I
105TH CONGRESS
1ST SESSION
H. R. 1670
To amend title 49, United States Code, to require air carriers to establish
procedures for responding to in-flight medical emergencies, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY 20, 1997
Mrs. KENNELLY of Connecticut introduced the following bill; which was
referred to the Committee on Transportation and Infrastructure
A BILL
To amend title 49, United States Code, to require air car-
riers to establish procedures for responding to in-flight
medical emergencies, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Airline Passenger Safe-
ty Act of 1997’’.
SEC. 2. IN-FLIGHT MEDICAL EMERGENCIES.
(a) IN GENERAL.—Chapter 417 of title 49, United
States Code, is amended by adding at the end the follow-
ing:
‘‘SUBCHAPTER III—IN-FLIGHT MEDICAL
EMERGENCIES
‘‘§ 41761. Treatment of in-flight medical emergencies
‘‘(a) IN-FLIGHT
MEDICAL
EMERGENCY
PROCE-
DURES.—
‘‘(1) 
ESTABLISHMENT.—Each 
air 
carrier
shall—
‘‘(A) establish a detailed list of procedures
to be followed by the air carrier in the event of
an in-flight medical emergency; and
‘‘(B) submit a copy of such procedures to
the Secretary not later than 180 days after the
date of the enactment of this subchapter.
‘‘(2) REQUIREMENTS.—
‘‘(A) STEPS TO BE FOLLOWED IN MEDICAL
EMERGENCIES.—The procedures established by
an air carrier under paragraph (1) shall ensure
that the following steps are taken, in the order
specified, in the event of an in-flight medical
emergency involving a passenger of the carrier:
‘‘(i) Attending to the passenger.
‘‘(ii) Notifying the pilot in command.
‘‘(iii) 
Requesting 
assistance 
from
medically-qualified passengers.
‘‘(iv) Consulting the in-flight medical
care manual of the air carrier.
‘‘(B) CARDIAC EMERGENCIES.—In addition
to the requirements of subparagraph (A), proce-
dures established by an air carrier under para-
graph (1) shall ensure that in the case of a car-
diac emergency a 4-step chain of survival plan
is implemented which requires, in the order
specified, the following:
‘‘(i) Activation of the emergency medi-
cal system (ensuring that emergency call
procedures are in place to summon skilled
aid).
‘‘(ii) Cardiopulmonary resuscitation.
‘‘(iii) Defibrillation.
‘‘(iv) Getting the patient to a full care
unit (such as a hospital) as soon as pos-
sible for advanced cardiac support.
‘‘(C) LEVEL OF ASSISTANCE.—The proce-
dures established by an air carrier under para-
graph (1) shall afford the same level of assist-
ance to passengers as are afforded to members
of the flight crew.
‘‘(3) AVAILABILITY OF PROCEDURES TO THE
PUBLIC.—Each air carrier shall provide to a pas-
senger of the air carrier, upon request of the pas-
senger, a copy of the procedures established by the
carrier under paragraph (1).
‘‘(b) LIFE-SAVING EQUIPMENT AND APPROPRIATELY
STOCKED FIRST-AID KITS AND MEDICAL KITS.—
‘‘(1) IN
GENERAL.—On and after the 180th
day following the date of the enactment of this sub-
chapter, each aircraft operated by an air carrier in
air transportation or intrastate air transportation
shall be equipped with—
‘‘(A) at least 1 piece of life-saving equip-
ment 
(such 
as 
an 
automated 
external
defibrillator) for use in responding to a cardiac
emergency;
‘‘(B) at least 1 first-aid kit; and
‘‘(C) at least 1 medical kit;
The air carrier shall restock such kits, as necessary,
before each flight segment.
‘‘(2) ACCESS TO EQUIPMENT.—Each member of
the flight crew on an aircraft described in paragraph
(1) shall have access to the life-saving equipment,
first-aid kit, and medical kit required under para-
graph (1).
‘‘(3) PERIODIC REVIEWS.—The Secretary shall
conduct periodic reviews of the life-saving equip-
ment, first-aid kits, and medical kits required under
paragraph (1) and shall require such additional
items to be included in the kits as the Secretary de-
termines appropriate.
