Woman dies while in-flight; Airline disputes relative's tale
 

http://www.msnbc.msn.com/id/23327116/?GT1=10856

Basically the relative is saying the flight attendants waited too long and that the oxygen tanks were empty... American says the flight attendants acted admiraly and according to how they were trained and that the equipment was working fine..

It is a scary situation all around... no telling how it is going to end... (i.e. if the relative will try suing or something)

I will say though I hope no one was actually sitting in the First Class cabin. The woman's body was put in the aisle of the FC cabin with a blanket over it for the remainder of the flight.

I realize they probably don't have a 'contengency plan' of what to do in case someone passes during a flight.. but really? That must have been disturbing. :(

The medical examiner did say the woman died of complications of heart disease & diabetes.

If the oxygen tanks were empty or they delayed in providing oxygen, it seems pretty bad, but oxygen isn't going prevent you from dying of heart disease, I wouldn't think.

The passenger's relative is saying the defibrillator malfunctioned, but the airline says it wouldn't work on her because her heart rhythm was too weak to shock back into natural rhythm.

I think it's sad the woman is dead no matter what, but I'm not sure that you can reasonably expect that airline personnel are going to save your life if you have a heart attack or a heart-disease related event mid-flight. I'll bet there's going to be a suit, so maybe we'll find out more about what obligation the airline has.

It would be a little freaky to have a dead body on the flight near you, but I'm not sure what the options are. There were probably fewer people and more space in 1st class.

ETA: Random literary moment: there's a short story, I think it might be by Willa Cather, about a women whose husband dies while they are on a cross country train trip and she decides that she has to pretend he's sleeping for the rest of the trip to the porters, conductors, etc, so they don't make them get off in the middle of nowhere to see an undertaker and wait for the next train. She knows that it's the difference between being home in less than a day and not being home for a week. I don't know that I could pull it off. I think I would be freaked out so much.

I really hope that the doctors/nurses that tried to help the woman on the flight don't get pulled into the suit if there is one since they were individuals who intervened to help the woman.

If they do get pulled into a suit, I would imagine it would make doctors/nurses think twice about trying to help someone in a situation like that for fears of getting sued for unsuccessful attempts to save an individual.

From reading the reports on MSN.com, this woman was not feeling well all day and probably should not have flown. Unfortunately, you cannot treat a heart attack in the air. Defibrillators only work if you are in V Fib...she may not have been. Oxygen would have helped her be comfortable, but I don't think the airlines have a mandate to have O2 available. They aren't a hospital. You can't blame the airline for a patient's bad health and its complications. I also don't expect a patient's family member to be able to give a reliable accounting of the events given the stress of the situation. Also, if the family member has no medical training, how would he know if things were not done correctly?

Aren't there some built in protections for people under these circumstances?

Are there federal "Good Samaritan" laws?

I had to dig up my book from my CPR class (which I just renewed two months ago so it is a newly printed book), the Good Samaritan laws are state laws. There is a law in all 50 states, varying slightly by state. I have no idea how the law is applied however in a flight from Haiti to NY.

The one thing I always took away from the GS laws is that you are expected to act 'within the scope' of your training. In other words, if you have only seen CPR done on TV and you break someone's ribs while attempting to mimic, you most likely would not be protected. That I think is something many people wouldn't be aware of.

Sorry for the slight hijack...

thanks for the info.. i wasn't sure if anything like that would exist to protect those who tried to help.

I see dead bodies all the time so I could sit in first class without a problem. :D Oh yeah- I'm a critical care RN so I'm around acutely ill people all the time and have coded so many I don't even have a guess at a number.

On a serious note- You need a shockable rhythm to have an AED function- that means V-tach or V-fib. If you're in a heart block, PEA, asystole, SVT, etc it is of no use. I wouldn't expect flight attendants to know how to 'save a life' other than basic CPR including use of the AED. Oxygen would not have saved this woman's life. I'm sure an investigation will occur, but their shouldn't be a lawsuit. At least I wouldn't award them damages.

