Being called to assist with an in-flight medical emergency

Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story – passed down from resident to resident – goes something like this: An airline attendant called for a veterinarian’s help. When no one answered, they settled for a doctor and an anesthesiology resident stepped up. He learned that a passenger traveling with her two cats had given them Xanax to calm them during the flight and their breathing had grown worrisomely slow. As it turned out, one of the cats had already met her tragic end but the other still had a pulse. The resident found a pediatric medical kit and placed a breathing tube in the poor animal, leaving his owner to squeeze an oxygen bag to ventilate the cat for the remainder of the flight.

Trained health care workers have long been called to perform outside hospital or clinic walls (the Boston Marathon attack was a recent, poignant example). But there is something particularly dramatic about medical distress in an enclosed space miles above sea level and particularly momentous about the decision to divert an airplane carrying hundreds of passengers.

Research from the department of emergency medicine at the University of Pittsburgh and East Carolina University decided to quantify this phenomenon in a study published recently. They reviewed medical emergency calls from five airlines to a response center between 2008 and 2010 and found nearly 12,000 emergencies had been called in during this period (that’s one per ~600 flights). More than a third of these had to do with a passenger nearly or actually passing out, while around 12% were breathing problems and another 10% were nausea and vomiting. Death was rare (0.3%) and most often from cardiac arrest.

Flight attendants are trained to handle many of the issues that come up but in nearly 50% of the incidents, a physician passenger was able and willing to provide back-up. The flight was diverted for only 7% of these emergencies, but about a quarter of the affected passengers sought care at a hospital upon landing – most often with concern for seizure, stroke, heart attack, or an obstetric emergency.

The Federal Aviation Administration mandates that U.S. planes carry an emergency medical kit with items like defibrillators, oxygen, intravenous fluids, and aspirin (the last three were most commonly used, according to this study). But there’s more: other passengers often volunteer their own prescription medications, they found; smartphones can act as medical equipment (my mother checks her pulse using her iPhone); and the on-ground medical staff at the response center provides an additional source of support.

I remember flying to St. Louis for a friend’s wedding just two days after my medical school graduation and wondering what I’d do if someone needed a doctor on the plane. Would I contribute anything of value without a resident or attending doctor looking over my shoulder, co-signing my every action? Surely on a flight from Boston, I calculated, there would be at least one physician more experienced than I was to step in.

The reality is, it’s hard to know a priori how your skills (as a doctor, nurse, EMT, guy who watches Scrubs on rerun) might contribute relative to the other resources available. The only way to find out is to volunteer and be honest about your training and what you do and don’t know. That’s why we’re protected by Good Samaritan laws. And fortunately, as this study points out, the vast majority of medical issues on flights are either manageable mid-air or self-resolving.

So now, with two years of residency under my belt, I’m more than ready to answer that call for medical assistance. Maybe one day I’ll be able to tell my own story of the time I saved a cat.

Ishani Ganguli is a journalist and an internal medicine-primary care resident who blogs at The Boston Globe’s Short White Coat, where this article originally appeared. 

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  • MikaBerner

    I was traveling on a East Coast to West Coast direct flight when I heard the overhead announcement request for medical assistance. My seatmate and I were getting acquainted and immediately got up and flagged me to attend to this situation. A middle aged recently diagnosed diabetic had turned greyish green and had a syncopal episode. By the time I reached him, the flight attendants had already placed oxygen on him.

    After a couple of minutes assessing him, the pilots asked me if I thought they needed to land the plane to get him to a hospital. That was when I was also told that the O2 canisters were mainly for the crew in case of an emergency loss of air pressure and that I would not be able to deplete any more than 15% of the smaller tanks. They had sort of a modified simple face mask and could only be set to 4 liters.

    They then had me speak to their medical assistance ground service via satellite telephone who repeated the same question of whether to land. Up to that point, I don’t know if I have ever had to make as critical decision as that!

    The patient appeared to be improving. Due to only being able to obtain a pressure by palp (jet engine noise and getting tossed around not very conducive to obtaining an accurate blood pressure), I hooked him up to their AED to see if it would identify a fatal rhythm which it did not. Luckily there was a critical care nurse in the seat in front of him and we were already teamed up in tending to him. She placed an IV into his hand and started to hydrate him. Between that and the O2, he did begin to perk up and I told flight control that I thought we could safely proceed to our destination and that he should be further assessed once we reached Boston and in fact upon landing, their was an ambulance crew waiting for him in the jetway.

    This happened during a time when I was regularly traveling back and forth, and I was able to get to know the flight crew. It was interesting what supplies they had in their medical kit. Plus I had been “unwait listed” out of first class due to a plane change unrelated to this issue. They were gracious enough to not charge me for my meal and I was acknowledged later by their corporate office a few weeks later of which I made a few small suggestions for supplies for their medical kits.

    I feel sorry for the owner who lost her cats, I should hope never to have to attempt to intubate a cat!

    • Jason Simpson

      Lots of pediatrics and anesthesia residency programs use cats in intubation training to simulate the small airways of newborns, so if you have a peds or gas doc on the plane there’s a good chance they’d be able to intubate a cat.

      • meyati

        Wow!! I didn’t know that

  • Barefootmeds

    Interestingly, although flight attendants are taught basic emergency skills, our ENT consultant told us that he was once asked to see a person on a flight who had a torrential nosebleed that wouldn’t stop. The attendant had told the patient to tilt his head BACK, and then proceeded to argue with the doctor when he told the patient to tilt his head forward…

    • meyati

      A little knowledge is a dangerous thing.

  • Jamie Holland

    Helicopters have saved many lives!

  • buzzkillerjsmith

    Helping people out when they keel over in public is no big deal for a doc or nurse, Dr. G. I’ve done a dozen times or more. Afterwards I go have lunch or something. No big deal.

  • ninguem

    I had a call for “is there a doctor on the plane?”……

    So I took care of the lady, everything is fine, show’s over, and I sit back down.

    So the flight attendants are all over me.

    They offered me free drinks.

    “Wow. Save a life, then sit back and have a drink. It’s just like the operating room. I feel right at home.”

    That’s all I said. Why did I get all those weird looks?

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