‘‘(c) IN-FLIGHT EMERGENCY PROCEDURES MAN-
UAL.—
‘‘(1) 
ESTABLISHMENT.—Each 
air 
carrier
shall—
‘‘(A) 
train 
flight 
crew 
members 
in
cardiopulmonary resuscitation and operation of
an automated external defibrillator;
‘‘(B) establish an in-flight emergency pro-
cedures manual, including cardiac medical
emergency response procedures; and
‘‘(C) submit such manual to the Secretary
not later than 180 days after the date of the
enactment of this subchapter.
‘‘(2) REQUIREMENTS.—The manual established
by an air carrier under paragraph (1) shall include,
at a minimum, the following:
‘‘(i) Instructions for the use of all
items in first-aid kits and medical kits.
‘‘(ii) Procedures for handling cardiac
emergencies and other immediately life-
threatening medical emergencies.
and first-aid procedures, including the use of each
supply in a first-aid kit; and
‘‘(2) at least 1 member of the flight crew on
such aircraft is authorized to operate an automated
external defibrillator (or similar life-saving equip-
ment) and to use a first-aid kit and medical kit.
‘‘(e) ON-GROUND MEDICAL CONTRACTOR.—Each air
carrier shall enter into a contract with a clinic, hospital,
or other accredited medical care provider to provide the
air carrier with medical advice at any time in the case
of an in-flight medical emergency. Upon entering into such
contract, the carrier shall submit the name of the medical
care provider to the Secretary.
‘‘(f) ASSISTANCE OF MEDICALLY-QUALIFIED PAS-
SENGERS.—Each air carrier shall take such actions as
may be necessary to ensure that when an in-flight medical
emergency takes place on an aircraft operated by the air
carrier, the flight crew assigned to the aircraft will solicit
the assistance of medically-qualified passengers. In solicit-
ing such assistance, the flight crew shall announce that
passengers who provide such assistance will be exempt
from liability, as provided in section 41768 of this title.
‘‘(g) RESPONSIBILITIES OF PILOT IN COMMAND.—
Each air carrier shall take such actions as may be nec-
essary to ensure that when an in-flight medical emergency
takes place on an aircraft operated by the air carrier, the
pilot in command will solicit and consider the advice of
a medical responder as to the condition of the passenger
that is the subject of the emergency and, as appropriate,
will take necessary actions for rerouting the aircraft to
the nearest airport.
‘‘(h) LAVATORIES.—Each air carrier shall take such
actions as may be necessary to ensure that a member of
the flight crew on an aircraft operated by the air carrier
in air transportation or intrastate air transportation will
check on any passenger that is inside a lavatory on the
aircraft for more than 10 minutes.
‘‘§ 41762. Ground procedures
‘‘(a) MEDICAL
PERSONNEL.—Not later than 6
months after the date of the enactment of this subchapter,
the Secretary shall establish procedures to ensure that ap-
propriate medical personnel, including a coroner in the
event of the death of a passenger, are present to meet
an aircraft upon the notification of an air traffic controller
of an in-flight medical emergency.
‘‘(b) PROCEDURES.—
‘‘(1) IN GENERAL.—Not later than 6 months
after the date of the enactment of this subchapter,
the Secretary shall establish procedures for in-flight
medical emergencies requiring an emergency land-
ing, including—
‘‘(A) establishing a medical facility to be
contacted when it is determined that an aircraft
will be landing at the airport after an in-flight
medical emergency; and
‘‘(B) designating an airport ground crew
that will meet the plane, including medical per-
sonnel assigned to the airport.
‘‘(2) LEVEL OF PRIORITY.—The procedures es-
tablished by the Secretary under paragraph (1) shall
ensure that an aircraft that is rerouted as the result
of an in-flight medical emergency will be afforded
the same level of priority for landing as an aircraft
that is experiencing mechanical malfunctions.
‘‘(c) FACILITIES IN TERMINALS.—Each air carrier
providing air transportation or intrastate air transpor-
tation shall establish a plan, and adequate facilities and
pathways in the terminal on the ground, to facilitate at-
tending to, and as necessary transferring, patients who are
removed ill from an aircraft or who become ill in the termi-
nal.
