles. Somewhere over Omaha, she experiences trouble. In a small room of a Phoenix hospital, a MedLink¨ communications specialist gets the call. "She's conscious, she's six months pregnantÉshe's had what she considers to be a contraction Éand lost quite a bit of blood," reports the pilot.

The crew has asked for assistance from any medically trained passengers on board. A doctor steps forwardÉ

Just off the emergency room at Good Samaritan Hospital, MedLink's emergency medical physicians handle calls like this one daily from crews of corporate aircraft and, more recently, airlines thousands of miles away. In the past, crews usually diverted when confronted with a medical emergency; now they have another option.

"It's a huge economic savings," says Joan Sullivan Garrett, president of MedAire, Inc., the company which provides the MedLink service. "I don't know any airline that isn't willing to land the plane for a medical emergency, any pilot, any crewÉThe problem is that they're not very astute in determining is this a life-threatening emergency or is it not? And frankly, they don't want to take the responsibility. They're not in the position to do that."

By contracting with MedAire, operators can call the MedLink service at any time and talk to an ER doctor who not only gives advice in treating the patient, but also helps determine whether the emergency is such that diversion is necessary. If called for, a MedLink communications specialist uses a database of information on over 5,000 airports to find the nearest airport and hospital.

MedAire started its business focusing on business aviation, but now airlines are starting to see its advantages. Here's how MedAire found its start and where it's going from here.

The missing link
MedAire opened its doors in 1987, and the first "patch"— or dispatch — to a communications specialist was received in November. A man on a charter flight from Dublin was having chest pains.

But before this call came in, a lot of work was done to educate MedAire's future customers — and even its doctors — on the need and value of an inflight medical emergency service. "The big question was could they bring value to these customers," explains Garrett. "Can you bring value from a physician to a lay person? Furthermore, can you get the physician to speak in lay terms? É There's a huge educational curve for physicians to be able to respond to a lay person."

Says Dr. David Streitweiser, an emergency medical physician at Samaritan and medical director for MedLink, "We were skeptical about the value of this service when it was presented to us 13 years ago. We didn't know if it would even work, talking remotely to non-medical people, sometimes talking to ...doctors and nurses who didn't have much in the way of equipment."

But Garrett says her eight years experience as a critical care flight nurse gave her insight into a need she felt had to exist. "Had I not had that experience, I don't think that I would've started this company. I don't think that I would've known what were the key success indicators for saving lives by lay people."

Streitweiser and the other doctors were won over when they saw that their work was actually helping passengers, and flight diversions were dropping. Now one airline reports that in the first month of service with MedAire, diversions dropped 85 percent, says Garrett.

Notes Streitweiser, "Passengers were actually getting more appropriate care, even on the non-diverted flights."

While convincing doctors and customers of the need, Garrett also built a foundation of information on airports, hospitals, and the specialties of those hospitals. "I recognized that by handling the call in flight, that was only a piece of the puzzle ...You could do a great job of saving their life in the plane, but they could die from the airport to the hospital."

Software was a huge investment for the company, says Garrett. MedAire is now in its fourth rendition of customized software, with some five years put into the most recent design.

Getting A Quick Response
Garrett's company is built around the three factors she believes it takes to handle a medical emergency aloft:

• Training "by people who understand that environment, the constraints of the environment, and all the variables associated with it," says Garrett.

"If you look at the criteria written by the FAA, for example, in terms of training flight attendants, Éit's not realistic. It's text book."

Training should be simple enough to remember, hit the basics of life support, and center around the most frequently occurring medical emergencies, she adds. MedAire has found that 14 percent of all calls to its service are cardiac related. "That means that every one of those has a chance of becoming a CPR victim...The focus should be the one thing that's not even required (by FAA): to be trained on CPR, " says Garrett.

MedAire offers the Medical Inflight Illness and Injury course which incorporates CPR training and training on automatic electronic defibrillators (AED), tools used to resuscitate cardiac arrest victims. Courses are usually held on customers' aircraft so that crews can see how to treat and maneuver a sick or injured passenger in a small area. "The idea is to be in the aircraft with them and help them design a plan," says Garrett.

• Tools: MedAire stocks its medical kits with the tools to treat medical emergencies the company has found most common among its customers. Tim Singleton, a MedLink communications specialist and instructor, recommends three staples: epinephrine for allergic reactions; glucose gel for diabetics experiencing low blood sugar; and nitro glycerine for heart patients.

AEDs are also distributed by MedAire. Garrett is a strong supporter of having them on board all flights. Passengers in cardiac arrest need help within minutes, she says; even diverting may take too long.

• Medical assistance on the ground: "Even as a flight nurseÉI always had my medical control to call when I got into trouble," says Garrett. This is where the MedLink service comes in, she says, especially since crews can rely less and less on assistance from medically trained volunteers on board. According to calls received by MedLink, from 1996 to 1997 medically trained passengers responded to 65 percent of inflight emergencies; in 1998 that number dropped to 56 percent. And, on smaller aircraft typically used in business aviation, it is less likely a medical physician is on board; help from the ground could be invaluable. Currently 15 carriers are signed up with MedAire, but MedAire's mainstay is still business aviation, says Garrett.

Passengers at risk
Now, with some 13 years experience in handling calls, MedAire is able to build statistics to estimate future trends. Looking at the number of patches they receive, Garrett reports that inflight medical emergencies are on the rise among clients, up 25 percent in 1998 over 1997. (This figure takes into account business growth.)

She believes this rise in the number of inflight emergencies mirrors a growth in the number of "at-risk" passengers. Airlines are altering policies and procedures to better accommodate the disabled, and the aging of the American population means more elderly passengers will be on board more flights in the future. Garrett adds that there is a need for medically prescreening individuals at the gate to safely accommodate special medical requirements of passengers.

"We always had the hypothesis that people who traveled with existing past medical illness in their history, that they had a more difficult time in flight...And what we've seen is that that hypothesis has been borne out and the fact that inflight medical emergencies are on the rise because there are more and more infirm or chronically ill people traveling," says Garrett. "There's no doubt in our mind that this is going to continue and with much greater frequency."

MedAire will be growing to meet that need, says Garrett, and will be exploring the use of new technology such as a vital signs monitor that can transmit not only its findings, but also a video image of the patient to a doctor on the ground — creating a "virtual" ER.

The company is also building a presence in South America and Asia. MedLink now has five call stations at its room in Good Samaritan; three specialists man them by day and two by night. A larger room for their center is in the works. Garrett's concern now is managing growth while keeping a focus on customer service.

...back on the flight to Los Angeles, the doctor on board reports, "The main issue is Énumber oneÉ she says that when we try and set her up a little bit, she feels like she's having more bleeding. And number two, I couldn't really hear any heart tones on the baby. ..She's not feeling any fetal movement at this point." His assessment: there's no need for diversion; the baby is most likely lost.

However, the MedLink physician recommends diverting the flight. As he says later, "The concern is that if she is really quote-unquote six months pregnant, this child is still potentially deliverable at this stage." He tells the doctor on board, "It seems to me from the information you're giving me that we need to have her get medical attention as soon as possible — this could be an early abruption."

The communication specialist talks with the crew and the air carrier's dispatcher to get the plane diverted to the nearest city. The airport is contacted so an emergency medical team will meet the flight. The specialist also calls the hospital and talks to the charge nurse of the ER, explaining the situation. Within an hour of the aircraft being on the ground, a Caesarian section is done, and the mother and child rest in ICU. "They have saved my life, as well as my baby's life," reports the mother. "Everything turned out well and my baby is here beside me."