Airlines Saving Lives With Defibrillators, But Water Purity May Pose Health Risks by Gina Shaw When we think about airline safety in the post-9/11 world, we primarily think about deadly serious issues, such as shoe bombers, airport metal detectors and debates over arming pilots. But your safety in the air also depends on how well your health is protected while you fly. This month, weíll take a look at two recent developments that could affect your onboard health. First, the bad newsóor perhaps you could call it the ìewwwî news. Have you thought about what might be in your airplaneís water supply? Some recent reports tell a less-than-appetizing story about what may be swirling around in there. This fall, when The Wall Street Journal sampled water from 14 flights (multiple airlines, multiple destinations, and a wide array of distances), they found a veritable civilization of bacteriaóeverything from salmonella and staphylococcus to an infection-causing, drug-resistant strain called pseudomonas. Sure, you probably drink bottled water from the flight attendantís cart, not straight from the bathroom tap. But what about when you duck into the restroom to brush your teeth after a long flight or to take medication? What about the water they make coffee with? And wh at about when they run out of bottled water and start serving tap? Flight attendant unions for American, Northwest, US Airways and United all confirmed to The Wall Street Journal that this is standard practiceóand they donít usually tell passengers unless they ask. This all sounds pretty disgusting, but how dangerous is it? ìWhether you get sick depends on how many micro-organisms are in the water. Your body, and your stomach acidity, can kill off many of these organisms,î said Dr. Karl Neumann, associate clinical professor of pediatrics at New York Hospital-Cornell Medical School and the longtime editor of the newsletter Traveling Healthy. ìItís just when they reach an overwhelming number that you tend to get sick, so if you drink a little bit of water, youíre probably fineóunless itís hugely contaminated, which is rare. Youíre unlikely to have a problem if you brush your teeth and then spit the water out.î Neumann said heís not surprised that airline water can look more like a bacteria breeding colony. ìI donít know how they clean the tap water storage areas on planes, but Iíd imagine it would be hard to do it adequately between flights. Vat-type storage is hard to clean. Hopefully, the ice cubes come from tap water thatís been cleaned, but again, the storage area has to be adequately cleaned as well. Bacteria and viruses can survive in ice for some time, although they donít multiply there.î Though most healthy people might not notice a problem if they drink some less-than-pristine airline water, Neumann advises certain fliers to be particularly cautious. ìItís more of a problem for older people because they have less acidity in their stomach, and itís also a problem for people whoíve had gastrointestinal surgery, and people who take medications that interfere with stomach acidity, like certain anti-ulcer drugs.î If you have these concernsóor if youíd just rather not play unwitting host to salmonellaóNeumann advises fliers to make sure the bottle of water the flight attendant hands them is sealed. When in doubt, bring your own. A more positive development for air travelers is the near-universal adoption of automated external defibrillators (AED) on all U.S. airlines and in most airports. In spring 2001, the Federal Aviation Administration adopted a final rule requiring all U.S. carriers to stock AEDs, along with enhanced emergency kits, on any domestic or international flight able to carry 30 passengers and at least one flight attendant. (The airlines were given three years to fully implement the rule.) With an AED, the flight attendant or an ordinary fellow traveler could be your lifesaver, or you could be theirs. Easier than CPR, AEDs have even been operated by children (including a 9-year-old at a Chicago airport). A study published in the Oct. 26, 2000, edition of the New England Journal of Medicine tracked 200 patients whose in-air cardiac arrest was initially treated with an AEDó40 percent survived. Earlier this year, another study that appeared in the New England Journal reported the results of AED use over the course of two years at three Chicago airports. In the study, 10 of 18 people shocked with the device were alive and in good neurological condition one year lateróthatís a 58 percent success rate. Contrast these numbers with the usual survival rates after sudden cardiac arrestóanywhere from 5 percent to 25 percent. ìYou really donít need much trainingóonly the will to do it,î said Neumann. Indeed, all but two of the patients in the Chicago study got AED defibrillation from ìgood Samaritanî bystanders. But he points out that after-care is critical. ìMost people whoíve been shocked out of cardiac arrest by an AED donít just stand up and say, ëOkay, Iím fine.í People who survive are usually people in a situation where thereís good back-up medical care, which is not always the case on aircraft. It may be several hours before you can get to the ground and have [emergency medical service] personnel at hand.î But thereís almost no down side to using the AED. ìIím not aware of errors being made or people dying because they were shocked. The ratio of good to bad is overwhelming,î Neumann said. The AED is calibrated so that it will not shock someone unless their heart rhythm is within certain parameters. All you need to do is make sure no one is touching the patient. ìThe machine is idiot-proof. Donít fear using it,î Neumann said. And donít hesitate: Thereís only a five- or six-minute window in which the shock of an AED is likely to restore the heartís rhythm. Gina Shaw is the medical writer for The Washington Diplomat.