Wow! We know so little of the passengers preboard health... We have no clear indication what her problems were in-flight other than the first-responders. She also could have had embolism or a stroke... Did the healthcare worker hear her heart rhythms? And I agree with the others, AED may have done very little without essential EMT equipment. The article stated she was a diabetic, she could have been going into post-prandial glucose shock which would have also caused heart palpitations and sometimes inability to breathe. The flight attendants did make the call to deliver O2 and although O2 may have not given her relief neither did defib. A 44 year old diabetic woman could have had silent myocardial ischemia leading to cardiac arrest... The riskiest thing to do to her is cool her down. But only a cardiologist should make that call...

According to the airline, the plane had 12 oxygen tanks on board. Twelve seems excessive to me, but by law they are required to have at least two. All involved say that the oxygen tanks were used. The family member being quoted obviously does not understand the ins-and-outs of CPR and defibs...he referred to the defib. as a "box" to the investigators and told people none of the tanks or the "box" worked. What he doesn't seem to be grasping is that they just didn't work on his relative.

It’s amazing how many people think that if someone’s heart stops, they stop breathing or both they will be revived with CPR or an AED. It’s not an absolute but unfortunately TV has perpetuated this mindset. I’d say the biggest culprit is/was Baywatch. It seemed like every drowning victim was revived after a few seconds of CPR/Rescue Breathing on that stupid show. Well enough of that rant. Who knows what was going on in that situation but if she had stopped breathing and her heart had stopped the best thing they could do was provide CPR to keep blood and oxygen flow to her vital systems until they could get her to proper facilities. It sounds like the relative was expecting spontaneous consciousness.

Here is an interesting article about how TV shows have changed the public’s perception about effectiveness of CPR and other lifesaving measures.

American Airlines says they did nothing wrong!

Makes me want to fly them, NOT!:rolleyes:

How in the heck can oxygen bottles be empty?

Something is wrong with this picture!:o

I doubt that the tanks were empty. Like Peppy said, the relative didn't seem to understand what was going on, all the knew was that the two different oxygen tanks they tried and the "box" didn't help the woman.

I hugely agree with this, it's actually the first thing I thought of when I read this. CPR is hardly ever effective, AED only marginally more so. I've been trained that the breathing portion of CPR is of minimal value, that if you cannot come to terms with putting your mouth over a stranger's mouth that the chest compressions alone will be almost the same as compressions with breaths.

Current CPR training is 30 chest compressions to 2 rescue breaths, but on TV it's maybe 5 to 5. :) And of course, anyone whose heart stops, no matter for how long, seems to live on TV. :rolleyes: I lost a close family member a bit over a year ago after his heart stopped. He was finally revived, but it was too late, his brain was gone. Of course a couple days later I saw someone on TV fully recover after an almost identical situation. It just doesn't work that way in real life. :o

Apparently, the events as first described the family member was inaccurate. It seems odd that this family member was so outspoken against the facts.

It will be interesting as this develops what will change with in-flight medical emergencies. According to the CNN report, she could have had an allergic reaction so severe that it obstructed her airway causing her to be unable to breathe. And she was thirsty and sweating post-prandially that could be suggestive of hyperglycemia in the context of possible insulin resistance.

I am partially making my call on this statement:

So neither O2 or AED would have made a lot of difference in this case... That is really sad.

Thanks for the link Dolphin.

Relatives of this person are not good objective witnesses as a general rule because of their emotional connection to the deceased/injured and also because of the prospect of a financial settlement.

I do not wish the deceased ill and God rest her soul, but since we are talking about accountability here let's just be honest about the fact that the head shots of her on the news indicate she was morbidly obese. Add in existing medical conditions and she was a ticking time bomb. Unluckily for the airline, the bomb went off a few thousand feet in the air.

