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http://www.cntraveler.com/stories/2016-03-23/doctors-share-what-really-happens-when-theres-an-emergency-mid-flight
TRAVEL INTELAIR TRAVEL
Doctors Share What Really Happens When There’s an Emergency Mid-Flight
Written by Rachel Rabkin Peachman March 23, 2016

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About seven percent of in-flight medical emergencies result in a diversion, according to a 2013 study.

 

 

This is what goes on after a flight attendant asks, “Is there a doctor on board?”
When traveling at 30,000 feet, you probably don’t expect to have a sudden health scare. But mid-air medical emergencies happen more frequently than you might think. While the Federal Aviation Administration (FAA) doesn’t track medical events on planes, in a 2013 study published in the New England Journal of Medicine, researchers estimated that there is an in-flight medical emergency in one out of 604 flights, or 16 medical emergencies per one million passengers. According to the researchers, the most common ailments that arise on planes include passing out (loss of consciousness due to a drop in blood pressure), trouble breathing, vomiting, and cardiac symptoms.

So, what happens when there is a sick passenger on a plane? The FAA requires all U.S.-based commercial airlines to have automated external defibrillators and emergency medical kits that are stocked with basic resuscitation equipment and medications on flights, as well as CPR, first aid, and defibrillator training for all crew members. But of course, in a true medical emergency, having a doctor on your plane is a massive relief—and frequently, there is one. “The latest review found that 30 to 60 percent of flights have a medical professional on board,” says J.D. Polk, D.O., an osteopathic physician and senior medical officer with the National Aeronautics and Space Administration (NASA).

Still, doctors are, not surprisingly, limited to what they can do on a plane. William Brady, M.D., a professor of emergency medicine at the University of Virginia Health System, has been called on for medical emergencies mid-flight several times. He stresses that it’s important to remember a commercial aircraft is not a flying medical unit, and it’s possible that “you may have a gifted physician[on board] who is an expert in treating a specific medical problem and has not treated the issue at hand for years.” But this hasn’t stopped physicians from stepping up when a flight attendant’s voice has announced over the loud speaker, “Is there a doctor on board?” Here’s what happened when these medical professionals answered the call:

MID-FLIGHT SCARE

“One of my more memorable calls to duty was on a flight from the U.S. to Australia. Midway across the Pacific Ocean, a young woman had chest pain, which is a daunting complaint if the patient were to require time-sensitive treatment thousands of miles from a hospital. I opened the supply box and I immediately felt naked, surrounded by non-medical personnel and a somewhat random collection of supplies…. I was armed with a Fisher Price-looking stethoscope in one hand and a bag of mini pretzels in the other trying to decide which would be more effective in treating this patient while passengers gawked at me like it was an accident on the side of a highway. Luckily for the patient, her chest pain was a combination of asthma and anxiety and was easily treated with an inhaler, cool compresses, body positioning, and emotional support. When I went back to my seat in coach, the flight attendant thanked me and put a fruit plate on my tray. She said, ‘Nice job. If you had placed an IV, we would’ve upgraded you to first class.’ Maybe next time.” —David J. Mathison, M.D., MBA, pediatric emergency physician and Mid-Atlantic regional medical director for PM Pediatrics, in Bethesda, Maryland

A CRUCIAL CALL

“I’m a podiatrist. When I was in my first year of residency, I was flying with my sister from Puerto Rico to Newark and there was an announcement asking for a doctor to please come to the front of the plane to help a sick passenger…. There I was coming back from vacation in ripped jean shorts, my hair braided with beads from the beach, dressed as a teen, being called as the ‘doctor on board.’ The passengers on the plane stared as I stood up and made my way to the front. The patient was a middle-aged man who had just had major surgery and had left the hospital, against medical advice, to get home for the winter holidays. He was sweating profusely, having difficulty breathing and chest pain, and he had a rapid pulse. I administered oxygen but he was worsening…. The first thing that came to my mind is that he was having a pulmonary embolus (a clot to the lung. The pilot asked me, ‘What do you want to do?’ Because I was so young, I was a little bit overwhelmed, but you don’t know what you’re capable of until you’re put into that situation. So, I explained that the situation was life threatening and we had to land. After I came out of the cockpit, he made the announcement that we would land in Bermuda. I’ll never forget when we landed, one passenger pointed at me and loudly announced, “That’s the girl who brought down the plane!” —Rebecca Pruthi, DPM, podiatric physician and surgeon, Foot Care of Manhattan

She said, ‘Nice job. If you had placed an IV, we would’ve upgraded you to first class.’
BABY ON BOARD