‘‘§ 41763. Aircraft specifications
An air carrier may not purchase or lease any aircraft
manufactured after the 180th day after the date of the
enactment of this subchapter unless the aircraft is
equipped with an emergency call button in each lavatory
on the aircraft.
‘‘§ 41764. Incident reports
‘‘(a) REPORTS BY AIR CARRIERS.—
‘‘(1) IN
GENERAL.—Each air carrier shall
transmit to the Secretary, within 48 hours of any in-
flight medical emergency occurring on an aircraft
operated by the carrier, a report containing a de-
scription of the emergency. Upon receipt of a report,
the Secretary shall make the report available to the
public.
‘‘(2) CONTENTS.—A report transmitted under
paragraph (1) shall contain, at a minimum, the fol-
lowing:
‘‘(A) A statement of the time that the
emergency was first made known to a member
of the flight crew.
‘‘(B) A detailed description of the actions
relating to and taken in response to the emer-
gency, including the time each action occurred.
‘‘(C) A detailed description of the symp-
toms of the passenger that experienced the
emergency, including the time each symptom
was recognized.
‘‘(D) A detailed description of any medical
treatment provided to the passenger, including
a list of any equipment used in providing such
treatment from a first-aid kit or medical kit
and the name, title, and address of any person
providing such treatment.
‘‘(E) A detailed description of any commu-
nication initiated by the pilot in command to an
air traffic controller or an on-ground medical
contractor, including the time of the commu-
nication.
‘‘(F) A detailed description of any medical
advice provided by an on-ground medical con-
tractor or a medically-qualified passenger.
‘‘(G) A statement of the time of any deci-
sion to reroute the aircraft as a result of the
emergency.
‘‘(H) A statement of the name and quali-
fications of any medically-qualified passengers
who assisted in the emergency.
‘‘(I) An assurance that all records concern-
ing the emergency (including records concern-
ing actions taken in-flight and on the ground)
were filed by the air carrier with appropriate
Federal, State, and local authorities within 24
hours of the emergency.
‘‘(b) REPORTS BY AIR TRAFFIC CONTROL.—Each air
traffic controller shall transmit to the Secretary, within
48 hours of any in-flight medical emergency reported to
the controller, a report on any actions taken by the con-
troller in response to an in-flight medical emergency that
required an emergency landing.
‘‘(c) CONSULTATION WITH MEDICAL FACILITY.—
After receiving a report from an air carrier under this sec-
tion concerning an in-flight medical emergency, the Sec-
retary shall—
‘‘(1) consult with the medical facility to which
the passenger was transferred after the flight to de-
termine whether the passenger was released from
the facility and the final condition of the passenger;
and
‘‘(2) include information obtained pursuant to
paragraph (1) in the report.
‘‘§ 41765. Family notification
‘‘(a) RESPONSIBILITIES OF AIR CARRIER.—
‘‘(1) INITIAL NOTICE.—As soon as practicable
after the time of an in-flight medical emergency in-
volving a passenger of an air carrier, the air carrier
shall notify the family of the passenger about the
emergency.
‘‘(2) COPY
OF
REPORT
SUBMITTED
TO
SEC-
RETARY.—Not later than 1 week after the date of
the emergency, the air carrier shall provide to the
family of the passenger a complete copy of the re-
port concerning the emergency submitted to the Sec-
retary pursuant to section 41764(a) of this title.
‘‘(b) RESPONSIBILITIES OF THE SECRETARY.—
‘‘(1) APPOINTMENT
OF
LIAISON.—Not later
than 48 hours after an in-flight medical emergency,
the Secretary shall appoint an individual within the
Department of Transportation to serve as a liaison
to family members of the passenger.
‘‘(2) COPY
OF
REPORT
SUBMITTED
BY
AIR
TRAFFIC.—Not later than 1 week after the date of
the medical emergency, the Secretary shall provide
to the family of the passenger a copy of any report
concerning the emergency submitted to the Sec-
retary by an air traffic controller pursuant to section
41764(b) of this title.
‘‘§ 41766. Compliance
‘‘(a) REVIEW OF AIR CARRIER COMPLIANCE.—
‘‘(1) IN GENERAL.—Not later than 1 year after
the date of the enactment of this subchapter, the
Secretary shall conduct a review of the compliance
of each air carrier with the requirements of this sub-
chapter.
