Medical emergencies occur on about 50 commercial flights a day in the United States. Many are minor — a passenger feels faint or becomes anxious. Others are life-threatening, like a heart attack or difficulty breathing. An article in the New England Journal of Medicine offered doctors and other health care professionals advice for handling a variety of situations. That prompted us to ask physicians for their stories. Here are a few of them. Gregg Greenough: An Ebola scare Keith Van Meter: A long CPR session saves a life Darria Long Gillespie: “Do I need to land this plane?” Wanda Filer: A woman was going in and out of consciousness Parveen Parmar: An older man, ashen gray, lying on the floor By Gregg Greenough: One of my most memorable calls was on a flight from Europe to the United States during the Ebola outbreak last fall. It was soon after Thomas Duncan, who was infected with Ebola, flew from Liberia to Dallas. About 90 minutes before we were scheduled to land, there was a call for a doctor. A man traveling from Liberia was saying he needed to vomit. With his eyes tightly closed, he told me he felt like the plane was spinning around — even though there was no turbulence. He didn’t want to open his eyes because he knew if he did he would vomit. I had just been through Ebola training at Brigham and Women’s Hospital, so I went through the checklist: fever, diarrhea, vomiting, abdominal pain, unexplained bleeding, exposure to someone with Ebola, and the like. He didn’t have any of these warning signs. I also asked what he had been doing in Liberia, and he didn’t seem to have engaged in anything that increased his risk for being infected. His symptoms were classic for positional vertigo, which I had seen many times. This sensation of spinning, often caused by an inner ear problem, can make you feel awful, but it isn’t transmissible. People on the plane, including the pilots, were getting anxious, since Ebola was fresh on everyone’s mind. With the flight attendant’s permission, I barricaded the man and myself into one of the plane’s bathrooms. There I was able to take his temperature and give him a medication to ease his symptoms. Despite my assurances that this was a form of vertigo and not Ebola, the pilots insisted on calling the CDC officer stationed at the airport. When we landed, the jet bridge wasn’t even extended to the plane. It was as if the entire plane was infected. After about an hour, the CDC official boarded, wearing the spacesuit-like gear required for health professionals taking care of someone with Ebola, along with two security guys in full hazmat gear. Now the other passengers were really getting nervous. There was a flurry of texting, taking photos, and posting to social media. By Parveen Parmar: My work in global health requires me to fly a fair amount. I’ve provided medical care in the air several times. In one memorable instance, I realized there was some chaos forward in the plane and heard someone ask (more like scream), “Is there a doctor on the plane?” I went up to find an older man, ashen gray, lying on the floor. One of the flight attendants started doing excellent chest compressions. It looked like she had been through this before. The plane was carrying an automated external defibrillator. We placed the pads on the man’s chest. The defibrillator detected organized heart activity, so we didn’t deliver a shock. Shortly after we placed the device on the man, his pulses returned and he began to move and open his eyes. The medical kit contained what we needed to start an intravenous drip through which we gave him IV fluids. As we were resuscitating and stabilizing the man, the pilot was diverting the plane to a major metropolitan airport. Emergency medical service personnel greeted the plane and transported the patient. He was awake and talking and able to follow commands. The entire process was incredibly efficient. Working in a tiny, cramped space with passengers looking on is difficult. It’s even worse when there is turbulence and the plane is bumping around. Thankfully, this patient was able to be seated and secured, but I can imagine instances where, if a patient is still requiring active CPR, this wouldn’t be possible for the patient or care team. Dr. Parveen Parmar directs the international emergency medicine fellowship at Brigham and Women’s Hospital in Boston and is an assistant professor of emergency medicine at Harvard Medical School. source
