The first widespread use of public life-saving defibrillators in the United States started on commercial airplanes. In 1995, American Airlines reviewed thousands of flight medical events and found at least 60 cases of apparent sudden cardiac arrests on board commercial flights each year. The Chief Executive Officer of American Airlines was persuaded to allow defibrillators on board, and the Corporate Medical Director (author) testified before the U.S. House of Representatives, Subcommittee on Aviation, Committee on Transportation and Infrastructure on May 21, 1997, on the rationale for their use. ¹ This eventually led to a Federal Aviation Administration (FAA) requirement that defibrillators and enhanced medical kits should be available on all airlines. In 1998, 25,000 American Airlines flight attendants began a training program on defibrillator use. ²

The first life to be saved occurred on February 18, 1998, on American Airlines Flight 2017 from Dallas-Fort Worth to Mexico City. ³ While in flight, Robert Giggey began having jaw pain and then became unresponsive. His wife, Carmen, screamed for help and a flight attendant, Shawn Lynn, and paramedic, Don Grohman, responded. Mr. Giggey was wedged up against the window, unconscious, and he was so large that he could not be moved to the floor. The two responders, with the help of other passengers, maneuvered him into position across the three seats in his row. Don and Shawn tried to revive Mr. Giggey without success. Don said aloud that he needed a defibrillator, but then quickly recalled, again aloud, that airplanes do not carry defibrillators. However, a defibrillator had been placed on that plane as standard equipment just 2 d prior to the flight, and the flight attendant had spotted it for the first time when she boarded the plane. The device diagnosed the lethal rhythm of sudden cardiac arrest and ventricular fibrillation. The paramedic made certain everyone was clear of Mr. Giggey and pressed the shock button. Robert Giggey’s body jumped up off the seat by about 2 ft, as witnesses recalled, and he immediately was found to have a carotid pulse. He came back to life immediately and began to move. The passengers in the airplane broke into wild cheers and applause. Robert Giggey died on July 17, 2022, and commented in 2019 that American Airlines gave him a quarter century more of life. After the event, Don Grohman went back to work as a firefighter-paramedic. Shawn Lynn had a religious experience during the resuscitation. She dropped her current plans, recommitted her life to her faith, and eventually went on to do missionary work at a Women’s Center in South Africa and Zambia. She assisted missionaries in various life-changing outreach as well as organized and directed teams that came from America to build churches. There was a reunion of the major players in Robert Giggey’s historic shock and save 10 yr later. One of Mr. Giggey’s grandchildren thanked Shawn Lynn for saving her grandfather. But she responded, “No. Thank you for saving me.”

Despite the program’s success, immediate public acceptance did not occur. The New York Times in 1997 wrote that “the FAA, according to Dr. Jon Jordan, the Federal Air Surgeon, is not ready to order more elaborate medical equipment aboard planes because just as it had claimed to the Congressional Subcommittee, it did not know what was needed.” They opined, however, that “the FAA may be overtaken by events in the marketplace.” ⁴ They noted that on July 1, 1997, American Airlines had placed defibrillators aboard all of its commercial jets, trained 2300 pursers to use the device, and was pressing Congress for a federal Good Samaritan law to indemnify medical professionals from malpractice suits.

However, other airlines began to follow American’s lead. US Airways would become the second U.S. domestic airline to begin carrying portable cardiac defibrillators on some of its planes and the first to install hand-held heart monitors that could diagnose when a passenger was suffering from a heart attack or other cardiac abnormalities. Delta and United then quickly announced plans to begin installing defibrillators and enhanced medical kits on their fleets the following year. Then British Airways in 1999 became the first large European airline to begin carrying portable cardiac defibrillators. The devices were spreading internationally as well. In 2001, the FAA ordered defibrillators to be placed on board all planes of U.S. airlines. The agency gave the airlines 3 yr to put defibrillators on all domestic and international flights and to get flight attendants trained in their use. It also was significant that the FAA ordered the airlines to upgrade their in-flight medical kits and to model them like American’s new enhanced medical kit.

A study showed that there had been 250 uses of an automatic external defibrillator by American Airlines between July 1997 and December 1999, or about 7.6 uses per month. ⁵ It was mostly used only as a cardiac monitor. In total, 15 unnecessary flight diversions were avoided, and 13 diversions were recommended because the automatic external defibrillators’ monitoring tools and programing detected medical issues serious enough to order a medical evacuation immediately. Out of 19 shock opportunities that grew out of those 250 uses, resuscitation was successful 11 times, or in 58% of the cases, at least in terms of immediate survival. The long-term survival rate was 47%. These results were far better than the 10% survival often seen from use in the field with paramedics on the ground.

Taking away any logistical excuses, the devices spread like wildfire to international carriers and all public places on the ground. It is but one example where aerospace medicine led the way in a now well-known national and international public health movement: public access defibrillation.