The Epidemiology of In-Flight Medical Emergencies

Shared by Eddie

Hi Colleagues, Attached is a video from the NEJM. It accompanied an article titled “in flight emergencies”, a few years ago. I thought it is a useful reminder to all of us, especially for the “frequent flyers” amongst us.I hope you will enjoy it.Eddie.

 

10 thoughts on “The Epidemiology of In-Flight Medical Emergencies

  1. Thanks Eddie. I have been called to assist in my younger days. Upgraded to First Class! Once I delivered an Indonesian pilgrim to Mecca who had not disclosed her pregnancy, after the flight made an emergency landing in Katunayake- got nothing!
    Narme

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  2. Thanks Narme. I understand.Once on a short haul Qantas flight, the cabin crew surprised me with two bottles of Australian shiraz on landing for my help.However, on a Malaysian long haul, a lot of promises were made but nothing was realised.!!

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  3. Thanks for posting the clip.Eddie. Assisting in inflight emergencies is indeed a unique professional challenge to all medical professionals.
    Have you heard of this old joke?about inflight emergencies
    A frantic call from flight attendant is there an Anaesthetist inthe The plane? After many requests the anaesthetist reluctantly volunteered to a grateful flight attendant, who thanks him and says breathlessly that there is a Surgeon in the first class cabin who urgently needs his light adjusted 😄😄

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  4. I have another view of air emergencies. Whenever there is a call for a doctor I try to make myself invisible or try pretend to be asleep. I always say” I am not a real doctor, only picture reader”. I also read palms and tea leaves!

    But my kind and compassionate wife puts her hand up and shouts “here is one” pointing to me. Now, I have no choice. I get up sheepishly and go up saying prayers for real doctor. First thing I declare is “I am a radiologist out of clinical practice for 40 odd years, but I will do my best’ . The pt was an older lady slumped in her chair but was answering questions. she said she was very weak. Her radial pulse was good and regular. “Dub Lub” sounded good on the flight emergency kit. No systolic murmur, opening snap and all that crap. I don’t recall what the hell they mean. The flight attendants were trained to measure the blood pressure and the defibrillator. I did not tell them I did not know how to use defibrillator. Thanbols / Raj did not teach me that!

    Then I thought she may be hypoglycemic. I went back and came with some confidence as I retrieved my glucometer. I am T2D. As i came back, there was another guy helping who was a family doctor. I thought God answers even hell bound person’s prayer. You cannot imagine my relief. I proceeded get blood sugar reading. It was mildly elevated not enough to account for her symptoms. Advised her to talk to her doctor about diabetes.

    The FP could not get a BP reading. I was sure even I can shine now getting BP reading. However I could not get a reading due the vibrations and other noises from the plane and of course my 8th nerve deficiency Since her radial pulse was regular and good, we agreed it must be exhaustion related travel and anxiety. she was taken to business class to lie flat as we suggested. She must have GOT BETTER IN SPITE OF TREATMENT or a lack of it, We did not hear a call for Mortician !

    I thought a newer compact automatic wrist BP recorder might be good for travel, even for REAL doctors!
    dharma

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  5. Thanks Dharma.Yes, every encounter in unfamiliar territory can be distressing.The reason that I put out the post was to reassure that most of the time it is something trivial but you may encounter difficult situations too.Often language issues can also create problems with history taking as the Chinese have taken to the air in large numbers.!Medical opinion and treatment in the confined spaces of an airplane can also be tricky especially when one is relaxing after a few glasses of wine or Scotch.Eddie.

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  6. I travel alone- so there is no one let the cat out of the bag .

    One time, when the ‘call came ‘ I sat tight and did the Dharma Thing- pretend to be sleeping !

    Out of the corner of my eye- I saw some young bright sparks come to the rescue- two nurses and a REAL Doc on board .
    The issue was – Diabetic pt who had to rush to make it to the flight, not had a good meal and went into hypoglycemia .
    All was good – and I went back to Sleep Mode !– the Best Mode for Retired Docs like me — retired almost 17 yrs ago — just too much stress on the job , and now, I am still Alive and Kicking, in this Wonderful World, while the Clock is Ticking !!
    eaglemd

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    • This was sent by Praxy for posting
      Dear Eddie
      I wrote the following in response to your Medical Emergencies on flights but it did not get into the blog so I am writing it again hoping it would be beneficial to others.

      A couple of years ago I was flying to Sri Lanka on my own on an Emirates flight when the pilot asked for Medical help as there was an emergency. Since I was retired and did not have any Medical Protection I did not offer help but when the pilot asked for help for the second time I felt I had to help.
      It was a Pakistani lady who was travelling to Islamabad with her husband and her daughter. When I saw the patient I panicked in case I could not diagnose and made a fool of myself and worried in case I made the wrong diagnosis and gave the wrong treatment and had the fear of been sued if it went wrong.But now thanks to Eddie I know that according to the Good Samaritan act of 1998 that we cannot be sued in helping in an emergency that. (Eddie please correct me if I have got it wrong )
      However the lady was only mumbling in monosyllables to the questions I asked her and her husband and daughter were not helpful either. I asked about chest pain history of high blood pressure and diabetes etc etc and then found out that she is a diabetic on oral hypoglycaemic drugs.By this time the lady was drifting into a coma and I had to diagnose if it was hyper or hypo glycaemia. Then I asked the husband if she was taking tablets or Insulin for diabetes . After much questioning I found out that she had taken oral tablets but not eaten anything and that later on she had vomited too. So it was easy to diagnose hypoglycaemia. I asked the Cabin staff for some sachets of sugar (they serve with the meal tray ) and put it in her mouth . Still there was no response and at this stage luckily I remembered reading in a BMJ about Glucogel which is rapidly absorbed into the blood stream if rubbed on the buccal mucosa. So I asked the cabin steward whether they have Glucogel. Then he brought a huge compendium of all the drugs they carry on board. I hurriedly looked through it and was relieved to find Glucogel there. So I squeezed the tube, I think it was a 10 mg tube, into the inside of her lips and the buccal mucosa and I was amazed at the rapid response. She started opening her eyes and I was happy that it was working and in about 10 minutes she opened her eyes fully and started looking around . Then I gave her a cup of tea with sugar which she drank without any hesitation and in another 15 to 20 minutes she was back to normal wondering what the fuss was about.My panic was over and the steward asked for my passport and other details and on the flight from Dubai to Sri Lanka I was upgraded to Business class. From that time onwards I have been upgraded to Business class many times when I have flown on Economy, and to first class if I travelled on Business class.
      The staff thanked me as they said that if there was no one to help they would have had to phone US for advice and if they had failed, the pilot would have had to do an emergency landing.So he was grateful that an emergency landing was averted.
      So dear friends please remember in Hypoglycaemia, Glucogel is extremely effective. Now when I book flights I always put Mrs but it is in their records that I am a doctor.After my own panic in trying to help I thought I will never offer my help on a flight but, Eddie your comments about not getting sued in helping in an emergency like that I might think otherwise.
      Thank you Eddie for that blog. Praxy

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      • Thanks Praxy for your interesting story.You did well and has been amply rewarded by Emirates.Yes, the Good Samaritan law is current.Eddie.

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  7. Thanks Praxy. I must remember Glucogel. Never heard of it before. Help if you are able without anticipation of a reward. I can empathize with you of fear of not knowing what to do especially for me. I have been out of clinical practice for over 40 yrs, But these words ring in my ears “even if you cannot heal, do not kill” Killing can be by commission or omission. It is perhaps not the result but the intent that matters. dharma

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