It makes sense that a person in this medical condition died.

It does not make sense that a plane full of passengers and a trained crew failed to do all they reasonably could in the circumstances.

My bet is that there will be a decent sized settlement out of court. It will all be about the airline deciding whether the cost of settling now will outweigh the cost of lost business and general ill will in the long run among the general public. It will have nothing to do with actual culpability.

I agree^^^

I will be asking my FIL who is a cardiologist who would know these issues. But both my husband and I asking where is the insulin stick? Because she was more likely to have that issue vs. a outright myocardial infarction. I am not saying she did NOT have sudden cardiac arrest, but her issue was hyperglycemia and conduction is not as good through hyperosmolar blood. That may the reason why the AED did not deliver desired results... O2 would have been better after reviving. But hyperglycemia is nasty to what it does to blood.

Agree.
Deep pockets and our legal system at work.:(
Truth be told, the family will most likely end up with less that what their attorney will get;)
However, if it goes to trial I for one would love to be on the jury:D

Okeeey... My FIL said that apparently the woman had her own O2 tank. But the airlines like folks to use their tanks as a restriction. She possibly had a respiratory illness requiring O2. Because it is a ~10 hour flight, why she failed to request a full O2 tank is beyond comprehension. And because it is a high altitude flight (because of the distance), even under compression there is less O2 around and for someone to have a respiratory illness with reduced O2 bad combination and dangerous, overall.

Apparently in other news articles, they are saying that the Dr. (Sulkin) said that the first tank malfunctioned and was empty... What would be the reason why he would be wrong? (according to my FIL).

Essentially, as everyone can see she was obese and type 2 diabetic. It is likely she had Coronary Artery Disease (CAD). That with a respiratory illness with a medical requirement for O2, EVERYTIME THERE IS AN EMERGENCY O2 IS USED--STANDARD OPERATING PROCEDURE!!! The reason is "RBC surface area" and loading it with O2... Lack of oxygenated blood that runs through the heart RAPIDLY causes cardiac dysfunction.

Defib would not work very well without O2 blood at high altitudes or hypoxic conditions...

That is how a board certified cardiologist calls it...

It is sad, but that is why the airline is saying 12 tanks. Improper procedures may be involved here, but the family may not get much support. :(

Please do post what you find out.

On the issue of the insulin stick- this raises a new question I would pose to you and others.

On insulin sticks- what if an airline had them in stock and then gave one to a person in an emergency and the person died of insulin shock or some other reaction?

I ask because it seems to me there is a whole other level of liability involved if a good samaritan administers a potential cure to someone that is beyond their own personal expertise to administer and the person suffering dies as a result of the attempted cure.

Or is there? I don't know.

It just seems to me that with a portion of the population having a potential reaction to insulin, any airline employee who administered it (or anyone who did so without an MD or RN and a knowledge of the patient history or how to deal with a bad reaction) would be open to additional liability.

My gut reaction is that the answer is kind of like the no-tolerance policy in many schools right now where administrators mitigate legal liability by not allowing any kind of situational judgement calls that could bring legal questions into play.

Disclaimer: I believe insulin sticks are based on weight... At least with diabetic coma you can give glucose or sugar as fast as they can digest it... I did that with a mouse before when for some reason we added to much insulin on fasted animals and my mutant mouse which has a body fat problem pooped out on me but were not hyperphagic--or don't pig out.

According my FIL ANY physician who has passed the USMLE, did a residency and got boarded in an area should KNOW how to treat in an emergency... Maybe they cannot do a specific neurosurgery, but to administer simple drugs, give O2, take a pulse, draw blood, basic dressing--they should know... Some may not, but then they get filtered out of the scene... Chit, I can do some basic surgery, administer some drug through the skin (and tail veins ;) ) and administer a drip--but I would NEVER do it to a person. Unethical.

