Stepping Up in the Sky
"I figured that the passenger would be an adult and there would be people more qualified than I was to help," Dr Tanz recalls. Goaded by his teenage daughter, Dr Tanz went to help, as did a pediatric endocrinologist also on board.
To their surprise, the patient was a child with a peanut allergy who was in respiratory distress. The child's emergency medications were in the family's checked luggage and, although the airplane's medical kit included an epinephrine autoinjector and an albuterol inhaler, the crew and physicians—flying in the near aftermath of 9/11—lacked scissors to cut open the shrink-wrapped packaging. In the end, the two doctors were able to help the patient with an inhaler and epinephrine injector supplied by other passengers.
"Later when we landed I found out that at least three other passengers on the flight were physicians," he says. "They all had excuses for not getting involved. One was a pathologist who didn't think he could help. One was a retired internist."
As a result of that experience, Dr Tanz says he no longer hesitates to get involved and has twice responded to in-flight emergencies involving adults suffering cardiac symptoms. In the first case he was able to step away as a better-trained cardiologist likewise responded. In the second, he and a psychiatric nurse administered aspirin and oxygen and monitored the patient's vital signs while communicating with physicians on the ground. The flight was given priority landing status and paramedics took the patient to the hospital. Dr Tanz doesn't know what happened to the man.
"I'm sure I'm not the right person to help without assistance from the ground for many situations," he says, "but I still have basic knowledge and can follow medical direction better than an average person if needed."
You Are Not Alone
That's exactly the message that physicians who provide on-ground emergency support to airlines want medically trained passengers to understand.
"The first thing that flying physicians need to know is that they are not alone," says Dr Martin-Gill, who works for UPMC, which contracts with 20 airlines to provide medical consultation services. In the air, he says, the first responders are the flight attendants, who the Federal Aviation Administration (FAA) requires to have training in basic first aid, cardiopulmonary resuscitation (CPR), and the use of an automated external defibrillator (AED). In addition, US commercial carriers and the vast majority of international airlines contract with organizations like UPMC to provide emergency medical support from the ground.
In the event of an in-flight emergency, different airlines follow different protocols, depending on their culture, says Dr Paulo Alves, global medical director of aviation health for MedAire, an International SOS company that provides in-flight medical support to about 60 airlines. Some crews will call supporting physicians on the ground before seeking assistance from healthcare providers on board, while others will first ask for passenger volunteers. Whichever approach the crew takes, on-board physicians should know that trained physicians on the ground are generally available if needed.
"I'm a frequent flyer and I've probably handled 15 cases while flying myself," says Dr Alves, a cardiologist. "But that doesn't even scratch the surface of the experience of one of our supporting physicians who may have handled literally a thousand of these."
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Shelly Reese. 'Is There a Doctor on Board?' Keeping Quiet vs Stepping Up - Medscape - Sep 17, 2015.
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