While recently on board an international flight, an in-flight medical emergency was called approximately one hour into a ten-hour journey. The overhead page most travelers may have heard while on a plane, “Is there a doctor onboard the aircraft?”
The air hostess quickly led me to the front of the aircraft where an elderly passenger had vomited a substantial amount of blood in the bathroom and near her seat. I requested a blood pressure cuff and a pulse oximeter, which were both readily available, and discovered the patient had extremely low blood pressure. Most concerningly, she was not very responsive to verbal questions from both her husband and me. I was able to place two large intravenous lines in her arms and giving her fluids, gastrointestinal ulcer medication, and nausea medications until her blood pressure stabilized. The pilot and I spoke with medical teams on the ground in Istanbul and New Delhi and decided not to divert the flight as the patient became more responsive and maintained both her oxygen levels and blood pressure. She ultimately survived despite having an esophageal variceal bleed and was swiftly treated on the ground at our final destination.
One of the most impressive points of this story was the magnitude of medical supplies available onboard the plane. This included patient monitors, airway equipment, medications, and intravenous fluids. With basic medical knowledge, these tools will allow someone to really step in and provide life-saving measures to a distressed passenger. On this particular flight, there were medications to treat a range of conditions, including chest pain, abdominal pain, asthma, diabetes, and severe allergic reactions.
With the ongoing coronavirus pandemic and Americans traveling yearly with cold and flu symptoms, it is important to be able to recognize and intervene when a situation becomes critical. One of the devices available on planes is the pulse oximeter, a simple device applied to the finger that reads a continuous oxygen level. In cases of milder respiratory distress, supplemental oxygen and face masks can be applied around the nose and mouth to increase the oxygen saturation. In cases of more ominous respiratory distress, most flights come equipped with intubation equipment to place a secure airway and provide oxygen via a manual bag until the flight can land — an intervention that is meant for trained medical professionals. Either way, simple steps like the use of inhalers and oxygen can help prevent a crisis while midair. For the layperson trying to figure out how you can help in one of these circumstances, high-quality cardiopulmonary resuscitation (CPR) with basic life support training can prove to be lifesaving. These courses are offered on a month to month basis by the American Heart Association.
If you yourself are ever in need of medical assistance on a flight, providing a concise medical history can help a healthcare professional to rapidly tailor an appropriate medical plan with efficient diagnostic measures. For those with numerous medical issues, medications, or implanted medical devices, providing a notecard containing this information can be highly valuable as well. Time is of the essence when dealing with a critical situation; in air, this is coupled with limited resources, so as a patient taking the time before a long journey to have this information on hand is almost always a good idea.
Without the assistance of the cabin crew, we certainly would not have been able to care for this woman as we did. The head of the crew assisted in getting medicines, obtaining vital signs, and helped me to maintain constant communication with the pilot on board. Having appropriate training for the entire crew onboard is invaluable, and again, CPR saves lives. If you are a physician and feel as though the medical situation requires interventions not available on the aircraft, you may be asked to relay this information to medical personnel in the closest city suitable for landing. Though this may be an inconvenience for the airline and passengers on board, diverting the flight is certainly reasonable if the situation is deteriorating.
In summary, if you ever find yourself as a patient or a passenger on a flight with a medical emergency, rest assured that there are appropriate medical tools on international flights. A doctor or nurse, given the right medical information, can truly save a life.
Sarang S. Koushik is an anesthesiologist.
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