Please allow me to invite you to share with me the experience of a transatlantic flight of a few months ago. I was privileged to travel business class when called to assist a patient. Entering economy class, I saw that every seat was taken, there was hardly space to move. Attending to the patient, I was faced with problems that may require some degree of preparedness by any physician traveling by air. One of them is managing the hostile or belligerent encounter. One may wonder, what happens to alcohol at an altitude of 7000 feet, where even plain water begins to boil remarkably quickly? What happens to the bubbly champagne imbibed freely en route? Should the consumption be restricted?
I had access to the on-board emergency kit. In habitual routine I went through the equipment and was distressed to find the laryngoscope batteries dead, inviting the specter of the call for a crash intubation and being unable to visualize the vocal cords. Blind naso-tracheal entry without muscle relaxant is only possible if the patient is in deep coma or near-death-enough to be flaccid. It should be part of mandatory quality assurance to ascertain that the laryngoscope batteries are fresh on every transoceanic flight entering Canadian airspace. In an emergency situation, I think the doctor should assume authority to have the patient moved into the more spacious forward section.
The answers to these questions should be available to all of our physicians. As an air pilot, previous member of the BCMA Traffic and Safety Committee, and as a Canadian aviation medical examiner, I would like to see them discussed at our next civil aviation seminar.
—G.A. Asche, MD
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