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Insta-CoGo: Death on a Flight From Haiti

Cindy Loose

The Internet is abuzz with an accusation that airline personnel initially refused to help a dying woman, then agreed to give her oxygen only to find that two oxygen tanks on board were empty.

Instant news, true or untrue, is both the greatness and the curse of modern communications. In this case, things may not be as purported. What we know for sure is that Carine Desir, 44, died Friday on an American Airlines jet from Haiti to New York. The New York Medical Examiner's office says the woman had heart disease and died of natural causes.

The woman's cousin, Antonio Oliver, told the Associated Press that a flight attendant twice refused to give Desir oxygen. When the crew did agree to help, Oliver says they discovered that two oxygen tanks were empty.

But American spokesman Tim Wagner gave me a different rundown this afternoon:

The passenger first complained of illness about an hour into the flight. "Our best information is that the cousin said she had diabetes and he wanted oxygen. The flight attendant said she wasn't sure oxygen would help, and stepped away to ask another flight attendent. Oxygen was administered within two to three minutes after the intial request."

All the oxygen tanks worked; they were checked pre-flight, says Wagner. A call was put out for medical personnel who might be on board, and seven people on board volunteered, including two doctors and a nurse, says Wagner. They took over the administration of oxygen. At one point one of them noted that she wasn't getting oxygen, and used a handpumped device that forces oxygen into the lungs. CoGo is guessing that the cousin might have assumed this meant that the oxygen tanks weren't working, when in fact it might simply have meant that a handpumped type was better.

Wagner said doctors and the nurse did CPR for 45 minutes, during which time the pilot decided to divert the plane to Miami and headed that way. However, once the woman was declared dead, the pilot decided to continue on to New York.

Here's a few more insights into basic procedures for medical emergencies on board flights:

* All planes carry on board a medical kit that flight crew must be trained to use. Requirements imposed in 2004 call for an upgraded kit, including a heart defibrillator.
* American was way ahead of the curve, voluntarily adding defibrillators on all planes in the late 1990s, according to FAA spokeswoman Alison Duquette.
* Defibrillators, contrary to popular notions, are not effective in treating all types of heart attacks. They monitor heart rate and other vital signs and administer a shock only if the problem is a particular kind of irregular heartbeat.
* Although crews are given basic training to use what's included in the mandated kit, they are not medical personnel and are trained to ask if there are medical personnel on board to help. Such help was both requested and received.
* Airlines are required to have two tanks of oxygen on board -- the oxygen masks over each seat are automatically triggered to drop if there is decompression in the cabin, and most can't just willy nilly be pulled down for use. Airlines are also supposed to have two backups if for some reason the other two fail or run out. American says it had 12 tanks on board.

Bottom line: More facts will undoubtedly emerge..

By Cindy Loose |  February 25, 2008; 2:47 PM ET  | Category:  Cindy Loose , Insta-CoGo
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Just as much as you do not trust the source of the initial story (Daily news), I dont trust an AA spokespersons account for what happened.

Talk to the doctors treating her and to some of the passangers near her that witnessed it.

Given the limited information who knows what the cause was. It could hypothetically been from her eating something she was allergic to on the plane.

Posted by: DJP | February 25, 2008 3:17 PM

I don't disagree with DJP. When I stated more facts will emerge, I was thinking of what will undoubtedly be more info coming from the medical personnel who tried to help--those I would trust the most--and other bystanders. It struck me from the start, however, to take the word of a cousin, who no doubt was very traumatized by the incident.

Posted by: cindy loose | February 25, 2008 3:58 PM

"At one point one of them noted that she wasn't getting oxygen, and used a handpumped device that forces oxygen into the lungs. CoGo is guessing that the cousin might have assumed this meant that the oxygen tanks weren't working, when in fact it might simply have meant that a handpumped type was better."

If the oxygen tanks were working properly, why would she have needed the hand-pumped thing?

Posted by: mccxxiii | February 25, 2008 4:28 PM

I'm not sure what the handpumped device you mention was, but it sounds like it was the standard ambu-bag used for reanimation.

If the patient stops breathing, as is typical in e.g. cardiac arrest, which is most likely what happened, having O2 in the facemask does nothing, you have to ventilate the lungs mechanically.... such as with the mentioned "device".

This has nothing to do with the O2 tanks "working" or not.

Posted by: cbum | February 25, 2008 4:33 PM

Just last week on a flight from Ft Lauderdale to DCA on Spirit Air, a passenger fell ill. An anouncement was made for medical passengers to assist, and two women emerged. Oxygen was given (I saw 4 tanks in the cabinet/hold) and a defibrillator was also available (though I don't think it was used/needed but not sure...I never heard "clear" and I was relatively close to the scene). The ill passenger apparently was unconscious for 10 minutes (I heard 2nd hand) and vomitted quite a bit. I thought the flight attendants handled the situation very well as did the passengers assisting(turned out to be an ER Nurse) and the passengers who sat patiently and stayed out of the way. Just for that reason, I would fly Spirit again (pretty much ONLY for that reason).

As a side note...the smell was horrible..but, better to smell vomit than fly with a corpse. Thankfully I had mint gum to help my senses.

