What happens when you are the doctor on the airplane?

I have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible.

For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the necessary action (Is not going to be easy with such limited capabilities, sometimes is just impossible, but is better an overreaction), is important because commercial planes fly at 8 NM/minute, and depending where are you flying ( flying over the ocean or africa) 10 minute delays could mean another 30 extra min to land or even several hours if you have passed a no return point in the middle of the ocean.

Don´t hesitate to take control of the situation regarding the patient, stewardesses and other passengers:

- Ask for the medikit (only physicians are allowed to use it). I have seen some chief stewardess resisting to bring it, just to avoid having to write the compulsory report. - If it is necessary to lay the passenger on the ground or other seats, bring him water or any other thing, just give the needed orders and ask for help. - Ask the stewardesses to keep other passengers away if they are interfering too much. - As soon as practicable give a report to the captain and if necessary ask him to land the plane. He will be waiting for it. - If possible never declare a decease onboard , first you could be wrong!, and it is a bureaucratic mess. Is better to keep trying CPR till the emergency team can take care of the patient. We apply this in Europe although it is not a written rule, I don´t know how it works in USA. -Remember when in doubt it is better to ask the captain to land. Everybody will lose an hour or two but a live will probably be saved.

If you are interested in medical "hacks" on long-distance flights, the award has to go to two doctors who were on a 1995 British Airways flight from Hong Kong to London when a patient had trouble breathing. They determined that the patient suffered a collapsed lung, so they made an incision in her chest, and used a coat hanger, brandy, and a tube from a medical kit to drain the lung. As I recall the story, there was also a nurse who assisted but I can only find the AP story which references the two doctors.(1)

I also have a relative who is a doctor/med school professor who does a lot of traveling, and has had to assist the crew three times with in-flight emergencies. One was a heart attack, one was deteriorating condition of an unknown cause (the flight was diverted to evacuate this man) and the third was a guy who had intense bladder pains mid-flight which turned out to be the result of downing a huge quantity of beer before the flight and being unable to urinate.

1. http://news.google.com/newspapers?id=ZBxOAAAAIBAJ&sjid=p...

I can't find it now, but my favourite 'doctor on a plane' story was from an anesthesiologist who struggles to sleep on a plane, so on a long haul flight took something to help him doze off. He woke up to the 'is there a doctor on the plane?' call, and called the flight attendant over. It turned out that he was the person that they wanted to attend to, they were concerned since he was passed out and drooling on the passenger next to him.

My dad, an electrical engineer, was once on his way back from a conference with a Concorde flight full of other EEs. In the air, the stewardess asked, "Is there an engineer on board?" Everyone responded enthusiastically. She was forced to clarify, "Is there an aeronautical engineer on board," to disappointment all around.

I must admit, some secret part of me always hopes I'll be in a situation on an airplane where they need an emergency perl script written . . .

The medical director of my paramedic program used to work for a hospital that provided medical control for a number of major airlines (generally speaking, even when they ask for a physician on a plane, they're also calling the airline's 'on call' doctor as well).

His scariest stories weren't due to the criticality of the patient, but rather the incompetence of the provider on board the plane (to the point that he, on several different occasions, had to instruct the flight crew to 'please keep him away from the patient for the rest of the flight'). Just because someone is a 'doctor' doesn't necessarily mean they're well equipped to handle a medical emergency (note: the physician interviewed here managed the patient perfectly appropriately).

It's possible he was just pandering to the room of soon-to-be paramedics at the time, but he said he generally instructed the flight crew to ask for a paramedic before a physician, simply because they're generally more comfortable working in the 'austere' medical setting found on a plane.

My wife is a surgeon; while we were flying to Morocco last spring, a man on the plane accidentally put himself into a diabetic coma. A nurse was sitting next to him and thought that he was having a heart attack. The attendants called for a doctor; my wife recognized the actual issue, and revived him by rubbing honey on the inside of his mouth and gums (the onboard medical kit had nothing of use beyond rubber gloves).

The other passengers on the flight actually did applaud her, which was cute, but I think they mostly did it because it meant that the flight didn't need to be diverted to Heathrow.

Okay, I'll share random doctor flight story - last week some family friends were flying to Hawaii for vacation, and a man across the isle said he had been on vacation for several weeks and didn't bring enough heart medicine. He said he would just get some more when he got home, but halfway through the flight he slumped down in his chair, unresponsive. There was a doctor on the flight that used a stethoscope to find there was no heartbeat. (Not sure if the doctor had his own stethoscope or if it was in an on board kit.) The doctor just looked up at the flight attendant and shook his head. Luckily, this flight was not to Hawaii. It was just a layover from Houston to LAX, so they were able to land in Phoenix to have a medical response team take the passenger off. Apparently when they took him off, they didn't use a board or anything - one man grabbed his wrists, another his ankles, and they carried him off, but they couldn't completely lift him so his butt was dragging on the floor down the isle. I thought that was a little weird.

Also, is it legal to just put a blanket on the guy, pretend he's sleeping, and then deal with it when you get to your destination? Our friends missed their connecting flight to Hawaii in LAX because of this ordeal.

My wife was on a flight from Taipei to LAX when they called for a doctor. She didn't see whether or not a doctor responded, but there were no further calls or announcements after that. Later when she went to the bathroom she saw a body bag on the floor near the bathrooms. When the flight arrived there were police waiting. Nobody could leave the plane until they were done with the body. No details were given to any of the passengers.

I'm curious if insulin is a standard part of the medkit. I was on a transatlantic crossing once with a coworker who went into diabetic shock (that's another long story).

A nurse was onboard the flight but no insulin. We had to divert and my coworker was laid up in a Newfoundland hospital for 3 days.

