Yes, There Is a Clinician in the House!
Randy Danielsen’s account of responding to an inflight emergency was interesting (Clinician Reviews. 2011;21[11]:cover, 16-17, 20). I lived and worked in southwest Alaska for eight years during the 1990s. I flew to visit my family in Ft. Lauderdale two to four times each year, mostly with Northwest Airlines, and responded numerous times to onboard emergencies.
A flight attendant told me that in some hunting seasons, they would have an emergency on every flight south. For some of the older “couch potato” types who had been moose hunting, the flight home would be the proverbial last stressful straw on the hunter’s heart.
On one occasion, I spent two hours on my knees on the first-class galley floor with a man experiencing a heart episode. It happened in a leg of the flight from Anchorage to Sea-Tac Airport in which diversion was not a possibility. Thankfully, he survived. Another time, there were two episodes in one flight: an elderly lady had a TIA and a young man (an RN himself) became seriously ill.
I was and am impressed with flight attendants’ abilities and with the emergency kits airlines carry. Northwest had, and I presume Delta still has, contracts with various emergency departments across the country, allowing medical volunteers to speak directly with an emergency physician and evaluate the need for flight diversion.
I have known of medical personnel who refused to acknowledge their presence due to fear of a malpractice suit. My conscience would never allow that, and I was always grateful when there were other medical people on board who volunteered to help with me, regardless of their level of training. I am now semi-retired and work in Alaska on a locums basis. Part of my preflight routine is to fasten my seat belt and offer a prayer that all on board will remain healthy until destination touchdown.
Judith Beach, ANP, BC, Anchorage, AK
I was thrilled to read an account of an “airline save” by a physician assistant. Representing the PA profession so well is something to be proud of. Unfortunately, my experience was a little different.
Five years ago, I was on a plane when the request for a physician was made. I sat back, anticipating a physician would be on board. When the second announcement came, I rang the call button. I explained to the flight attendant that I was a physician assistant and would be happy to help. She hastily responded, “That’s ok, we found a nurse,” and ran to the back of the plane. I was dumbfounded but sat back, as I am not one to force myself in any situation.
As the years have gone by, I have wished I’d had the courage to approach the flight attendant later and explain what a PA is!
Sarah Spelsberg, MS, PA-C, Jacksonville, FL
I had an unfortunate experience during a summer vacation about six years ago at our timeshare on Sanibel Island, Florida. A young man in his early 40s was in the pool with his daughter and friends when he collapsed against the side of the pool. I was very close by, and we lifted him out and rolled him over, soon learning he was without a pulse or respirations.
None of the staff or guests stepped forward to initiate CPR or ask if I needed help until a physician came from another area of the pool. Together, we began CPR in 100° heat. I had initiated a 911 call and requested an AED. The timeshare staff did not have any emergency equipment available, and I was soon told that an AED wasn’t available either.
We continued CPR for nearly 20 minutes before a basic life support (BLS) unit arrived; they attempted to place an esophageal airway and used their AED. Needless to say, there was no response, and it took another 10 to 15 minutes before an advanced life support (ALS) unit arrived. IVs were placed and meds were attempted. They continued their attempts at resuscitation and moved the patient to the ambulance for the 30-minute ride to the nearest hospital, where he was then pronounced dead.
After the situation was over, the security manager for the timeshare (which is a very large organization and houses several hundred guests at any time) pulled me aside and told me that he was new in this job and had requested AEDs, but the request had not been honored. He hoped that I would write a letter to the management to state the dire need for emergency equipment and training on behalf of the staff.
I did send my concerns to the upper management of the organization, noting that the timeshare is 30 to 40 miles from the mainland, with only one ALS unit and two BLS units on the island. Though I never received any feedback, I asked the next year what the emergency plan was and where an AED was located. I was happy to know that they had a plan in place and that trained personnel were assigned for just that purpose, with an AED on their golf cart.
The young man was a survivor of 9/11 as a firefighter who responded to the towers with his unit. It had taken him a few years to muster the ability to get on an airplane for a family vacation.
Sometimes it takes a fatality to put the gears in motion, sad to say.
Fran Newman, FNP, Newport News, VA
Your story of the inflight emergency reminded me of my encounter. Several years ago, a similar call was made for a medical person. I also identified myself and visited the patient in the back of the plane. He was Spanish-speaking, coming from the Dominican Republic, but I had learned Spanish so did not need a translator (which makes history taking much better).
He complained of back pain and headache. His blood pressure was 190/130 mm Hg. No history of treatment; he was tachycardic and boisterous. I assumed that his aggression was a mental status change due to elevated blood pressure. I asked if anyone on board had nitroglycerin sublingual tablets; two people volunteered theirs. I administered one tablet and rechecked his blood pressure five minutes later, at which point it was reduced to 110/90 mm Hg. His back pain had subsided, and his behavior calmed. During this time, I used up three canisters of oxygen at 3 L/min.
The fun part was that I visited the cockpit of this 757 to communicate with the medical personnel on the ground. The plane was flying itself, with the pilot and copilot merely monitoring the systems and constantly writing things down.
I didn’t feel the need to divert because I didn’t think the patient was having an MI. I was initially concerned about aortic dissection, but the dramatic response of the blood pressure, the patient’s mood and otherwise normal vital signs (pulse was regular and decreased from 120 to 88 beats/min), and resolution of the back pain helped me to rule it out. Just as in Dr. Danielsen’s case, when we landed, the medics came on board and whisked him off.
I was rewarded by the flight crew with a bottle of champagne. I was also upgraded to first class, where I had a lively discussion with my fellow passengers about the physician assistant profession. This memory is priceless; I only wish I could have known the outcome and final diagnosis. And yes, I documented every single thing that I did and turned it over to the medics.
Lincoln Allen, RPA, Bronx, NY