# AED's, airplanes and a bumpy ride



## bigbaldguy (Dec 29, 2011)

We have Phillips Heartstart FRx AED's on the aircraft. When using an AED in a vehicle you're supposed to pull over, obviously this isn't an option on an aircraft. After doing some googling on the topic I can't find anything on exactly how smooth it would need to be for them to work. Anybody have any idea how the background vibration on a medium sized aircraft would effect an AED? What about light or moderate turbulence? AED's have been successfully used inflight so it is possible but most of the examples I've found have been on very large aircraft (777,747,wide body airbus) which tend to have a smoother ride then say a 737. So any ideas?

I started thinking about this after reading a recent post. I know that the airline I work for has had three instances in recent years where an AED was applied but no shock was advised.


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## Medic Tim (Dec 30, 2011)

it would advise shock  in asystole or pea as the turbulance may make it look like v fib or you would have to wait until it is more smooth if it picks up artifact.

where I work medics have shocked asystole and pea because the aed advised shock while driving.\\ we use the Mrx and frx


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## Veneficus (Dec 30, 2011)

don't know about aircraft, but i read a study about 7 years ago that demonstrated that the listing and pitching on small watercraft had no effect on the function of AEDs.


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## bstone (Dec 30, 2011)

Veneficus said:


> don't know about aircraft, but i read a study about 7 years ago that demonstrated that the listing and pitching on small watercraft had no effect on the function of AEDs.



Would love to see this. Do you recall which journal?


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## medicdan (Dec 30, 2011)

My bet is that like all equipment used on HEMS and fixed-wing EMS aircraft, the Philips AED needed FAA device approval. 
Take a look at this, 
http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgAdvisoryCircular.nsf/list/AC%20121-33/$FILE/AC121-33.pdf


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## MMiz (Dec 30, 2011)

I was on a Northwest Airlines A320 back in 2005 and was handed a LifePak 500 AED when a man was unconscious.  

My biggest concern wasn't the bumpiness, but rather the lack of space we had in the back galley.  Fortunately it wasn't used, but it would have been a feat clearing everyone prior to a shock.


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## Veneficus (Dec 30, 2011)

bstone said:


> Would love to see this. Do you recall which journal?



I think it was JEMS actually.


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## jjesusfreak01 (Dec 30, 2011)

Wish all the AEDs on planes had screens, so I could see if it was about to do something stupid.


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## bigbaldguy (Dec 30, 2011)

Medic Tim said:


> it would advise shock  in asystole or pea as the turbulance may make it look like v fib or you would have to wait until it is more smooth if it picks up artifact.
> 
> where I work medics have shocked asystole and pea because the aed advised shock while driving.\\ we use the Mrx and frx



So it might shock in situations where a shock does no good but it wouldn't fail to deliver a shock when it was needed?


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## Veneficus (Dec 30, 2011)

jjesusfreak01 said:


> Wish all the AEDs on planes had screens, so I could see if it was about to do something stupid.



I do not understand this?

The AED decides if a shock is indicated or not. It does not charge unless it is. What do you need a screen for?


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## bigbaldguy (Dec 30, 2011)

jjesusfreak01 said:


> Wish all the AEDs on planes had screens, so I could see if it was about to do something stupid.



I believe, and this is just from word of mouth that some very large over water aircraft have monitors that can transmit info to ground medical control for analysis.


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## Veneficus (Dec 30, 2011)

bigbaldguy said:


> I believe, and this is just from word of mouth that some very large over water aircraft have monitors that can transmit info to ground medical control for analysis.



yes, this is true, I have actually had the opportunity to open the doctors medical kit on a transatlantic lufthansa flight. 

it is better stocked than any ALS ambulance I have ever been on.


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## medicdan (Dec 30, 2011)

bigbaldguy said:


> I believe, and this is just from word of mouth that some very large over water aircraft have monitors that can transmit info to ground medical control for analysis.



It's my understanding that many airlines (perhaps not yours) subscribe to a service called "MedAire" that provides (and maintains) inflight medical kits and equipment, but also provides on-line medical control to pilots and passenger responders in time of inflight emergencies. They offer a product called the TempusIC, summarized below
http://www.rdtltd.com/index.php?id=5&parent_id=1

http://www.medaire.com/corp_aviation.asp

The TempusIC can measure, among other things, BP, HR, Pulse Ox, ECG (12-lead), ETCO2, RR, Tymp temp, FSBS, and has a webcam, mic, etc. for communication. 