“In December of 2009, I was on a Southwest Airlines flight from Chicago to Salt Lake City when they asked if there was a doctor on board because a woman was in labor. Now, it’s relatively common to have medical emergencies on board but a delivery on board is extremely rare. I felt a little panic because I’m an internist and I care for adults primarily…but I put my hand up to help. I went to the back of the plane to the flight attendants and the lady in labor on the floor, who turned out to be about four weeks from her due date, traveling to Salt Lake City for an adoption where the intended parents lived. A psychiatric nurse and pediatric nurse volunteered to help too. We were about an hour away from touch down in Salt Lake City and I saw that the baby’s head was crowning…. It was just a matter of 15 minutes, and a healthy baby boy was born. One of the nurses had a pair of makeup scissors with a rounded tip, so we used those to cut the umbilical cord and I used my shoelaces to tie [it]. Some passengers with children also gave us blankets. The pilot announced the birth and said jokingly, ‘We have a security breach—we’ve found an extra passenger on board with no ID and no luggage.” Everyone clapped and it felt really joyous. Because it was a private adoption, to this day I don’t know the lady’s name. But a year later, I got a letter in the mail with a picture of a one-year-old boy in an Air Force flight jacket. The mom and dad who had adopted the baby boy thanked me for delivering him and told me his nickname was ‘The Jet.’ I was so grateful for that bit of closure.” —John Saran, MDVIP physician affiliated with Edward Hospital in Naperville, Illinois

FEELING THE PRESSURE

“A young man had suddenly gone blind in one eye as we got to cruising altitude. When I got to his seat, I saw that he had a dilated pupil, and he told me he’d just had an ophthalmologic procedure done to repair a detached retina. I was aware that the procedure required an ophthalmologist to inject a gas bubble into the middle of the eyeball, which would lightly press against the detachment for a few weeks until a seal could form between the retina and the wall of the eye. Under normal circumstances, the eye absorbs the gas bubble over time. The problem here was that when the aircraft reached cruising altitude with a cabin pressure of 8,000 feet, it caused the bubble in his eye to expand and press against the artery at the back of his retina, which collapsed the artery and blinded him…. I asked the pilot if he could reset the cabin pressure from 8,000 feet to 2,000 feet. Because of my background in aerospace medicine, I realized that would increase the amount of air in the cabin, and the engine would need to work a little harder and burn more fuel, but it would help the patient. Fortunately, the pilot calculated that they had enough fuel to make that adjustment and he reduced the cabin pressure. It allowed the gas bubble in the passenger’s eye to shrink, and he immediately regained sight.” —J.D. Polk, D.O., an osteopathic physician, senior medical officer with the National Aeronautics and Space Administration (NASA), and previous assistant secretary for health affairs and chief medical officer of the U.S. Department of Homeland Security

We were about an hour away from touch down in Salt Lake City and I saw that the baby’s head was crowning…
A BIG RELIEF

“Four years ago, when I was a surgical intern, I was on a flight from Tokyo to Los Angeles when I answered the overhead page for a doctor. The flight attendant led me to the back of the plane where there was a 65-year-old man who was unable to urinate. He looked extremely uncomfortable, and said he had a history of an enlarged prostate. He’d also taken a Benadryl to sleep, which I knew can cause a blockage in the neurotransmitters that help the prostate relax. Since the urethra passes right through the prostate, if the prostate doesn’t relax, you can’t urinate, which can result in severe pain and possibly bladder rupture. We were about four hours into the flight and it would be more than six hours until landing, so I got the medical kit and miraculously, it had a Foley catheter. As an intern, I was used to putting in a ton of Foley catheters before surgery. So we went upstairs to the first-class dining area where it was more private and I had him lie down. I sterilized the catheter as best I could, and used lidocaine from the kit to help numb the catheter when I inserted it. It immediately started draining urine, and I found a water bottle to put at the other end of the catheter to collect it. He immediately started feeling better. About an hour later while I was sleeping, the flight attendant brought over a handful of snacks and a champagne bottle from first class.” —Hyuma Leland, M.D., resident physician in the division of plastic and reconstructive surgery at the University of Southern California

TRAGEDY IN THE SKIES

“Around Christmas time 1997, I was on vacation with my wife and kids flying from New York to Miami when the flight attendant announced that they were looking for a doctor. I asked what I could do and the flight attendants brought me to a 25-year-old woman who had passed out in the aisle. She was traveling alone and was unresponsive when I got there. A newly trained paramedic also got up to help. We started administering CPR immediately on the floor of the aisle, but we had none of the equipment we needed to keep her alive. At the time, the in-flight medical kits had no oxygen, no breathing tube, and no device to pump oxygen into the lungs. And there was no defibrillator. The pilot asked if I’d like to make an emergency landing into Miami and I said yes. I continued doing CPR throughout the descent…to keep her heart pumping…but I didn’t think she was going to make it. As soon as we landed, the paramedics were there to take her to the hospital where she was pronounced dead. I was so affected by this, and so disturbed that I didn’t have the tools that could have made the difference. She had no prior history of cardiac issues, and it turned out that she had suffered an arrhythmia (an irregular heartbeat), and she would have done very well with a defibrillator. Immediately after the incident, I lobbied Congress, the National Transportation Safety Board, and the FAA to ask that airlines expand their medical kits and change their protocol. In 1998, Congress passed the Aviation Medical Assistance Act, which requires that all airlines carry expanded medical kits and an automatic defibrillator. I am gratified every time I get a letter from someone thanking me and telling me that their life was saved because of the defibrillators and medical kits that are now on planes.” —John Knight, M.D., hand and wrist surgeon, and director of the Hand and Wrist Institute in Los Angeles

 

 

 

 

 

 

 

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