Transatlantic Flight Medical Emergency

While we were at the midpoint of our transatlantic flight between the American continent and Europe, an announcement requested if there was a physician aboard as there was a medical emergency.  I went immediately to the rear of the aircraft to offer my help. I was presented with an elderly lady who was diaphoretic, pale and having difficulty breathing.  On asking a flight attendant immediately brought me a stethoscope and a sphygmomanometer and I was able to establish that the patient’s blood pressure was low (80/60 mm Hg).  I placed the patient in a recumbent position on the floor and elevated her legs.  I also asked for oxygen and a member of the cabin crew immediately brought forward an oxygen tank that was fully functional.  To my pleasant surprise the fight attendant not only knew where it was but knew how to operate it and also told me that it was recently checked.  The medical kit had enough supplies for basic emergencies but not to treat a full code as in a hospital.  Actually, in my opinion the chance to have aboard physicians and assistants knowledgeable to run a full code is slim, therefore an emergency cart is not necessary.  My intervention by placing the patient in a recumbent position and elevating her legs resulted in an increase of the blood supply from the periphery to the center.  Oxygen supply via a nasal cannula resulted in a reversal of hypoxemia, a common phenomenon even among healthy passengers, as well as a few encouraging words from me that everything will be fine created a good response.  During the resuscitation flight attendants assisted me and were in contact with the cockpit just in case the flight needed to diverted.  According to an article published in New England Journal of Medicine, medical emergencies occur in about 1 in every 604 flights.  Although the number of passengers that fly every year is vast, approximately 2 billion, which represent one third of our planets population, only 7% of the emergencies required for the airplanes to be diverted.  In the USA there are two centers, one in Pittsburgh and one in Phoenix, where emergency room physicians advise flight crews on how to help patients.  In 75% of the emergencies, health care professionals aboard the plane came forward.  Doctors helped in half of the cases, nurses in 20% of the cases and others in the remaining.  Although Delta Airlines offered to pay me for my service I do not think it is necessary as it is the physicians’ duty to help fellow human beings as needed.  I was pleased to see that Delta Airlines has adequate supplies that maybe needed for minor emergencies and also personnel who are trained and willing to assist in such events.

 

 A good review article on how to respond on emergencies on commercial flights was published in N Engl J Med, Vol. 346, No. 14 · April 4, 2002