"Is there a doctor on the plane?"

[NJEMT95]

Anyone have any experiences as a passenger on a commercial flight where someone needed medical attention?
Did (or would) you assist as an EMT if there wasn't a doctor?
Would we be given access to the doctor kit onboard the plane?

 

[MMiz]

Here is my experience several years ago.

I assisted as an EMT after noticing no one else volunteered. A nurse came back a minute or two later.

I was given access to the medical kit, I only administered nitro. The kit was well stocked with a variety of drugs.

Afterward they simply wanted to know what seat I was in. I wrote down my seat, contact information, and a brief narrative.

I got a certificate, 5,000 frequent flyer miles, and several extra bags of peanuts.

 

[Summit]

Remember, the cabin is pressurized to an equivalent of 8000ft, so expect vitals accordingly (HR&BP slightly up, SPO2 slighty down from their resting baseliine). The longer the flight, the more likely that any given passenger is dehydrated, drunk, jonesing for a smoke, and whacked out on ambien.

If you need those around you to stop pestering you, put on the childrens-playset stethoscope for the kit and auscultate a BP. Palp it too because you won't hear korotkoff sounds, but people in the nearby seats will probably leave you alone for a minute.

Ask the flight crew for the medical headset. You'll find the airline's consulting OLMC physician on the other end.

The pilot decides whether to divert the aircraft. So, be ready to make a case if you need to.

Oh, and it is almost a statistical certainty that there is AT LEAST one MD or RN on a domestic 737. On any large aircraft on an international route, probably 2 MDs and 3 RNs. But, they are probably drunk, on ambien, or don't speak English. The MD was probably a proctologist anyway.

 

[medicsb]

As an EMT, you're going to be much more limited as to what you can do with the medical kit. As a paramedic, some (all?) US airlines have a way to get you in touch with a physician. I know Univ. of Pittsburgh provides online medical control for a number of airlines and can grant a paramedic medical command to treat a patient on an airline.

I had a roommate many years ago who worked as a flight attendant and I was kind of surprised by what they had on board. If I recall they had IV supplies, fluids, airway supplies including a laryngoscope and ETTs, dextrose, NTG, ASA, epi, and a bunch of other stuff I'm forgetting.

 

[Handsome Robb]

There's a thread around somewhere where our resident flight attendant addressed this exact topic. Where's that bald man when you need him?

 

[TacomaGirl]

Never been in that situation. Never given it much thought either until now.

 

[Drax]

Here is my experience several years ago.

I assisted as an EMT after noticing no one else volunteered. A nurse came back a minute or two later.

I was given access to the medical kit, I only administered nitro. The kit was well stocked with a variety of drugs.

Afterward they simply wanted to know what seat I was in. I wrote down my seat, contact information, and a brief narrative.

I got a certificate, 5,000 frequent flyer miles, and several extra bags of peanuts.

Best happy ending ever.

 

[ExpatMedic0]

Its happened to me 3 times, and luckily every time a doctor has been on board.

 

[DesertMedic66]

I'm not a doctor but I slept at a holiday inn express.

 

[NPO]

These are the current recommendations for airline medical kits by the Air Transport Medicine Committee.

Medications:

Epinephrine 1:1000
Antihistaminic, inj.* Dextrose 50%, inj. 50 ml (or equivalent) Nitroglycerin tablets or spray
Major analgesic, inj. or oral
Sedative anticonvulsant, inj.
Antiemetic, inj.
Bronchial dilator inhaler
Atropine, inj.
Adrenocortical steroid, inj.
Diuretic, inj.
Medication for postpartum bleeding Sodium chloride 0.9% (minimum 250 ml)
Acetyl Salicylic Acid for oral use
Oral beta blocker
List of medications—generic name, plus trade name if indicated
on the item


Equiptment:

Stethoscope
Sphygmomanometer (electronic preferred)
Airways, oropharyngeal (appropriate range of sizes)
Syringes (appropriate range of sizes)
Needles (appropriate range of sizes)
IV Catheters (appropriate range of sizes)
Antiseptic wipes
Gloves (disposable)
Sharps disposal box
Urinary catheter
System for delivering intravenous fluid
Venous tourniquet
Sponge gauze
Tape adhesive
Surgical mask
Flashlight and batteries (operator may decide to have one
per aircraft in an easily accessible location) Thermometer (non-mercury)
Emergency tracheal catheter (or large gauge intravenous cannula) Umbilical cord clamp
Bag-valve mask
Basic Life Support cards
Advanced Life Support cards

 

[AtlasFlyer]

Would we be given access to the doctor kit onboard the plane?