Someone without official training did make the call on O2 administration to this passenger. She really did not have the MEDICAL EXPERTISE to refuse O2 even if her airline rules and training stated differently. SOP of ER services is to deliver O2... That's standard of care...

So now the airline has to consider how to be an ER? I dunno? :confused:

Good discussion! :)

That would be terrible and a perfect example of "no good deed goes unpunished".

Airline employees are simply that, airline employees. They cannot be expected to be paramedics as well. Basic first aid/CPR? Sure. Anything beyond that, it's the risk you take when you are somewhere that paramedics/911 can't respond.

If there is a lawsuit and they win, it's as ridiculous as the woman who spilled hot coffee on herself.

Several links about the Mc Coffee case:
http://www.lectlaw.com/files/cur78.htm
"The trial court subsequently reduced the punitive award to $480,000 --
or three times compensatory damages -- even though the judge called
McDonalds' conduct reckless, callous and willful.

No one will ever know the final ending to this case.

The parties eventually entered into a secret [COLOR=blue! important][COLOR=blue! important]settlement[/COLOR][/COLOR] which has never
been revealed to the public, despite the fact that this was a public
case, litigated in public and subjected to extensive media reporting.
Such secret settlements, after public trials, should not be condoned.
-----
excerpted from ATLA fact sheet. © 1995, 1996 by Consumer Attorneys of
California"
http://www.okbar.org/public/judges/mcdonaldsoutline.pdf

Point well taken!

Eye witnesses can see things differently of course.

But, the question would be the timing of lack of help in a proper manner.

She may have already have been deceased.

CPR has changed from the old 5-3 as I was trained with the Ski Patrol and is now more breaths to compressions.

So, who is going to admit who was in error?

The part in the article Dolphin linked to had a quote that concerned me.

Maybe I am reading into it too much, but this is what I know of AEDs. They look for a "shockable" rhythm (usually pulseless v-tavh or v-fib). It will not shock if it is "asystole" (flat line). So, I wonder what the actual rhythm was that it didn't work.

Dealing with death at 30,000 feet
 

Dealing with death at 30,000 feet

In-flight fatalities give passengers an up-close view of human frailty

http://www.msnbc.msn.com/id/23395706/
NEW YORK - When Rubina Husain's husband died aboard an airliner, she shielded her 10-year-old daughter's eyes so she wouldn't see her daddy's body carried through the cabin.
Then, with the corpse covered up and tucked away in a rear galley, the passengers who had stood around and stared after the man collapsed returned to eating and chatting. The Athens-to-New York jetliner continued on to its destination for eight or nine more hours. And the in-flight movie was shown as planned.
"It felt like a never-ending flight," says Husain, whose husband died in 1998 after an asthma attack. "I felt like: Why doesn't this plane just crash and kill me? Why don't I just die?"...........

F/U to original posting:
......."Decades ago, in the early days of commercial flight, all stewardesses were nurses. Now, the FAA mandates that flight attendants receive non-professional-level training in such methods as CPR, but they are not required to be able to use the syringes and intravenous drips in onboard medical kits.
Northwest said that doctors, nurses or paramedics are aboard an estimated 96 percent of its flights. MedAire said medical professionals stepped forward to help in 48 percent of the more than 17,000 medical situations it was called on to help with last year."......
"Desir's husband and two children, ages 23 and 10, have hired a law firm to investigate the death of the Brooklyn nurse.
"My wife died on the plane," her husband, Mario Fontus, told The Associated Press. "And I want to know what happened on that plane."
Airline defends response after in-flight death

Relative claimed faulty gear; American said flight crew ‘acted admirably’
http://www.msnbc.msn.com/id/23327116/

Can you imagine having to sit on a flight for 8-9 hours after your spouse has died and been stuffed somewhere else "convenient" on the plane? That must be horrid.

I agree. I don't know how they should handle it to do it better because, no matter what, it's going to be awful.

I suppose knowing that it's horrible for the family no matter what, they try to minimize the event for everyone else.