This happened once to my father on a flight. He's an orthopedic surgeon (the woman in this story really hit the jackpot with an a anesthesiologist--the only thing better would be an ER doc, I think), and someone was having chest pains. He determined very quickly that it was not a heart attack or other critical condition, but through the whole ordeal, the passenger next to the patient (who did not know the patient and had no medical training) kept second guessing my dad's requests and diagnosis. The flight attendants ended up "asking" this other guy to move several rows back to an empty seat.

Everyone's a critic.

I'm a former ski patroller, which is a kind of outdoors EMT / paramedic. Once, on a flight from Seattle to Boston (for a YC interview!) I walked to the aft bathroom only to find a young woman who had collapsed there, still prone and lethargic, with a stewardess standing over her with a look of annoyed disgust. An evaluation indicated she was probably just dehydrated, so I had the still-annoyed stewardess bring her water, which revived her. (Of course I recommended that she see a doc when we landed just in case, but I doubt she did.) After an hour or so we were able to get her back to her seat. The rest of the flight was uneventful. The only thing that never added up was the bizzare attitude of the stewardess.

(edited: semi-conscious -> lethargic)

I have one question regarding the question: "Did you end up getting sued?"

Why would the doctor get sued? Why would that question even be asked? I didn't feel like any type of catastrophic event happened to merit a lawsuit.

I just want to tell you both good luck. We're all counting on you.

An interesting interview. I wonder if he gets upset if people call him Shirley?

I was flying transatlantic with a friend who has a medical degree when they called for a doctor.

There was an older fellow who had a heart condition for which he was taking medication. His reasoning had gone something like "I need to take one of these pills four times a day, but I'll be traveling, so I'll just take all four of them right before checking in". Needless to say, this didn't work very well, and he was having sort of issue with his heart as a result. The poor guy was so scared he literally shit himself.

My friend actually had to make the call whether we needed to land on an airport in Greenland to get the guy to a hospital. He thought about it for a minute and decided that the guy was going to live, so we continued to Amsterdam, where an ambulance was waiting.

As a "thank you" from KLM, my friend was allowed in the cockpit during landing (this was before 9/11), and he got a bag full of little bottles of alchoholic beverages. Unfortunately, he's a teetotaller.

Everytime I have seen a doctor call on airplane it was either an allergic reaction to food, or some guy who opened his duty-free bottle on the plane and had a little too much fun.

Cool story.My girlfriend is a flight attendant. I hear a lot of stories from her and it is very common to ask if there are any doctors on the plane. What crazy is that people in-flight non stop (we just don't hear about it). Anything from heart attacks to other health problems, even just because they are old.

Sometimes they will put a blanket over the body, sometimes they will pretend that the person is sleeping. Depending on the situation.

I don't really get into the details but that's the scoop.

=)

I used to work with a consultant paediatric neurologist who had the call go out on a trans-pacific flight for a heart problem. She was hesitating before responding because the last time she had anything to do with hearts or adults was in medical school 20 years earlier, and was frantically running through what she could remember of cardiac medicine. Just as she made up her mind to respond she was beaten to the response... by a cardiologist.

This was a very interesting article, given that I just experienced something similar.

Flight from SFO -> IAD last week. As soon as we took off, they asked for a doctor. He spent 2 hours treating the patient before they started drink service, and continued until we landed. We were all quite worried about the person, but found out at the end of the flight that they had overdosed on NyQuil. That made the whole ordeal fairly frustrating.

"The medikit was actually really comprehensive ... that contained ... even morphine."

I am surprised that it contained morphine. Pain killers would not help much in resolving whatever medical issue is occurring.

Besides, is it not dangerous to report the fact that morphine is available on a flight? Some medkits are easily accessible and can be taken when the flight attendants are not looking.

Oh stewardess, I speak jive.

Here's the google cache version (site is under heavy load) ... http://webcache.googleusercontent.com/search?q=cache:www.coc...

An uncle of mine was in a situation like this once. He was sitting in first class and had to tend to someone in economy class. He decided that it would be best that he stayed by the man he was tending to so my uncle swapped seats with the man's wife. They gave him a bottle of wine for his help but I would have expected something more.

I was half-dozing on a Southwestern flight when a stewardess came on the PA system calling for any physician to identify themselves.

I spoke up, and the crew directed me toward the back. They already had this incredible medical kit opened in the aisle. I mean they had everything....ACLS drugs, defibrillator, suction, a complete mini-pharmacy, and what looked like a few plastic-7 wound and/or trauma kits at the least. I mean, I was practically drooling over this high-tech kit.

Of course, it was also at that moment that I started frantically running through cardiac code algorithms in my head, and pondering exactly how long it had been since I'd actually dealt with a code in a hospital, with plenty of trained staff, lab support, etc.

Of course, it wasn't any kind of life-and-death situation at all - a young person very stressed and anxious about relocating and the actual conditions of the flight, who'd been hyperventilating, hadn't eaten or had anything to drink for many hours, near-syncopal, etc etc.

I tried my hardest, but couldn't think of a single thing to use out of the medi-kit. I wanted to use it.

I just sat down next to her and listened, which is 90% of medicine anyway.

Southwest was great - gave me two round-trip tickets to anywhere for taking a few minutes to talk.

A colleague at University of Hawaii wrote a paper about dealing with psychiatric emergencies in the air. One thing that stuck out in the paper was the interesting phenomenon of what he called "honeymoon psychosis", with one of a young newly married couple away from home for the first time, possibly on their first flight, all leading to some interesting disturbances on those long pan-Pacific flights.

I'm confused. Why is this on HN?

Unreadable on mobile (pre text or something preventing reflow). And no byline or date, so completely useless. Fuck off basically.