[Federal Register Volume 65, Number 109 (Tuesday, June 6, 2000)]
[Notices]
[Pages 35971-35973]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-14086]


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DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration


Emergency Medical Equipment

AGENCY: Federal Aviation Administration (FAA), DOT.

ACTION: Notice of decision.

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SUMMARY: This notice is issued pursuant to the Aviation Medical 
Assistance Act of 1998, which requires the Federal Aviation 
Administration to determine whether or not to require automatic 
external defibrillators at airports. To carry out this mandate, the 
agency reviewed data on the medical capability at the airports most 
used by passengers to respond to cardiac events. Based

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upon this review, the Administrator of the Federal Aviation 
Administration has determined that it is unnecessary to propose a 
regulation to require automatic external defibrillators at airports.

FOR FURTHER INFORMATION CONTACT: Robert E. David, AAS-300, Airport 
Safety and Operations Division, Office of Airport Safety and Standards, 
Federal Aviation Administration, 800 Independence Avenue, SW, 
Washington, DC 20591, telephone (202) 267-3085.

SUPPLEMENTARY INFORMATION: On April 24, 1998, the Aviation Medical 
Assistance Act of 1998 (the Act), Pub. L. 105-170, 49 U.S.C. 44701 was 
enacted. The Act requires the Administrator of the Federal Aviation 
Administration to make decisions on whether or not automatic external 
defibrillators (AED's) should be required:
     On passenger aircraft operated by the air carriers and/or
     At airports.
    The act specifies that the decisions shall be made in one of the 
following three forms:
     A notice of proposed rulemaking requiring AED's, or
     A recommendation to Congress requiring AED's, or
     A notice in the Federal Register that AED's should not be 
required.

Background

    The following information has been reported recently in various 
medical journals and the press:
     Cardiac arrest (the stopping of effective pumping of blood 
by the heart) reportedly strikes over 350,000 Americans every year, 
typically those 41 to 65 years old.
     The most common form of treatable cardiac arrest (a 
substantial portion of all cardiac events) is caused by an abnormal 
heart rhythm called ``ventricular fibrillation'' (where the heart is 
still beating, although ineffectively pumping blood.) Ventricular 
fibrillation is treatable with defibrillation, electric shocks that 
stimulate the heart to resume beating normally.
     Survival of individuals undergoing ventricular 
fibrillation can be as high as 90 percent in some circumstances, if 
defibrillation is provided during the first minute following collapse 
and subsequent cardiac care is rapidly provided.
     For every minute that defibrillation is delayed, survival 
is reported to fall about 10 percent, dropping below 50 percent after 6 
minutes.
     By providing early electrical correction of ineffective 
heart pumping, therapeutic defibrillation is more effective than CPR in 
sustaining life and function in certain situations.
    A defibrillator, when place on the chest of a person suffering from 
ventricular fibrillation, can shock that person's heart back into 
proper rhythm. Originally defibrillators were bulky and complex units 
that were designed to be used by specially trained medical personnel, 
such as doctors or paramedics. These manual-style defibrillators were 
used as part of an Advanced Life Support (ALS) system.
    Defibrillator technology has progressed with the introduction 
AED's. AED's are lightweight, compact, virtually maintenance-free, 
simple to use, and can deliver repeated, high-amperage shocks that stun 
the heart cells long enough to give the heart an opportunity to restore 
its normal rhythm if possible. Because these battery-powered systems 
voice-prompt step-by-step guidance, non-medical personnel may use them 
fairly confidently to assist in certain, especially treatable cardiac 
emergencies. In fact, both the American Red Cross and the American 
Heart Association include instruction on these devices in their basic 
cardiopulmonary resuscitation (CPR) classes. AED's currently cost 
approximately $3,500 per unit, AEDs have been placed in many public and 
private buildings and AEDs have been issued to non-medical personnel 
such as police and firefighters.
    The type of AED most commonly used can monitor a person's cardiac 
function and administer a shock if indicated. The machine determines 
whether, and when, an individual needs an electric shock. If 
defibrillation is needed and is successfully performed, further medical 
interventions may be necessary to stabilize a stricken passenger. Both 
AED's and manual-style defibrillators produce the same medical results 
when used on a person experiencing ventricular fibrillation.

