PHOENIX-Inflight medical emergencies are on the rise-but so are airlines’ efforts to respond.   Inflight medical emergencies are on the rise-but so are airlines’ efforts to respond. An aging but on-the-go populace and the 1986 Air Carrier Access Act requiring U.S. carriers to ticket more people with health problems are credited with an estimated fivefold increase in such incidents. Though no one has comprehensive data, a study by the FAA’s Civil Aeromedical Institute in Oklahoma City calculates U.S. domestic flights’ medical emergencies rose from about three a day in the late 1980s to 15 a day from 1990 to 1993.   Though some carriers still depend solely on MDs or others to volunteer, many airlines-prodded by lawsuits, anticipation of new FAA rules, and complaints from physicians and passengers-are spending big bucks to provide more care.   Eleven of the nation’s 62 passenger airlines have installed automated external defibrillators. Many are training cabin crews in advanced first aid and CPR. American and United Airlines staff their headquarters with consulting physicians available 24 hours a day. Dozens more carriers contract with commercial companies, like industry leader MedAire in Phoenix, to provide physician consults through telemedicine links-with a few carriers patching calls back to passengers’ seatback phones.   Though airlines have long held that they are not flying hospitals-early industry requirements that flight attendants be nurses have long gone the way of the Pan Am Clipper and white-tablecloth dining aloft-Congress is pressuring the industry.   In passing the Aviation Medical Assistance Act last year, Congress ordered the FAA to decide whether to force airlines to upgrade crews’ medical training and equipment. A big question is whether to require carriers to install automated defibrillators. The FAA’s report was due in November.   Meanwhile, for most airlines, more than half the time the first responder will be another passenger, with MDs predominating for some airlines and nurses for others. According to MedAire, in the 2,378 airplane emergencies it handled in 1998, no one with medical training came forward only 28% of the time.   Dr. Andy Jagoda, who teaches emergency medicine at N.Y.’s Mount Sinai Medical School, says, “All physicians should be first responders.” Mount Sinai is adding a 20-hour first-aid course for med students. Physicians travel, Dr. Jagoda says, “and there always seems to be something happening on a plane.”   United’s statistics show medical personnel onboard in emergencies from 60% to 65% of the time, and that 75% of these volunteers were physicians.   For those who do volunteer, U.S. laws assure Good Samaritan protection from liability. But skills don’t always match the emergency at hand. Nor are all MDs eager to assist (see related story).   And some doctors called on to assist say that the current FAA-required medical kit is inadequate for many emergencies. For instance, cardiac treatment must be done with a single dose of epinephrine, two sets of syringes and needles, and 10 nitroglycerin tablets.   The FAA was directed to study the defibrillator question after a 1998 Congressional hearing. Among several widows who testified was one who described her husband’s fatal inflight heart attack en route to the Bahamas in 1996 and the frustration of a volunteer physician at finding no defibrillator onboard and no needle for injecting epinephrine available. The MD did CPR for 45 minutes.   The FAA is weighing whether to order all carriers to have more sophisticated medical kits like those made by MedAire, where drugs include lidocaine and atropine.   Though MedAire says its consults cut flight diversions, events that cost airlines between $3,000 and $100,000 depending on whether the plane has to dump fuel and if passengers need to be accommodated overnight, its biggest selling point is promising improved outcomes.   MedAires’s Dr. David Streitwieser recalls an emergency over Omaha on a Cairo-to-Los Angeles flight. A 38-year-old woman, six months pregnant and losing blood, asked for medical help. Though a volunteer neonatalist was recommending the flight continue, thinking he had determined the fetus had already expired, Dr. Streitwieser quickly got an ob-gyn consult and a likely diagnosis of abruptio placentae. On his say-so, the pilot agreed to divert. Within 60 minutes the plane was grounded, and the baby had been successfully delivered by C-section. “It was a situation where the onboard physician probably had flawed judgment,’’ he said.   Obstetrical emergencies are relatively rare inflight, making up 3% of total cases and 7% of diversions, according to MedAire. Some airlines won’t let pregnant women onboard within a month of due date.   But patients with cardiac problems appear to be flying more, and airlines are providing supplemental oxygen on request. Aerospace Medical Association Society guidelines say patients should be able to fly three weeks post uncomplicated MI, six weeks after a complicated MI, and two weeks after CABG. Only if patients appear to be ill on boarding are airlines likely to ask for a physician’s fit-to-fly certificate. And one increasing emergency that airlines may be bringing on themselves is the risk of deep venous thrombosis brought on by cramped seating in coach. Researchers are calling it “economy-class syndrome.’’ -Carolyn Colwell