Interesting technology, no?


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## bigbaldguy (Dec 30, 2011)

emt.dan said:


> It's my understanding that many airlines (perhaps not yours) subscribe to a service called "MedAire" that provides (and maintains) inflight medical kits and equipment, but also provides on-line medical control to pilots and passenger responders in time of inflight emergencies. They offer a product called the TempusIC, summarized below
> http://www.rdtltd.com/index.php?id=5&parent_id=1
> 
> http://www.medaire.com/corp_aviation.asp
> ...



Very interesting. I can definitely see something like that being of huge help. We do have the ability to contact medical control for advice ect. but nothing like this. For any vitals beyond pulse rate we page for medical assistance and hope like hell someone comes forward.


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## Medic Tim (Dec 30, 2011)

bigbaldguy said:


> So it might shock in situations where a shock does no good but it wouldn't fail to deliver a shock when it was needed?



If it recognized the artifact it may keep re analyzing when the pt is in a shockable rythem. Bit otherwise yes. According to our cqi department


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## Flight-LP (Dec 30, 2011)

Just tell the Captain to enter a holding pattern, lol.

An AED is safe to use on a 73x. As previously mentioned, in addition to 510k approval, the units must be approved by the FAA. Having defibrillated quite a few times in small jets, turboprops, and even a POS Cessna 414, I can attest it will work just fine. 

Another consideration is the reality to the airborne cardiac arrest scenario. Honestly, does it really matter if the AED shocks PEA or asystole? Chances are the time involved to divert and get a new clearance, if the Captain even gets one, will significantly reduce any hope of a positive outcome. Face it if your at cruise altitude, you are looking at 20 - 30 minutes minimum before you are safely on the ground and that is if you are near a usable airport with appropriate services. Plus let's play the "you get them back" scenario. How effective will post resuscitative care be? Do you have ALS personnel who can care for the patient? Do you have the needed equipment? How long will your O2 supply last (a "D" cylinder will give you 20 minutes tops)? Do you have ability to compensate for the gas laws (especially Boyle's when you get down to 10,000 feet)?

In my mind these would be more important issues than if an AED might shock something that couldn't get any worse than it currently is.


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## bstone (Dec 30, 2011)

Veneficus said:


> I do not understand this?
> 
> The AED decides if a shock is indicated or not. It does not charge unless it is. What do you need a screen for?



Equipment sometimes fails. Good to know if you're going to shock a NSR by accident.


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## akflightmedic (Dec 30, 2011)

bstone said:


> Equipment sometimes fails. Good to know if you're going to shock a NSR by accident.



And if that NSR which you are seeing is actually a non pulse producing rhythm...?

Seriously?? Please show me the literature where an AED has shocked someone who did not need it. There have been AED failures either through operator error or the machine failing to shock, but show me a case where it said a shock was indicated and delivered it...even though truly not needed.


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## jjesusfreak01 (Jan 1, 2012)

Veneficus said:


> I do not understand this?
> 
> The AED decides if a shock is indicated or not. It does not charge unless it is. What do you need a screen for?



The worry would be that motion artifact was mimicking a shockable rhythm when the patient was in a non-shockable rhythm, confusing the AED. If they could assure me that this didn't happen, then no problem.


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## Flight-LP (Jan 1, 2012)

If it is motion artifact, the machine will not shock, it will advise to not touch the patient or that motion is detected. As AK said, there are no viable reports available indicating a false positive delivery of electricity.

Remember these devices are built, marketed, and utilized for their simplicity. they became popular for BLS and First Responder agencies because they were easy to use and required no technical knowledge or skill. They are now improved to be used by the lay public. The machine is smarter than you and can interpret a rhythm better than you. A screen is not necessary. 

In case you still don't believe us, then do a little research on the LifePak 300 and discover why it is no longer utilized and why they never developed a newer model similar to it. You may not likfe the answer you find, but it is at least the honest truth.


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## KyleG (Jan 9, 2012)

Kind of a dumb idea/question: But Couldn't they use a monitor off an ALS rig to test the idea? Like read a strip and see what it does. Of course we would need to have a monitor on an airplane and have an arrest happen.


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