In response to Randy Danielsen’s story of emergency response on the airplane, a recently graduated NP recounts how, on a celebratory vacation, she found her newly minted skills tested over the Pacific Ocean.
In response to Randy Danielsen’s emergency response on the airplane, I had the same kind of experience some 20 years ago. I was a new nurse practitioner, having graduated from UCLA. With my master’s degree tucked under my arm, I was celebrating by going to Honolulu, then on to Maui. We were about two hours into the 4-1/2–hour flight from LAX when an overhead call came for a physician. I thought, “Oh my, what’s happened?” Apparently, no physician was on board, so I responded.
From my seat in the front cabin, I was directed to the back of the plane. What I found was a women in her 50s who appeared to have had urinary incontinence and seemed short of breath. I struggled into the small space, and the woman told me she had heart problems. She appeared uncomfortable and could only tell me about a pain from her knee to her chest. “Wow,” I thought, “do we have an MI situation here, or a CVA, or did she just have a PE?”
As in Dr. Danielsen’s situation, I was impressed with the flight attendants’ training, help, and knowledge; they had an emergency kit that included a blood pressure cuff and a stethoscope but no AED. I took the woman’s BP, placed her on O2, and looked at her medications. I asked if her family was with her, but she was traveling alone. Her BP stabilized (I don’t remember her readings), her knee pain went from severe to minimal, and soon her dyspnea was better.
About 10 minutes later, the pilot came back and asked what I wanted to do. I stated, “She needs the nearest ER.” But we were over the Pacific Ocean, about halfway to Honolulu! The pilot decided to continue the flight. I monitored the patient for another hour, reviewing her medical history and medications. But her symptoms were improving, and she was very grateful. The flight attendants were also appreciative—I was given two bottles of wine and moved to first class for the last hour of the flight.
The patient was taken off the plane by paramedics as soon as we arrived. I received a letter of thanks from the airline, with coupons for free headsets and drinks on future flights.
And yet, it still scares me that I found myself managing this medical emergency alone on an airplane over the ocean. What if the patient had not stabilized?