Is there a doctor on board?

Source: flickr

Imagine you’re a doctor flying back to the US from Singapore with a medical colleague. Shortly after your first class lunch, the Korean man across the aisle groans and regurgitates his meal. The flight attendant announces: “Could I have your attention, please. Is there a doctor on board?”
Moments later a female passenger also vomits. Both the man and the women have a nasty rash. You consult your colleague — who happens to be your boss – and she fears this is an outbreak of meningitis and soon the whole plane will be infected. Next thing you know, your boss is vomiting and is positive for a rash. Three more passengers follow suit.
You perform a tricky, in-flight spinal tap, with crude equipment, on the Korean man. Your conclusion: The sick passengers are suffering from mass hysteria. It’s not meningitis. But the Korean man is still extremely ill.

What diagnosis would fit the symptoms? He could be a drug courier who swallowed cocaine-filled condoms, only to have them burst in his digestive tract. The only way to save him is to operate.
Searching the passengers, you find someone who admits to having a small ceramic knife that made it through security. With the Korean patient on the floor, a 12-year old boy presses down on his shoulders. The patient’s pain is relieved by the pressure. This tells you the problem is not cocaine.
Brilliant diagnostician that you are, you whip out the man’s wallet and find a receipt from a scuba diving rental supply store. The patient has the bends. You instruct the pilot to descend to 5,000 feet as quickly as possible. The patient recovers. The rest of your flight is mercifully uneventful.

How common are in-flight medical emergencies?

If this sounds a bit dramatic, that’s because it’s from an episode of House, MD. But there are in-flight medical emergencies every day, as many as 350 worldwide. Another way of looking at the numbers: There’s one medical incident for every 1000 to 1400 departures. One out of 5000 flights are diverted to an unscheduled landing due to a medical emergency. The chances of a fatality are estimated at one in a million.
The most common medical emergencies in flight are fainting, loss of consciousness, stomach upsets, respiratory problems, heart problems, seizures, and musculoskeletal problems such as strains, sprains, and fractures.

Be prepared: Airlines anticipate medical emergencies

The chances of there being a doctor on your flight are 85 out of 100, according to one survey. That’s the same as saying, for every 118 passengers, chances are one will be a medical professional.
The airlines have anticipated the possibility of going it alone, however. Since 2004, commercial airlines have been required to carry enhanced medical kits, including automated external defibrillators. They’re also required to train the flight crew on the use of medical equipment.
Airlines are also prepared to communicate with medical professionals on the ground. Northwest Airlines has an arrangement with the Mayo Clinic for emergency consultations. American Airlines has an in-house, full-time medical staff. United employs about a dozen doctors who take turns being available 24-7.

The Good Samaritan doctor

If there’s a doctor on board, you can be reasonably certain that he or she will volunteer to help. It’s part of the ethics of being a doctor. “That’s our technical obligation and part of the public’s trust in us – that we will respond as best we can,” according to Dr. Priscilla Ray of the American Medical Association.
The conditions during flight are not ideal for practicing medicine, which increases the risks. At 8000 feet, the level of oxygen in the cabin is about 75% of normal, which exacerbates respiratory and cardiac difficulties. There are Good Samaritan laws that can protect doctors from lawsuits, but there have been in-flight emergencies that end up in court. It’s an unfortunate fact of life for doctors in a litigious society such as ours.
Airline staff are expected to check the credentials and ID of a Good Samaritan doctor. If this hasn’t been done, and you’re the stricken passenger, you’re advised to ask about the doctor’s “training, credentials and experience if information isn’t offered upfront.” That certainly makes sense, but in the heat of the moment, and with time at a premium, you’re apt to be distracted by the urgency of your distress. Perhaps the following real life incident will help you – or an alert traveling companion – be a little wary of just any old doctor who offers to help.
Two women had become ill on a flight from Quebec to Paris. Dr. Coopersmith, a Canadian physician on the flight, had attended to both of them and then returned to his seat. There was a second doctor on board who also became involved with one of the women. Dr. Coopersmith was aroused from his sleep by the flight attendant: “She was uncomfortable with the behaviour of the doctor who was tending to the other unwell patient – and who was preparing an injection to give to the passenger. On seeing Coopersmith approach, the other doctor, apparently angry, tossed the syringe into the cart and returned to his seat.”
Perhaps there’s a kernel of plot here for yet another TV medical drama.
Related post:
Fear of flying: Will I catch swine flu on an airplane?