"Is There A Doctor On Board?" This Time, There Was

June 28, 2013

As a physician, you are always on the job; even on your flight to a family vacation in Florida when a medical emergency occurs.

Earlier this month, my family and I decided to take an early summer weekend trip to central Florida to visit our relatives. My two daughters had just finished the school year, and as promised to them if their grades were good, they were promised a trip to visit their aunt and uncle in sunny Florida. As we boarded the airplane for a direct flight, my children were very excited to be going away for a few days.

Shortly after the plane reached cruising altitude, I noticed a very obese woman sitting across the aisle from us seemed to not be feeling well. The person sitting beside the woman was using a magazine to try to calm her down by fanning her. I then noted the flight attendant going over to check on her. I heard the passenger beside the woman tell the attendant that she was not feeling well and thought she was going to pass out. At that time, I elected to make it known to the crew that I was a physician and was happy to check on her if needed. I was quickly given permission to assess the woman's condition.

The crew brought me a medical kit that consisted of a stethoscope and a blood pressure cuff. Unfortunately, the woman was very obese and the cuff was not large enough to get an accurate blood pressure measurement. As I questioned the woman about her condition, she informed me that she was short of breath and felt nauseated. I asked the crew to make oxygen available to the woman, thinking that she was possibly having a vasovagal episode. I continued to question the woman about her condition and it was at that time that she informed me that she felt a pressure in her abdomen moving into her chest. I quickly looked in the medical kit and found the routine medications that could be used for an ACLS emergency. I had nitroglycerin available, but since I was not able to get an accurate blood pressure and could only palpate a very weak and thready carotid pulse. I was fearful to use nitroglycerin.

I found a bottle of aspirin and gave a tablet to her and asked her to chew it up and swallow. Shortly before using the aspirin, she became very diaphoretic and clammy. She then told me that she was having a sharp pain in her chest and was feeling very nauseated and was about to vomit. At this point, I was very concerned regarding her condition and informed the crew that she needed to be transported to a hospital as quickly as possible. In just a few seconds, the plane changed course and we started our descent. Once we had landed, the EMS crew and police department awaited our arrival into the gate. I assisted the woman into a wheelchair and helped transport her off the plane.

Once she had left the plane, the crew came to me a few minutes later and informed me that she was on the way to the hospital and that her condition was stable. As we sat at the gate and awaited takeoff, I reflected on the recent events. The condition of the woman and the limited history I was able to obtain led me to conclude that she very likely had a myocardial infarction during our flight. I have been a physician for almost 13 years, and fortunately had never before been asked to provide emergency services to an ill person during a commercial flight. I am hopeful that she ended up doing well and that she was able to get to a hospital rather quickly after her condition became critical. It would not bother me at all if I am able to go another 13 years - and hopefully longer - before I have to act in a similar situation for an ill person during a family vacation.

In a situation such as this, I felt that I acted appropriately and assisted the woman to the best of my abilities with the limited equipment available on the airplane. In retrospect, it would have been nice to have had a larger blood pressure cuff, a pulse oximeter, and other equipment to more appropriately assess her condition. Unfortunately, I do not know the woman's name, nor do I know the final outcome of the events after she arrived at the hospital.

I am hopeful that she ended up doing well and hopeful that once her condition was treated that she was ultimately able to finish her trip to Florida.