http://www.eurekalert.org/pub_releases/2011-05/bidm-psh050211.php The concepts now at the center of the health care quality movement, adopted in large part from the airline industry, should be used to standardize the processes and the equipment for in-flight medical emergencies, according to two Beth Israel Deaconess Medical Center physicians. Writing in an online release for the May 11 Journal of the American Medical Association, Melissa Mattison, MD and Mark Zeidel, MD, note that because the airline industry has adopted root cause analysis of accidents and near misses "most individual flight attendants will never experience an emergency landing or evacuation during their careers. "By contrast, in-flight medical emergencies occur frequently. Yet the kinds of approaches that have improved flight safety have not been extended to providing optimal care for passengers who become acutely ill while on board airplanes." The authors note that despite 10,000 in-flight medical emergencies identified by European airlines over a 5-year period, each airline has its own reporting system and protocol. And while emergency medical kits are mandated to contain medications and equipment, actual kits vary by airline. The US Federal Aviation Administration, which mandates that flight attendant training includes CPR and the use of automated external defibrillators, the FAA does not require standard curriculum or testing. As a result, physicians responding to emergencies can face a broad array of challenges including cramped physical space, emergency kits whose contents are unfamiliar, inadequate, and poorly organized, and flight crews unaware of how best to assist the physicians. Mattison and Zeidel offer a four-step plan to improve the treatment of passengers who become ill in-flight.