In response to Randy Danielsen's story of emergency response on an airplane, the author offers advice on being prepared to respond and also describes how sometimes a scary situation can have a relatively simple "fix."
In 30 years of cross-country flying for family visits and conferences, my husband and I both have experienced more than one call to help a passenger in distress. He is a maternal–fetal medicine (high-risk obstetrics) physician, and I am a family nurse practitioner in primary care. We both stay current on CPR and AED use (although no AED has ever been available when needed!), and he was even motivated to take the ACLS course a few years ago. I’ve begun to carry copies of my RN and NP licenses—and my board certification card, too!—as my licenses have been requested either before or right after an urgent in-flight situation. Once, when a woman fainted in the aisle near my husband, he had to show a conference registration letter with his name and “MD” behind it—just to be allowed to open a plastic tackle box containing a BP cuff and a stethoscope in it!
Our most recent scenario: About three hours into an early-morning, very full flight from Buffalo to San Jose, we began to hear an older woman screaming for help from the back of the plane. An announcement followed, requesting a physician’s assistance. My husband, because his strength is in obstetrics, does not always respond right away. I often wait for the second call, too, assuming that a doctor on board is preferred to an NP. But since the second call came rather quickly and my seat was on the aisle, I rose and hurried back to see what was going on. The screams had become louder. What could be the matter?
When I shouted through a closed bathroom door that I was a nurse, an elderly woman opened the narrow door and squeezed out, wild-eyed and panting, flailing her limbs and certainly able to speak! Because the roar of the jet engines was so loud there, I put my mouth close to her ear and asked, “What’s wrong? Why are you screaming for help?”
In a lower voice, she said that when she got up from the toilet, she had terrible back pains and leg cramps and was certain she was having a stroke. What made her so sure? She recited a long list of medical diagnoses of cardiac and vascular type, followed by about 15 related medications, including diabetes agents, antiplatelet meds for her atrial fib, and thyroid medications, too. One sister had died of a stroke, and she feared dying of a stroke, too.
She had not taken most of her medications that morning because she had spent most of the night cooking meals to freeze for her husband and had barely made her flight. She and her sister were off to Lake Tahoe to celebrate their birthdays with a week of gambling and resort dining (although the sister seemed too feeble to leave her seat and help). All of the woman’s medications, including her potassium tablets, were in her suitcase in the belly of the plane.
Thanks to four years working as an RN in a neurosurgical/surgical ICU, I was sure she was not experiencing a CVA. But after calling for water and instructing the flight attendants to ask for bananas from among the passengers, I did a quick neurologic assessment. As the woman responded to my questions and drank the water, she became calm and cooperative, verifying my sense that she was neurologically intact. Her pulse was now steady and the screaming had stopped.
In addition to two donated bananas, a physician finally arrived from the front row, asking what was going on. My husband also came back to see how he could help.
We declined potassium tablets offered by two passengers, knowing that people don’t always keep medications in their original containers. Once our “patient” ate the bananas and drank the water, though, her cramps seemed to ease up. Her wild look was gone, and she even smiled a bit. We had no BP cuff and no other equipment, but her pulse was stable and she was calm.
Over a 10-minute period, a flight attendant relayed my initial assessment to the pilot, who then relayed it to the ED group on the ground. These consultants sent several questions, and my answers were relayed back. The decision was made to continue flying, but we were told that if the woman became distraught again, we should land at the nearest airport. We stayed with her in the galley for about 45 minutes. When she asked to be seated again, we knew she was going to be fine. By then, our destination was only 30 minutes away.
About six weeks later, the airline sent my husband and me a nice letter of thanks and an unrestricted voucher for a year’s worth of round-trip travel anywhere in the United States. Appreciative as we were, we were happy to be of help—and happy not to be responsible for the decision to land or continue.
A flight attendant once told me that over a 15-year career, she had personally delivered two or three babies, had placed a blanket over a man who died of an MI en route, and had talked down many a panicked passenger. But she is always relieved when a nurse or doctor (or PA) answers the call for help. She would prefer to assist!