Managing medical emergencies at 30,000 feet

Managing Medical Emergencies at 30,000 Feet

Aug 6, 2015 - U.S. airlines, it turns out, contract with services that give them access to medical professionals on the ground. Had there been no doctors or nurses on my flight — and, in some cases, even when there are — the flight attendants would have called one of them.

Date: August 6, 2015
Source: Washington Post
Author: Kate Silver

Gray-haired and gray-faced, the woman grasps a friend’s hand for support and shuffles toward the airplane’s bathroom. A few minutes later, she wobbles back to her seat and a voice comes over the PA: “Is there a medical professional on the plane? A passenger needs assistance.”

“I’m a doctor,” answers a woman seated behind me, holding up her hand.

Another woman rushes up the aisle to help, and a small crowd gathers as other passengers make room for the medical professionals.

Flight attendants scramble back and forth with glasses of orange juice and what appear to be packets of sugar. Passengers gossip among themselves: The woman has diabetes; she was too nervous to eat before boarding the plane; she has nausea and a headache and can’t communicate.

The doctor encourages her to drink something. Her head bobs, and then she dry heaves.

An hour passes. A call goes out to the passengers for glucose and a glucometer. Five people volunteer theirs. Two more doctors, a very serious man and another woman, join the medical group. He’s an internist, the passenger grapevine buzzes, she’s an ER doctor — on her honeymoon!

The woman’s head continues bobbing. A flight attendant brings a large medical kit, and gloves are handed around. A large needle is extracted from the kit, and the gloves are bloodied. Soon an IV is hanging from the luggage compartment.

The captain emerges from the cockpit, his face long with concern. He confers with the medical personnel, then announces over the PA that the plane is about an hour from its destination, and, since the patient is in good hands, the plane will be continuing on. You can practically feel the change in cabin pressure from the passengers’ collective sigh of relief.

When we land, an ambulance hasn’t yet arrived, so one of the doctors waits with the groggy woman as we all file off, back into our lives, our vacations, trying to shrug off the event.

But it sticks with me. When I get home, I start inquiring about how often this happens, and how passengers and flight crews respond. It turns out it’s more common than you might think.

Boots on the ground

U.S. airlines, it turns out, contract with services that give them access to medical professionals on the ground. Had there been no doctors or nurses on my flight — and, in some cases, even when there are — the flight attendants would have called one of them.

In the United States, there are two main services that airlines call. One is MedAire, which runs the MedLink Global Response Center, where physicians from the emergency department of Banner-University Medical Center Phoenix handle calls, and the other is the UPMC Communication Center, where physicians from University of Pittsburgh Emergency Medicine deliver advice.

Christian Martin-Gill, a physician at UPMC Communication Center and assistant professor of emergency medicine at Pittsburgh, has done extensive research on in-flight emergencies and co-authored the study “Outcomes of Medical Emergencies on Commercial Airline Flights,” which the New England Journal of Medicine published in 2013. In the analysis, he says he sought to find out whether flying is, indeed, safe. The researchers reviewed 11,920 calls made by five domestic and international airlines to the center between Jan. 1, 2008, and Oct. 31, 2010. Based on that data, they estimated that the 2.75 billion total passengers who fly each year experience 44,000 in-flight medical emergencies. That boils down to one in every 604 flights, or nearly 50 every day.

In those cases, the most common symptoms included fainting or lightheadedness (37.4 percent), respiratory issues (12.1 percent), and nausea or vomiting (9.5 percent). Just over 7 percent of affected flights landed because of the illness.

The surprising finding for Martin-Gill was this: In 3 out of 4 of those medical emergencies, a medical professional was on board to volunteer, and 50 percent of the time, that medical professional was a physician.

In other words, having medical professionals step up is more common than not, and that’s a good thing for sick passengers. Because while flight attendants must be trained in CPR and using an automated external defibrillator, they will be the first to tell you they are not medical professionals.

Flight attendants are familiar with the contents of the onboard emergency kits (which include, in part, syringes, needles, a blood pressure meter, devices — in three sizes — to open airways, an IV set with tubing and tourniquet, and a variety of medications) but they’re not trained to use those items. That’s when you hope that the person sitting next to you is either a nurse or doctor, and/or they happen to be carrying exactly what you need — like glucose or a glucometer, in the situation I saw — that they’re willing to share.

“This is kind of a wilderness environment, because you’re up 30,000 feet in the air, and it’s nice to see people come together and help each other out,” says Martin-Gill.

Calling the shots

Lauren Nehmer, a pediatric oncology nurse at Children’s Healthcare of Atlanta, has been on three flights that involved medical emergencies. Two she stepped in to help with, and the third, she says, already had enough volunteers.

On a flight from Milan to Atlanta, a teenage girl was having a seeming allergic reaction that made her throat itch. Fearful of the reaction worsening and impacting her breathing, Nehmer and another nurse gave her Benadryl through an IV, and, four hours later, a shot of epinephrine. When the plane landed, the girl was met by ambulance and taken to the hospital, where she recovered.

On a flight to Asia, Nehmer and another nurse came to the aid of a man who complained of severe abdominal pain. She says that he hadn’t been able to urinate for at least 12 hours before their flight (she says she thinks he had prostate cancer or some larger medical issue causing the problems). The solution, she says, was to insert a catheter to give him some relief — which they did, right there on the plane.

She adds that in the air, you have to be creative when it comes to materials. While the emergency kit was equipped with catheter tubes, she had to find a container to hold the urine. The plane’s hot tea pitcher came in quite handy. “I was like, oh, God, that seems wrong, or weird.”

Nehmer says in that situation, she knew just what to do medically. The stressful part, she says, was when the flight crew asked her opinion on whether the plane should divert from its course. “Their concern was they were about to enter Russian airspace. And I’m like, oh, my God, you’re asking me if you should divert this plane of like 500 people? Are you kidding me?” The flight kept on course.

Nehmer adds that if you’re a medical professional who flies frequently, you have to be prepared for anything. “When you do a lot of traveling, you just kind of open yourself to that,” she says.

Sara Nelson, who is the international president of the Association of Flight Attendants, has seen her fair share of medical incidents since she began working as a flight attendant with United Airlines in 1996. “When I was flying a full schedule, I would say that I encountered it at least once a month, to different degrees,” she says.

She says diabetic issues — low blood sugar in particular — are a frequent occurrence, and on a number of occasions she has sacrificed her home-made snack to help out. “I have given up my peanut butter and jelly sandwich many times,” she says.

She shares the stories she’s heard over the years that stick with her: there was the man who collapsed by the bathroom, and a flight attendant revived him with the automated external defibrillator, even after a passenger — whom she later learned was a doctor — took his pulse and proclaimed he was dead. There were the flight attendants who delivered a baby in the air, unwrapping the umbilical cord from around the child’s neck during the birth, with instructions from on-the-ground physicians.

“We have saved many lives,” she says.

While the medical emergency itself is stressful enough, Nelson says that since Sept. 11, 2001, there are also security issues to consider. Flight attendants are aware that any unexpected incident could be intended to divert the crew’s attention as part of a terrorist attack. “When there is a medical emergency, we take that seriously and we respond to the health emergency, but every member of the crew also goes on high alert for a potential security threat,” says Nelson. “After September 11, we’re not only first responders, but we also became the last line of defense.”

Despite those risks, Nelson says that in almost 20 years as a flight attendant, she’s seen, time and again, the goodness of people who are willing to help a stranger in need, whether they’re doctors, nurses, emergency medical technicians or passengers.

“You’re up there in this metal tube at 35,000 feet, and you’re all in this together,” she says.

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