‘‘(2) CONTENTS OF REVIEW.—In conducting a
review of an air carrier under subsection (a), the
Secretary, at a minimum, shall—
‘‘(A) review the in-flight medical emer-
gency procedures of the air carrier;
‘‘(B) review the in-flight medical emer-
gency procedures manual of the air carrier;
‘‘(C) conduct checks to determine whether
life-saving equipment are in proper working
order and whether first-aid kits and medical
kits of the air carrier are fully stocked; and
‘‘(D) conduct checks to determine whether
emergency call buttons on aircraft operated by
the air carrier are operational.
‘‘(b) REVIEW OF AIRPORT COMPLIANCE.—Not later
than 1 year after the date of the enactment of this sub-
chapter, the Secretary shall conduct a review of the proce-
dures established at each airport for meeting passengers
with medical emergencies.
‘‘§ 41767. Studies
‘‘(a) STATISTICS
ON IN-FLIGHT MEDICAL EMER-
GENCIES.—
‘‘(1) IN GENERAL.—The Secretary shall keep
statistics on the number of in-flight medical emer-
gencies occurring each year based on reports submit-
ted to the Secretary by air carriers and air traffic
controllers and shall make such statistics available
to the public.
‘‘(2) ANNUAL LIST.—The Secretary shall pub-
lish on an annual basis in the Federal Register a list
of the number of in-flight emergencies occurring in
the preceding year. Such list shall categorize such
emergencies by type of illness, type of treatment af-
forded, whether or not the aircraft was rerouted,
and the final condition of the passenger.
‘‘(b) USE OF SATELLITE COMMUNICATIONS.—
‘‘(1) STUDY.—The Secretary shall conduct a
study of the feasibility of using satellite communica-
tions of Global Position Satellites as a method of im-
proving communications between pilots, ground med-
ical personnel, and air traffic controllers.
‘‘(2) REPORT.—Not later than 1 year after the
date of the enactment of this subchapter, the Sec-
retary shall transmit to Congress a report on the re-
sults of the study conducted under paragraph (1).
‘‘§ 41768. Limitations on liability
‘‘(a) LIABILITY OF AIR CARRIERS.—An air carrier
shall not be liable for damages in any action brought in
a Federal or State court arising out of the performance
of the air carrier in obtaining or attempting to obtain the
assistance of a medically-qualified passenger in the case
of an in-flight medical emergency.
‘‘(b) LIABILITY
OF INDIVIDUALS.—An individual
shall not be liable for damages in any action brought in
a Federal or State court arising out of the performance
of the individual in providing or attempting to provide
medical treatment in the case of an in-flight medical emer-
gency.
‘‘§ 41769. Definitions
In this subchapter, the following definitions apply:
‘‘(1) FIRST-AID KIT.—The term ‘first-aid kit’
means a kit that includes standard supplies com-
monly found in a physicians bag, including
endotrachial tubing, bicarbonate of soda, and such
additional items as the Secretary determines appro-
priate.
‘‘(2) IN-FLIGHT
MEDICAL
EMERGENCY.—The
term ‘in-flight medical emergency’ means a medical
emergency occurring during a flight in air transpor-
tation or intrastate air transportation.
‘‘(3) MEDICAL EMERGENCY.—The term ‘medi-
cal emergency’ includes—
‘‘(A) heart emergencies, including cardiac
arrest;
‘‘(B) lack of breathing or shortness of
breath;
‘‘(C) loss of consciousness;
‘‘(D) stroke;
‘‘(E) profuse bleeding;
‘‘(F) shock; and
‘‘(G) such other emergencies as the Sec-
retary determines appropriate.
‘‘(4) MEDICAL
KIT.—The term ‘medical kit’
means a kit that includes—
‘‘(A) a portable defibrillator;
‘‘(B) portable oxygen bottles (or canisters)
and 
tubing 
(with 
necessary 
endotrachial
masks);
‘‘(C) lidocaine;
‘‘(D) epinephrine;
‘‘(E) nitroglycerine tablets; and
‘‘(F) such additional items as the Sec-
retary determines appropriate.
‘‘(5) ON-GROUND MEDICAL CONTRACTOR.—The
term ‘on-ground medical contractor’ means a medi-