Is there a doctor on board? The midair emergency call medical professionals dread | Air transport

BRitish Airways Flight 032, bound for London, was still on the Hong Kong tarmac when Professor Angus Wallace heard the announcement from passengers feared by many doctors: “If there is a doctor on board, could they make themselves known to the cabin crew.” »

Wallace, then head of orthopedic surgery at Queen’s Medical Center in Nottingham, answered the call, as did Dr Tom Wong, a medical resident at the time.

It was 1995; the two men were asked to assist Paula Dixon, 39, who had fallen from a motorbike while heading to the airport. The problem appeared to be bruising and a potentially fractured right forearm, which doctors splinted after takeoff.

But an hour into the flight, Dixon developed chest pains and his condition began to deteriorate. Doctors diagnosed him with a potentially fatal tension pneumothorax – a collapsed lung caused by air trapped in the chest cavity – and possibly rib fractures.

They couldn’t receive immediate advice from ground staff, so Wallace decided to operate. The plane’s medical kit contained a urinary catheter and lignocaine, a local anesthetic, but “that was where the routine equipment ended,” Wallace later wrote.

The duo’s in-flight improvisation has since become legendary in medical circles. They “prepared heated towels for sterile curtains”, made a check valve from a water bottle with holes punched in the cap, and used part of a coat hanger, sterilized with “five star brandy”, to insert a tube into Dixon’s chest, releasing the trapped air.

“Within five minutes the patient was almost completely recovered,” Wallace wrote in the British Medical Journal. “The patient remained seated in her passenger seat and settled in to enjoy her meal and in-flight entertainment.”

In-flight medical emergencies are not common: around one in 604 flights, according to an American study, or a rate of 16 incidents per 1 million passengers. The vast majority, according to Lufthansa data, occur on international flights. Deaths on board are even rarer: around one in 3 to 5 million passengers.

“All these people are looking at us”

But those statistics may be little comfort to a doctor awakened mid-flight by a request for assistance, as was the case for Matt, who was flying from Brisbane to Canberra almost a decade ago when a man at the front of the plane collapsed.

Matt, who asked to be identified only by his first name, was urged by his father to help him, although he was only an intern – a doctor in his first year of paid work. “When I arrive, he is out of breath, but he talks to me. I do an initial assessment and I feel the pulse, but it is quite weak,” he remembers.

The flight attendant asked Matt if he thought they should divert the plane to Sydney, which would cut several minutes off the flight time. “All these people are staring,” adding pressure to “at least pretend to know what I’m doing,” he says.

The man’s heart rate was extremely slow, suggesting a potential cardiac cause, but he appeared “pretty safe” – conscious, talking and not complaining of any chest pain. “I don’t know what’s wrong,” Matt told the crew, “but I don’t think five minutes will make much of a difference.”

The plane landed as planned, was met by paramedics on the tarmac and the man was safely taken to hospital. The airline staff gave Matt a bottle of wine as a thank you. “They had white or red, and being an intern, I was like, can I have both?” (They nodded.)

Matt remembers being given something that looked like a “toy stethoscope” when he asked the crew what medical equipment was on board. For years, Australian doctors have complained that the equipment carried by airlines is not standardized.

Under current Australian regulations, planes carrying more than 30 passengers for more than an hour must carry emergency medical kits – but the contents of those kits are “at the discretion of the operator”. Ian Hosegood, executive director of safety and health at Qantas, says the airline’s planes all carry first aid kits, defibrillators and emergency medical kits.

“We carry equipment well above regulatory requirements – from Narcan and EpiPens to antibiotics and advanced respiratory tools – so our teams are prepared for any eventuality,” he says.

“Our crew handles a wide range of in-flight medical situations, including cases where the right equipment and training make a real difference,” says Hosegood. “On a long Pacific flight, for example, a passenger suffering from severe pain due to urinary retention was treated on board using a simple device from our medical kit, which saved us from being diverted.

“Passengers have suffered cardiac arrest mid-flight and have been successfully resuscitated by our crew using CPR and a defibrillator, often with the assistance of a volunteer on-board doctor. »

Four hours into a flight to Canada from Australia – “far enough that I really didn’t want to turn around” – a woman across from Justin*, an emergency room doctor, had a seizure and lost consciousness. His wife immediately offered to help him.

Two other medical professionals came to help, including a young doctor. “They were very stressed,” Justin recalls, and they deferred to him after exchanging specialties.

The woman was fine after regaining consciousness – she had forgotten to take her epilepsy medication. After providing information to medical staff on the ground via satellite phone, the remainder of Justin’s flight was uneventful.

Legal stress

In Australia, off-duty doctors have a professional duty – but no legal duty – to assist in an emergency. If they choose to help, they are protected by law from civil liability if they act in good faith.

Despite this, there is an understandable reluctance to provide in-flight assistance, particularly on international flights where jurisdiction is less clear.

“There’s always the stress of the forensic side and the stress of the fact that it’s something important,” Matt says. He’s heard of doctors deliberately having a glass or two of wine at the airport or at the start of a flight, so they can say, “I’m under the influence, I can’t make a decision, I don’t want to be involved.” »

He says: “If you don’t have a specialty in critical care – for example, you’re a psychiatrist – you probably wouldn’t have done critical care work for a very long time. The risk you’re willing to accept is probably the most important thing – it’s a completely unfamiliar environment.”

In the unlikely but feared event of death at 10,000 meters, what would happen for the rest of the trip? Last year, a distressed Australian couple described being on a flight during which a woman collapsed and died. The husband sat next to her body, covered in blankets, for several hours.

The International Air Transport Association’s guidelines for onboard deaths suggest moving the body to a seat “with a few other passengers nearby,” or returning it to its own seat if the plane is full. It is recommended to restrain yourself with a seat belt, as well as to cover the body with a body bag if there is one, or a blanket if not.

If you were to have a medical accident in flight, you couldn’t hope for better luck than Dorothy Fletcher. In 2003, Fletcher, then 67, had a heart attack while flying from Manchester to Orlando, Florida, for her daughter’s wedding. When the call for help went out, no fewer than 15 cardiologists, on their way to a cardiology conference, stood up. She spent two days in intensive care upon arrival, but recovered in time to attend the wedding.

*The name has been changed