Possibly. But if you're not qualified to use the items, DON'T. (IE, if you're not qualified to do IVs, don't go sticking people. Common sense.)

There are several kits onboard airline airplanes. There are first aid kits, which are your standard boo-boo kits (bandaids, gauze, splints, etc). Those are usable by the flight attendants and anyone else. Then there are the "Medical Kits". Per the rules, those are only to be given to MDs or DOs. However, the captain does have the authority to allow other qualified medical personnel access to the kits, and allow them to use things in the kit in accordance with the individual's level of medical certification. For example, with the captain's and/or MedLink's blessing, an EMT could be allowed to administer aspirin, use the cuff and bag. A medic could be allowed to use the IV supplies.

The decision of whether or not to land immediately/divert to closest airport or continue on to destination is up to the captain. You may or may not be asked to give your opinion on the matter but the decision is up to the CA.

Expect to be asked to provide proof of medical certification to the flight attendant or captain. Also, you are considered to be "volunteering" your services, and may not charge the airline or the patient for your time or services. Yes, the airlines had to actually make that disclaimer because some doctor actually BILLED the airline and the patient for "services". How tacky is that...

 

[wanderingmedic]

JEMS wrote an article about this a while ago. Here it is.

Based on that article, I think I would step in and help if I were needed. If not, i'd go right back to sleep.

 

[NPO]

I generally don't step in unless there's actually something I can do. Compressions as a by standard until ems arrives or keeping someone calm or what ever sure. Beyond that nothing. But knowing what I know now, if I ever find myself on a plane during a medical emergency I may be included to assess the need for intervention, wait for a higher lever practitioner to step forward, and if none, aid if nessicary since they actually have a healthy compliment of tools.

 

[TheLocalMedic]

I dealt with this situation on a flight to Canada a number of years ago...

They asked for anyone with medical training to notify a flight attendant towards the end of the flight. I didn't see anyone else volunteer, so I stood up (with my wife doing a cute little "go bear, go!" cheerleader routine) and was taken to the back of the plane. Apparently someone else beat me to it though, because a guy who said he was a doctor was talking to a guy who was obviously short of breath.

So I let him do his thing and heroically watched... for a while anyway. It was quickly apparent that this guy was out of his depth. He started off strong, taking a listen to his lungs and asking him some questions about his history, but after that he just sort of stalled out. I sort of stepped forward and asked him something like, "So, what do you think?" I mean, the guy was an asthmatic and you could hear him wheezing audibly, so I was hoping to prod him into grabbing the oxygen bottle and the nebulizer that was in the med kit the flight attendant had brought.

Instead he started going off about how he was concerned that the change in altitude may be causing flash pulmonary edema... Which prompted a quick exchange about exactly what kind of doctor he was (presumptuous but necessary, considering that I didn't know this guy from Adam). Turns out he's a medical student.

Needless to say I thanked him kindly for his help and politely slid between him and the patient so I could actually do some good. A few rounds of albuterol later and the passenger was about 100% better, and they put me in touch with a real physician on the ground who pretty much said to do more of the same unless something changed. Best part is we were close enough to Vancouver that we didn't have to diver the plane and we all got there on time.

Airline sent me a nice card with some bonus stuff, which was nice. And I also got to have a neat little talk with the med student about leaving the big boy work to the people with proper training and certification. He was pretty chagrinned.

 

[Danno]

These are the current recommendations for airline medical kits by the Air Transport Medicine Committee.

I'd have to assume theres also an AED onboard right?

 

[NomadicMedic]

AEDs were mandated on commercial aircraft on 2004.

 

[samiam]

I dealt with this situation on a flight to Canada a number of years ago...

