Potential error in the use of an automated external defibrillator during an in-flight medical emergency

In-flight medical emergencies are uncommon, generally non-lethal events. In fatal cases, the most common cause of death is a sudden cardiac event. This fact, and the awareness that early defibrillation is the most important determinant of successful cardiac resuscitation, have led to the increasing availability of automated external defibrillators (AEDs) aboard commercial airplanes. AEDs are sophisticated and extremely reliable devices that are designed to be used by trained laypersons in the hope of minimizing the crucial time to defibrillation. Although designed to be foolproof, both machine- and operator-dependent usage errors have been recognized. In this case study we report a unique operator-dependent error involving the misreading of an AED instruction window, briefly review the history of AED use in the airline industry, and underscore the need for a sound knowledge of basic life support skills when working with these devices. We conclude by making recommendations to prevent similar errors from occurring in the future.