Health Crisis On a Plane

Is there a doctor in the…air?

In movies, television shows, or perhaps in real life, we’ve all probably heard somebody frantically ask this question:

“Is there a doctor in the house?”

A while back, I was in that situation. My wife and I were on a transatlantic flight when a passenger fell into a coma. Since I’m a doctor, I rushed to her side. I soon learned she was diabetic and had overdosed on insulin. Although I’m a neurosurgeon and her situation was outside my specialty, it was a pretty basic medical emergency: get glucose into her system STAT.

Her glucometer read 20- a dangerously low blood glucose level. If it didn’t get up to the 80-100 range fast, she might die. Normally, I could have given the woman a sugary drink, but she was unconscious.

Step one was to get the medical kit, which is standard equipment on all commercial aircraft. The kit on this flight, however, was poorly stocked. It should have had an IV bag with glucose (sugar water), but it only had one with normal saline..., and another vial of glucose separately. Time to improvise.

Luckily, there was an anesthesiologist on board who placed the IV and gained access to the woman’s bloodstream. I grabbed the glucose vial from the flight attendant and made a hole in the IV bag, and poured the glucose into the saline. The makeshift solution worked; after about a quarter of the sugar water bag got into her bloodstream, the woman awakened.

The threat of death was averted, for now. But there was only one IV bag, and it was rapidly approaching half empty. We adjusted the rate as best we could but there was no IV dispenser so we were just eyeballing it.  I alerted the crew that the situation would become critical again soon, and that we had to get her to a hospital without delay. That meant getting to the closest airport and medical center.  But we were in the middle of the Atlantic!

Initially I felt some pressure from the pilot to forge ahead to JFK airport.  We were already beyond the halfway point.  He was reluctant to immediately consider other alternatives. When I said that I wasn’t sure really how long the IV bag was going to last and we could have another emergency on our hands if we ran out of the sugar water, he divulged to me that there was a closer airport and medical center which was in Halifax, Nova Scotia. I was surprised that he initially balked at my recommendation to divert the flight.   He clearly was putting pressure on me to stay the course with statements like “The patient is better now, right? Are you sure we need to divert?”

Fortunately, I stuck to my guns and said we still had an unstable situation on our hands. But given the recent events in the media, I could see where a more tentative person, or even me if I was pushed hard, may have caved in to the pressure and acquiesced to the Pilot’s preference to keep the plane on course to the intended airport.

After a few more “Are you sures?”, the pilot agreed and we got the woman back on the ground. Fortunately she made a great recovery. But the aftershock of that pressure stayed with me.  And the first time it has surfaced was when I saw the article below.

That’s why this Bloomberg Article about a man who was suing an airline captured my attention. On a flight from Chicago to Rome, the man had suffered an attack of acute pancreatitis. A physician on board said it was urgent for the plane to land so the man could get treated, but his recommendation was ignored. The captive passenger spent much of the flight curled into the fetal position on the floor as he suffered through bouts of vomiting. And that was only the beginning of his ordeal. After the flight was over, he was laid up in hospitals for three months.

This case is extreme, but hardly unique and it’s quite possible that the best option was to forge on (not all the details of the case are available to the public). However, there have been many reports of passengers having a medical crisis that was not handled properly while airborne. Based on these unacceptable episodes and what I experienced myself as a doctor in flight, I want to make two important points:

1. Flight attendants receive training in basic emergency care, and can contact ground-based medical consultants for advice on how to handle a health crisis during a flight. I’m sure this advice is generally solid, but it’s no substitute for a healthcare professional at the scene who can deal with an afflicted passenger directly. Of course, they should put the brakes on well-meaning but perhaps ill-informed passengers who want to help. But heeding the advice of an on-board expert in real time could make the difference between life and death.
2. There should be insurance policies for airlines that provide compensation for flight diversions resulting from medical emergencies. Since diversions are rare, such a policy would be well worth it. (How rare? According to a 2013 study reported in the New England Journal, medical emergencies occur in only one out of every 604 flights. Only 7% of those emergencies resulted in diversion—although, perhaps more should.)

Airlines should be thankful when they have a doctor on board during a passenger’s health emergency. There’s no good reason to bypass this invaluable “safety belt” when time is of the essence. Diversions may be costly, but you cannot put a price on a human life.