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Friday, March 11, 2016

Is there a doctor on board?

I have done a fair amount of flying over the years and never encountered any major issues except for some light turbulence but nothing like the recent Spirit Airlines brawl that broke out yesterday. However, that all changed last month on a short flight to Vegas for a quick getaway.

My husband and I were relaxing and about midway on our 4.5 hour flight from Detroit (DTW) to Las Vegas (LAS) when I was awoken to the overhead lights being turned on and the announcement of "Is there a doctor on board" over the intercom. As my mind was still waking up and trying to process what was going on my spouse next to me was nudging my shoulder telling me I needed to go help (since I am an internal medicine physician). At first I hesitated thinking to myself surely there must be another physician on board that is closer to the woman lying on the ground and more experienced than I am but then no one jumped up from their seat so another overhead announcement was called asking for ANY medical personnel on board for assistance. At this point I rushed over the the woman at the front of the plane trying to navigate around the small crowd that was starting to form in the aisles trying to get a glimpse of what was going on. When I arrived to the woman she was conscious and able to tell me that she had gotten really lightheaded when she went to stand up to go to the bathroom and just collapsed to the ground. I asked the flight attendant what medical equipment was available on board and she told me that they had a basic first aid kit, some basic drugs such as aspirin and nitroglycerin, an AED, and portable oxygen. I was able to check her blood pressure which was normal and she ended up doing just fine after this but the whole experience started to have me question exactly what the standard policies and procedures were for medical emergencies in flight and what equipment and supplies aircrafts carried.

Standard airline emergency medical kit (EMK)

Taken from
It appears most planes (at least US carriers) are required to carry a basic first aid kit which contains items such as bandages and splints, portable oxygen bottles, at least one automated external defibrillator (AED), along with an emergency medical kit (EMK) which is envisioned more for use by doctors. The contents and quantity of equipment is carefully regulated by the Federal Aviation Administration so its pretty universal. The EMK contains drugs and equipment a paramedic or above would be familiar with such as a stethoscope, blood pressure cuff, bag-mask resuscitator, oral airways, nitroglycerin (at least 10 tablets), aspirin (at least four tablets), albuterol (one metered-dose inhaler required), dextrose 50% (at least 25 grams), injectable 1:1000 epinephrine for an allergic reaction (at least 2 mg), oral antihistamines (at least four tables), IV antihistamines (at least two ampules) and cardiac resuscitation drugs, including IV 1:10,000 epinephrine (at least 2 mg total), atropine (at least 1 mg total) and lidocaine (at least 200mg total). Five-hundred milliliters of normal saline, an IV drip set and a variety of needles and syringes are also to be equipped. Although not required, many other carriers will also carry additional drugs such an as the antiemetic ondansetron (Zofran), glucagon, nalbuphine (an opiate for pain relief) and naloxone (to reverse opioids).
I also believe flight attendants are required to be trained in basic first aid and CPR including the use of an AED but they should also have access to a ground-based physician via phone in the event that no medical personnel happen to be on board. MedLink is a very common telemedicine service used by many carriers. In the event of a true emergency the pilot will make the final decision of diverting to the closest airport although this can be tricky especially in the case of a transcontinental flight. The most typical case for diversion would be a suspected heart attack, stroke, or seizure. Luckily in my case the situation wasn't a true emergency and the woman did just fine but I'd be curious to know what happens when someone actually ends up dying while in flight. Also its important to point out that since the passing of the Good Samaritan laws in 1998, medical providers are legally protected when providing assistance off duty and in good faith. I was given a $150 travel voucher for my help which was unexpected and greatly appreciated and the flight attendant told me that was the highest gift she could give me in flight. The rest of the trip was uneventful but this was still the first time anything like this happened to me.

Bottom Line

While this was the first time anything like this happened to me I certainly hope it is the last. Luckily the lady was fine and no emergency landing was required but it definitely could have been much worse and I'm sure people have died in flights or suffered serious heart attacks or strokes. I'd be curious to know what happens during true emergencies on trans-oceanic flights or where they place bodies in the event of an in flight fatality.

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