Airports Considered

    Under Title 14 of the Code of Federal Regulations (CFR) part 139, 
operators of airports having scheduled air carrier service with 
aircraft having more than 30 seats are required to have an airport 
operating certificate issued by the FAA. While not all airports are 
certificated, the airports most frequently used by passengers are 
certificated. Part 139 covers all aspects of airport safety for the 
prevention and mitigation of aircraft accidents; it does not cover 
passenger medical matters in the airport passenger terminal building or 
in the aircraft on the ground at the airport. (In general passenger 
medical care, as opposed to safety, especially on the ground, is within 
state, not federal, jurisdiction). The drafters of the Act recognized 
the differences in the environment presented by an aircraft and an 
airport for an individual experiencing a medical event. In an aircraft, 
individuals experiencing medical events are isolated by flight from the 
usual emergency care and must rely on the medical resources in the 
aircraft. In an airport, individuals experiencing medical events have 
available to them the usual emergency medical care plus potentially can 
rely on the full spectrum of modern medicine.
    The drafters of the Act provided that the decision regarding 
requiring AEDs for airports and air carriers could be in different 
forms. As a result the FAA decided to undertake separate, but parallel 
and coordinated, efforts in gathering and analyzing information for 
airports and air carrier aircraft. The decision published here applies 
only to airports. A decision regarding AEDs on air carrier aircraft 
will be issued separately.
    The report from the Committee on Transportation and Infrastructure 
that accompanied the Act stated that the FAA should consider the size 
of the airports in determining if AEDs should be required. The 
Committee also expressed their expectation that the FAA would take a 
judicious approach in drawing the line with respect to airports. In 
view of the Committee report language, FAA decided to focus its effort 
on airports with an average of 275 or more daily enplanements (100,000 
annual enplanements.) In simple terms, an enplanement is counted for 
each passenger who begins a trip or changes planes at an airport. There 
are 215 airports that have scheduled air carrier service with an 
average of 275 or more daily enplanements.
    There is quite a variance in the number of enplaned passengers 
between individual airports. For example, 83 airports have 1 million or 
more annual enplanements and account for 92 percent of all 
enplanements. At the top end of this group there are Atlanta's 
Hartsfield and Chicago's O'Hare that each have more than 30 million 
annual enplanements. At the other end of the spectrum are airports like 
Syracuse-Hancock International and Albany International, that each just 
exceed 1 million annual enplanements.
    Similarly, there are 72 airports certificated under part 139 that 
have more than 250,00 but less than 1 million annual enplanements. 
These airports account for 5.4 percent of the total annual 
enplanements.

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    There are another 60 airports certificated under Part 139 that have 
more than 100,000 but less than 250,000 annual enplanements. These 
airports account for 1.5 percent of the total annual enplanements.
    The preceding 215 airports (83 + 72 + 60) account for 98.9 percent 
of total annual enplanements. The remaining airports certificated under 
Part 139 have less than 100,000 annual enplanements and are part of the 
airports that comprise the remaining 1.1 percent of annual 
enplanements.
    Airports having this type of scheduled air carrier service are 
usually owned and operated by units of state or local government. Some 
of these airports have medical doctors located on the premises; others 
have units staffed with paramedics located on the airport; while others 
have the primary emergency medical response in the community respond to 
medical situations at the airport.
    Under Part 139 airports serving scheduled air carrier aircraft with 
more than 30 seats are required to provide for basic emergency medical 
care during the operations of these aircraft. This medical care is part 
of the Aircraft Rescue and Firefighting response to airfield incidents; 
however, emergency personnel used to meet this requirement frequently 
respond to medical emergencies throughout the entire airport although 
this is not required by part 139.

