Flying on a return trip from Chicago to San Francisco, I can’t help but feel a little on edge. It’s not the fear of flying that is leaving me a little less relaxed than the pleasant, middle-aged woman peacefully slumbering in the seat next to me. It’s the possibility of hearing the announcement few doctors are comfortable hearing during travel: “Is there a doctor on this flight?” New physicians go through plenty of training throughout their years in medical school and residency that some may call extraneous. As a physician going into primary care, I have practiced countless times reading complex imaging and reviewing pathology slides. Although I do find this training at least somewhat pertinent to my clinical field, I wonder why time has not been spent training me and my colleagues on something that we may all have to deal with at some point during our professional lives — a commercial airline medical emergency. Medical schools and residency programs should train medical students and new physicians how to confidently handle an emergency while aboard a commercial flight. Doctor, please place an IV and start fluids A big issue that physicians may face during an in-flight medical emergency is one that should not be an issue at all: Setting up the proper medical equipment for emergency care. Much of medical delivery in hospitals and clinics has been fragmented by medical specialty. Nurses with whom I work are experts in the intravenous placement of catheters. Pharmacists are relied on to prepare medications. Medical assistants know exactly where all the equipment is located our medical facility and how to get it quickly and efficiently. Physicians, including myself, are not nearly as great at any of these tasks as our interdisciplinary colleagues. But when a medical emergency occurs in an airplane and there are no nurses or emergency medical technicians on flight, it is largely up to the physician to set up the most appropriate equipment for the patient’s needs. Even an excellent diagnostician can get sidetracked with this task. (For those needing a visual brush-up on IV placement, see this excellent videodemonstration.) Doctor, what meds should I get? Most clinical physicians prescribe dozens of medications every day to treat a spectrum of patient ailments. These physicians also have at least a basic knowledge of available life-saving medications during a medical emergency and know how and where to get it. Up in the friendly skies, however, it’s a different story. I could not find any published surveys on this, but few medical colleagues that I’ve spoken with can name more than a handful of emergency medications that are available on a commercial airplane. I’d like to think that potentially life-saving time spent frantically searching through an emergency medical kit could be better used on efficiently providing such interventions during these in-flight medical emergencies. Doctor, what do you think is going on? Sometimes a patient having a heart attack grabs his chest in agony. Other times, a patient having a heart attack may complain of nausea and vomiting. Ideally, a physician of any specialty that aids a nauseated passenger at a high epidemiologic or historical risk for heart disease will entertain the possibility that a heart attack may be the cause. However, I suspect that this clinical concern does not occur as much as it should in this unusual patient setting. Physicians should be educated during their medical training on both typical and atypical signs and symptoms of common, life-threatening emergencies that may occur in-flight on commercial planes. Take home point After a few unremarkable hours of flying, the plane lands and I and the rest of the passengers exit the plane wonderfully unscathed. Hoping to raise my confidence for the next flight, I promise myself I will dig up a few clinical reviews of the management of commercial airline emergencies before the day’s end. This should not have to happen after seven years of intensive medical education. Clinical physicians completing their residencies should be formally trained in commercial airline emergency medicine. This should involve real-time emergency simulations and repeated certification of the handling of basic medical equipment. For the sake of future generations of physicians, let’s do our due diligence as a profession and incorporate structured training in commercial airline emergency medicine to medical education. source
I travel a lot between Taiwan and Canada/ USA and had experienced helping passengers 4 times in 5 years. First was a vietnamese pregnant woman who had vomiting and diarrhea. No meds given, just monitor her vital signs , check fetal heart beat, and NPO, except water. I explained to her if symptoms persist or if she's dehydrated, I'll give her IV fluids. Second patient was a child with asthmatic attack, fortunately, he brought his meds with him, I instructed him to use his inhaler once more, and to take his oral meds altho few hours earlier than the required time , it relieved him. Third was a 5 yr old girl with fever, who kept on crying. Lungs were clear,with soft nontender abdomen, there's an acetaminophen tablet on board, so I gave half dose and smashed it into powdered form. I advised the mother to give her oral fluids too, she got better and slept the remaining hours on the plane. Actually there's not much you can do on board because there's no medications available except for CPR use. If the asthma attack got worst, i might use oxygen and give epinephrine. ( as I told the parents what my plans will be) , sad to say, there's no laryngoscope/ endotracheal tubes and ambubags on board. The last patient had a chest pain on board, he has stents implanted on coronary arteries previously. vital signs were normal so I asked the flight attendants to let him lie down ( he was transferred to first class cabin), i instructed him to loosen his belt and clothing, gave him nitroglycerin ( which he broughr in his carry-on) and i ordered oxygen. The stewardess was reluctant to open the small oxygen tank at first thinking if he doesn't consume it, the whole tank will still be disposed, but as the chest pain persisted longer, i was able to persuade them to give. The old man was relieved of the chest pain after the oxygen. I monitored him every hour and checking his vital signs more than 5 times ( it was 14 hours flight) . I also tried to look at the defibrillator and studied its instruction manual in advance in case I might need to use it but of course praying and hoping Not to! I think it's important to know what you have on board and what you can give and do. Basically, basic care and monitoring is still the best you can do to most calls on board. By the way, I work as intensivist in Taiwan.
