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Are Defibrillators on All Planes Too Costly?

Makes more financial sense on larger jets, says study

TUESDAY, Sept. 25, 2001 (HealthDayNews) -- Cardiac defibrillators are proven lifesavers in public places, especially airplanes, where medical help is far away. The Federal Aviation Administration, citing studies showing their value, recently issued an order that all U.S. aircraft with at least one flight attendant should have a defibrillator on board by 2004. But is the expense justified?

Probably, says a new study, at least for planes carrying more than 200 passengers. But the smaller the plane, the less cost-effective the devices become, says the study reported in the Sept. 26 issue of The Journal of the American Medical Association.

No reliable statistics are kept on how many airline passengers have heart attacks in the air, but study author Dr. Peter Groeneveld, a fellow at the Center for Primary Care and Outcomes Research at Stanford University, says the estimate is about 200 a year.

"Without an automatic external defibrillator, your chances of surviving sudden cardiac arrest on an airplane are virtually zero," says Dr. Steven Bailin, an electrophysiologist at the Iowa Heart Center in Des Moines. "With each minute that goes by, your chance for survival decreases by 10 percent."

Groeneveld and his colleagues looked at all costs involved in placing defibrillators on airplanes, including the cost of the machines (about $3,000 each), their maintenance, medical training for the flight attendants and follow-up care for cardiac arrest patients.

They say the survival rate would be about 17 percent, meaning defibrillators, if installed on all passenger planes, would save about 35 people a year.

The cost would be slightly more than $35,000 for each quality-adjusted life-year gained to install defibrillators on planes that carry more than 200 passengers, say the researchers. For aircraft carrying 100 to 200 passengers, the cost would be almost $41,000 per quality-adjusted life-year. And, if the airline industry were to put defibrillators on all passenger airplanes, the cost would jump to $94,700 per quality-adjusted life-year.

A quality-adjusted life-year means a year of perfect health for a survivor whose quality of life would remain the same. In comparison, the authors say a driver's-side air bag in a car costs $30,000 per quality-adjusted life-year, while adding a passenger-side air bag boosts the cost to $76,500.

While looking at the issue from a mostly monetary perspective may seem somewhat callous, Groeneveld says we all face an infinite number of threats to our safety every day. And, he says we simply don't have the resources to eliminate every threat. So, rather than make decisions based on emotions or politics, he says, "These kinds of studies can help policymakers delineate how to spend a limited amount of dollars."

Groeneveld says, "Pretty clearly, putting defibrillators on large aircraft seems to be the right thing to do." However, considering the recent terrorist attack, he says putting extra money into new security measures might make more sense than spending it on defibrillators for small planes.

"These are already hard times for the airlines," says Bailin. Still, he says defibrillators probably should still be installed on planes that carry more than 50 passengers. These planes are more likely to travel long distances and have crew members who could operate the machines, he says. "As part of 'getting back to normal,' we do need to sustain the momentum that is already in place to put [defibrillators] on commercial aircraft," says Bailin.

For many airlines, however, it already may be a moot point. "We already have defibrillators on all our planes," says Beth Harbin a spokeswoman for Southwest Airlines. "We saw the advantage in it and wanted to be able to help our customers if needed."

What To Do

The American Heart Association has information on defibrillation and heart attacks which can be treated with a defibrillator.

SOURCES: Interviews with Peter Groeneveld, M.D., fellow, Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, Calif., and Steven J. Bailin, M.D., electrophysiologist, Iowa Heart Center, Des Moines; Sept. 26, 2001, The Journal of the American Medical Association
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