Data Gathering

    In order to determine whether or not AED's should be required at 
airports, the FAA assessed the current capability of airports having 
scheduled service with air carrier aircraft having more than 30 seats 
to respond to medical events that an AED could possibly be used. The 
information sought by the FAA on an airport's capability consisted of 
answers to the following four questions:
    1. Are AED's located on the airport?
    2. Are manual-style defibrillators located on the airport?
    3. If the answers to both questions 1 and 2 are ``No,'' is there an 
off-airport response available to cardiac events that occur on the 
airport?
    4. If the answer to question 3 is yes, can the off-airport medical 
response reach the airport in 6 minutes or less?

(Question 4 is based upon the generally accepted medical guideline that 
it is necessary to start defibrillation within 6 minutes of the cardiac 
event; see Background above.)

Analysis of Data

    Data were reviewed for 130 airports having 100,000 or more annual 
enplanements. Information was also collected on defibrillators in 
general.
    A review of the data for the 83 the airports with more than 1 
million annual enplanements revealed that all but four had AED's. Of 
these four, three had manual-style defibrillators. The remaining 
airport had an off-airport response within 6 minutes. These 83 airports 
that enplane 92 percent of the total annual enplanements appear to have 
the medical capability to address cardiac events in which AED's may be 
of assistance.
    Data was collected for 27 of the 72 airports that have 250,000 or 
more but less than 1 million enplanements. This represents a 37 percent 
sample. Of the 27 airports, 17 (63 percent) had AED's. None of the 
remaining 10 airports had a manual-style defibrillator, but six of them 
had an off-airport response of less than 6 minutes. The remaining four 
also had an off-airport response but it exceeded 6 minutes. Including 
the six airports with an off-airport response of less than 6 minutes 
with the 17 airports that have AED's reveals that 85 percent of the 
airports in the sample of 27 airports appear to have the medical 
capability to address cardiac events in which AED's may be of 
assistance.
    Data was collected for 20 of the 60 airports that have 100,000 or 
more but less than 250,000 enplanements. This represents a 33 percent 
sample. Of the 20 airports, nine (45 percent) had AED's. None of the 
remaining 11 airports had a manual-style defibrillator, but five of 
them had an off-airport response of less than 6 minutes. The remaining 
six also had an off-airport response but it exceeded 6 minutes. 
Including the five airports with an off-airport response of less than 6 
minutes with the nine airports that have AED's reveals that 70 percent 
of the airports in the sample of 20 airports appear to have the medical 
capability to address medical events including those in which AEDs may 
be of assistance.
    For the latter two data groups it would be statistically unreliable 
to extrapolate the results from the samples of 27 and 20 airports to 
remaining airports in the group, since neither sample would qualify as 
a random sample. However, both samples serve to confirm reports that 
AED's are becoming commonplace. For example, some airports that 
initially responded that they did not have AED's were contacted to 
obtain clarification about the availability of off-airport emergency 
response. In the ensuring months between the first response and the 
subsequent contact, three of these airports had acquired AED's.
    In summary, data gathered on 130 airports indicates that 108 (83 
percent) had defibrillators. Including the 11 airports that have an 
off-airport response rate of less than 6 minutes shows that 119 
airports, or 91.5 percent, appear to have the medical capability to 
address medical events including those in which AEDs may be of 
assistance.

Decision

    The majority of units of state and local government that operate 
certificate airports, having scheduled air carrier service with 100,000 
or more annual enplanements, have already taken the necessary steps to 
provide for the medical capability to address cardiac events at their 
individual facilities. In addition, all available information indicates 
that local acquisition and availability of AED's in public places is 
increasing.
    Finally, it is unclear as to whether the FAA has the authority to 
require AEDs in an airport. The regulation and the provision of medical 
care with a state are traditionally state functions that the states 
have vigorously monitored and controlled. Indeed, the airport serving 
the vast majority of passengers today have medical care available 
(including AEDs) without Federal regulation.
    In view of the foregoing, the FAA has determined that no regulation 
will be proposed to require AEDs at airports.

Woodie Woodward,
Acting Associate Administrator for Airports.
[FR Doc. 00-14086 Filed 6-5-00; 8:45 am]
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