Posted by: A sometimes traveler | February 25, 2008 4:43 PM

If there's a medical expert out there correct me if I'm wrong, but I believe that an oxygen tank and mask is more or less passive--oxygen is provided instead of normal air and that's basically the difference--the patient continues breathing on their own but just getting enriched oxygen. By contrast, those bags you see people squeezing on medical dramas force air into the lungs, so are used if someone's not breathing on their own. My expertise is based on watching E.R., so don't quote me, but I'm pretty confident of my T.V. education.

Posted by: cindy loose | February 25, 2008 4:46 PM

You know, I'll be interested for more facts to emerge, as well.


My father is a physician, and over the years he has been tapped twice for medical advice on planes. Both times (one within the past two years, one years ago), the pilot landed the plane as soon as possible so the person could get the immediate care they needed based on his recommendation. And I can assure you, they landed the plane *without hesitation* - my father would have given them h*ll if he thought otherwise.

AA may very well be in the wrong here. But they may have done all the correct things as well. A sad outcome at any rate.

Posted by: Chasmosaur | February 25, 2008 5:02 PM

As pointed out, the bag-valve mask (BVM) was likely used as a mechanical means to provide oxygen to a non-breathing person. It has the added benefit of providing nearly 100% oxygen versus 20-30% from a non-rebreather mask.

An AED (automatic external defibrillator) can only shock certain heart rhythms and if the patient had something else it is of limited value. Paramedics and hospitals have more sophisticated defibrillators which can be used to assess and shock other rhythms, but you will not find these in public area. The doctors and nurses on board likely rendered as much care as they could given the available equipment and probably determined that continued CPR was not going to make a difference in the patient's viability.

I am sure that we will hear more in the coming days, but I would give the benefit of the doubt to AA on this one.

Posted by: Lester Burnham | February 25, 2008 5:25 PM

On a three hour flight, one hour into the flight a request is made for oxygen. Then, "Flight attendants are trained not to automatically give oxygen to every passenger who requests it but instead use airline criteria to judge when it's needed, said Leslie Mayo, a spokeswoman for the union representing American's attendants." At some point the flight attendant exercised the airline criteria to decide if it was needed. The number of requests is debatable. With two hours left, we know that CPR was delivered unsuccessfuly for 45 minutes of that time. That left one hour and 15 minutes. Part of that time was spent considering diversion to Miami and part of it was spent in continuing the trip to NYC post-mortem. Assuming all that decision making took a whole 15 minutes, there was at the most a one hour gap between the time oxygen was requested and CPR had to be administered. Assuming AA is correct that "..of 12 oxygen tanks on the plane (which) the crew checked ... before the flight took off to make sure they were working, Wilson...said at least two were used on Desir," two questions arise: (1) why was a second tank needed during this one hour period if the "crew was sure" the first one worked, and (2) what is the capacity of either of these tanks vis a vis that one hour period? Sometimes it isn't more opinions we need, it's just evaluating the ones we've already been handed.

Posted by: neveragainamerican | February 25, 2008 5:55 PM

If there were no working oxygen tanks, but the woman had needed oxygen, then the pilot could simply have released the emergency overhead masks. You know, those plastic things they show before every flight? ("Put your own mask on before helping those around you . . .")

That they didn't need to do that demonstrates, pretty clearly, that the woman didn't die for want of fresh oxygen. Obviously a tragic outcome, especially for one so young, but I sincerely doubt that she died because the equipment on the plane didn't work.

Of course, a public statement from one of the doctors would clear things up, but not surprisingly I bet they don't want to get any more involved than they already are. The airline will gladly hang them out to dry if anything doesn't sound right.

Posted by: Andy | February 25, 2008 6:30 PM

However, once the woman was declared dead, the pilot decided to continue on to New York.

Yeah, since she was dead anyway, why not go on to your destination - we wouldn't want to make anybody late. If the plane had stopped at the closest safe airporo the woman's body could have been taken out of the plane in a respectful way, instead, the pilot continued on to his original destination. Sort of the ultimate example of the coarsening of american culture.

Posted by: Anonymous | February 26, 2008 11:08 AM

"However, once the woman was declared dead, the pilot decided to continue on to New York.

Yeah, since she was dead anyway, why not go on to your destination - we wouldn't want to make anybody late. If the plane had stopped at the closest safe airporo the woman's body could have been taken out of the plane in a respectful way, instead, the pilot continued on to his original destination. Sort of the ultimate example of the coarsening of american culture."

But HER ultimate destination was NY, too. If they took her body off the plane in Miami, her family (who were waiting for her in NY) would have had to arrange to transport it to NY. I think AA made the right call, there.

Posted by: Harrisburg, PA | February 26, 2008 11:33 AM

"However, once the woman was declared dead, the pilot decided to continue on to New York....Sort of the ultimate example of the coarsening of american culture."

I think this was the wisest choice. Even though it was a sad situation for her family, all the other passengers on the plane weren't too unduly inconvenienced. BUT MOST IMPORTANTLY, the shipping cost of her dead body was minimized. I can vouch that shipping your dead relative's body a long way can cost A LOT. It was better for her family too.

Posted by: Milwaukee, Wisconsin | February 26, 2008 11:46 AM

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