Re: Preparing for an in-flight medical emergency

There truly is an app for everything, and I’ve downloaded airRx. It looks good, and I will use it.

Thank you to Drs Gillespie, Rumball, and Wilson for their article [“Preparing for an in-flight medical emergency,” BCMJ 2017;59:195-196]. There truly is an app for everything, and I’ve downloaded airRx. It looks good, and I will use it.

I agree with everything the authors suggest, but I fear the landscape has changed. Twenty years ago when I was called to a cardiac arrest halfway to Oahu, the team approach worked and medical equipment was provided promptly.

On a recent flight to Hong Kong, on a well-known carrier, I responded to a call for a physician and attended a patient clearly in cardiovascular shock. I identified myself as an intensivist willing to care for the patient and asked for the medical kit immediately.

The flight attendant informed me they had to wait until there was clearance from the ground-based “consultant.” This is a process I have since learned is subscribed to by numerous airlines. I had to wait what seemed like forever but probably was 15 minutes for a linked call to the consultant, who had limited knowledge, and in the meantime, they advised me to cover the patient in a warm blanket. The medical kit was then provided, but not before I signed a form taking full responsibility for the patient’s care.

The patient stabilized with a litre of crystalloid, and I gave her an ASA. I advised the staff that the flight could continue 2 hours further to Hong Kong without diverting to Taipei. I learned subsequently from her son that she had a pulmonary embolus.

I have since learned, by speaking to a captain of the same airline, that in a true medical emergency such as this, I should inform the flight attendant that due to the nature of the patient’s condition, I need to speak to the captain immediately. The captain can then authorize the release of the medical kit.

And if you think that by attending a patient you are entitled to some consideration of gratitude, you are misinformed. You are doing it because you are a physician and it is rewarding to resuscitate someone. I got a handshake from the chief flight attendant. The airlines know that 50% of flights will have a doctor onboard, they are relying on it, and furthermore, they want to make you liable for it.

I look forward to reading about more of these events on airRx’s web page.
—Grant McCormack, MD, FRCPC

Grant McCormack, MD, FRCPC. Re: Preparing for an in-flight medical emergency. BCMJ, Vol. 59, No. 5, June, 2017, Page(s) 254 - Letters.

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Ralph Jones says: reply

Regarding Dr McCormack's recent letter, I too have heard airborne tales of medical woe. Thankfully, there are positive experiences. Two years ago on a Lufthansa flight to Abu Dhabi I was twice called to action. The first case was an unresponsive young Asian woman whom it transpired had never had an alcoholic drink in her life until then. Her response was a “coma.” "Does she do this sort of thing often?" I asked her sister. "Yes," was the answer. We left her to choose when to emerge.

The airline gave me a 30-Euro certificate to spend on their duty free service. We were just contemplating what to buy when the second emergency arose. A young woman thought she may have been having a serious reaction to seafood she had eaten the day before. She wasn’t, but I got another 30 Euros to spend. Insufficient for decent whisky, so I bought my wife a Swarovski bracelet.

Hopefully no one has an ideas about traveling on Lufthansa with a group of friends who feign medical emergencies sufficient for their doctor companion to earn a bottle of Johnny Walker blue label.

—Ralph Jones, MD

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