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.