In the past, we assessed how productive a primary care physician was by how many RVUs he or she generated. With the move toward accountable care organizations, quantity of visits...
If you are ever at an airport and see me standing in line for the plane that you are about to board, just turn around and find another flight… because something bad is probably going to happen. In-flight medical emergencies are reported to occur once every 604 flights but I have not been on anywhere near that number and I’ve been asked to provide assistance at least a half dozen times. Last month, I was flying to the American College of Chest Physicians meeting and had not one but two calls to provide medical assistance.
Somewhere over Tennessee, one of the flight attendants asked over the overhead speaker “If there are any medical personnel, please come to the front of the plane”. So, my wife and I both went up and there was an elderly woman who was unresponsive in her chair. She had a weak and bradycardic pulse and was diaphoretic. Her daughter said that she was diabetic so I handed a nurse who was on board her carry-on bag and asked her to search for a glucometer. There was a guy who was an EMS and I told him to get a blood pressure (it turned out to be normal). After a copy of minutes, she started to wake up. We never did find the glucometer but someone had a lollipop that we gave her just in case.
I moved to the seat across the aisle from her for the rest of the flight and then as we were landing, the flight attendant asked me to come see another unresponsive elderly woman a few rows up. She was traveling alone but had a medical alert bracelet that listed her medical conditions (including partial complex seizures) and medications as well as the phone number for her son. She had a strong pulse and a normal respiratory rate so I just gave her a few minutes and she started to come to but was confused, disoriented and pretty clearly post-ictal. Two sets of EMS units arrived to take the two women off of the plane. Both were OK – the first woman turned out to have a vasovagal reaction and the second patient was, in fact, post-ictal from a partial complex seizure.
Most of the time I’ve been asked to help during an air flight, it has been because of syncope or nausea; fortunately, I’ve never had to do in-flight CPR, deliver a baby, or pronounce anyone dead. So what do you do if you are called to provide medical assistance?
The first thing to realize is that you are never alone. The flight attendants can contact a emergency medicine physician on the ground who can help talk you through whatever medical problem you are faced with so you should not be afraid to help since you are going to have back-up by someone who does this for a living. The second thing to know is that every airplane doing a flight in the U.S. is required to have an emergency medical kit and these have most of the items you need for the most common in-flight medical emergencies. The kit will include:
- Automated external defibrillator (AED)
- Blood pressure cuff
- Oral airways
- Bag-mask ventilation set
- IV administration set
- Albuterol meter-dose inhaler
- Diphenhydramine (tablet and IV)
- Epinephrine 1:1,000
- Epinephrine 1:10,000
If you need something that is not in the kit, often some other passenger may have it in their carry-on bag so you can ask the flight attendant to make an overhead request for the equipment or medication that you think you might need.
Aircraft often fly at 35,000 feet altitude but they are pressurized to 8,000 feet. To put this in perspective, there is about 25% less oxygen per volume of air at this altitude than at sea level. For this reason I will order a high-altitude hypoxia simulation test for my patients with lung disease when they are planning air travel. In this test, the patient will breath 15% oxygen and then then an arterial blood gas or a transcutaneous oxygen saturation measurement is taken to determine if they need oxygen in flight.
But it turns out that the most common reasons for medical emergencies are just otherwise common conditions: Syncope (37%), respiratory problems (12%), nausea/vomiting (9%), cardiac symptoms (8%), seizures (6%), and abdominal pain (4%). Only 1 out of every 300 in-flight medical emergencies progress to death.
As a physician, you are not obligated to respond but most of the time, you are going to be a lot more capable of managing an in-flight emergency than a lay person. But if you don’t want to have to deal with a medical emergency during air travel, just don’t get on the same plane as me… because something bad always seems to happen when I’m aboard.
November 20, 2018