They asked for anyone with medical training to notify a flight attendant towards the end of the flight. I didn't see anyone else volunteer, so I stood up (with my wife doing a cute little "go bear, go!" cheerleader routine) and was taken to the back of the plane. Apparently someone else beat me to it though, because a guy who said he was a doctor was talking to a guy who was obviously short of breath.

So I let him do his thing and heroically watched... for a while anyway. It was quickly apparent that this guy was out of his depth. He started off strong, taking a listen to his lungs and asking him some questions about his history, but after that he just sort of stalled out. I sort of stepped forward and asked him something like, "So, what do you think?" I mean, the guy was an asthmatic and you could hear him wheezing audibly, so I was hoping to prod him into grabbing the oxygen bottle and the nebulizer that was in the med kit the flight attendant had brought.

Instead he started going off about how he was concerned that the change in altitude may be causing flash pulmonary edema... Which prompted a quick exchange about exactly what kind of doctor he was (presumptuous but necessary, considering that I didn't know this guy from Adam). Turns out he's a medical student.

Needless to say I thanked him kindly for his help and politely slid between him and the patient so I could actually do some good. A few rounds of albuterol later and the passenger was about 100% better, and they put me in touch with a real physician on the ground who pretty much said to do more of the same unless something changed. Best part is we were close enough to Vancouver that we didn't have to diver the plane and we all got there on time.

Airline sent me a nice card with some bonus stuff, which was nice. And I also got to have a neat little talk with the med student about leaving the big boy work to the people with proper training and certification. He was pretty chagrinned.

Being a medical student myself, its not fair to make that generalization and frankly I am a little offended by the way you handled that situation. Obviously it depends on how far through medical school he was but once we have gotten thru the first year we have hit anatomy, phisio, pharm and Physical Diagnosis (Basic Clinical Medicine type stuff History, BP, Cardiac, Respiratory Exam, Iv's etc.) as well as many more. At that point we have more training then an EMT. If he was any further through like say 3rd year he would be well beyond a paramedic training wise. We also go to the hospital and host community clinics 1st thru 3rd before actual clinicals. Obviously he might not be 100% confident in what he was doing but he was probably thinking at a higher level then you were. We are taught to think third order and think critically beyond symptoms and appropriate responsive protocols. Granted If I had been in that situation I would have made clear that I was a medical student to the flight attendant and that I was confident in doing a initial assessment and relaying that to a ground physician and going from there. I would be comfortable acting as an extension of the ground physician assuming I was not doing anything invasive. With those symptoms I would automatically go to asthma with a ddx of COPD Bronchitis or CHF (Hopefully he would not be flying in the late stages of CHF). Many of us including my self have BLS and ACLS certifications as well as WFR etc. I think the way you handled the situation was a little condescending and a more appropriate response would have been to introduce yourself and work together. Assuming you were more qualified it would have been a good teaching/learning opportunity for you and the med student and would have achieved the same result for the patient with out embarrassing the med student who was trying to help. Since you got there so early you cannot assume he would not have handled the situation appropriately in that he would have provided care with out contacting a ground physician etc. Just some food for thought.

 

[MedicJon88]

I agreed that instead of brushing off the medical student abruptly in that instance- it could have been a learning experience for all involved, providing treatment for the medical student: And learning to guide higher level providers to appropriate treatments while they are out of their normal element(i.e.dermatologist is MD or DO as well, but would you want him or her to perform a needle-t or needle-cric vs an emergency personnel?)

However, regardless of thinking order and running through differential diagnosis- once you have identified the initial signs and symptoms such as shortness of breath with adventitious lung sounds, treat them. Even BLS providers know to initiate oxygen therapy and then continue with the assessment. The medical student in question, by the description of event, failed to initiate any sort of treatment in a timely manner. Which is why the paramedic noticed and intervened, albeit bluntly, to the patients best interest.

 

[samiam]

The medical student in question, by the description of event, failed to initiate any sort of treatment in a timely manner. Which is why the paramedic noticed and intervened, albeit bluntly, to the patients best interest.

I definitely agree the student had yet to provide any care when care was due and based upon the way the story was told it seemed like he choked a bit. However we do not exactly know the time frame. The main point was that there was a much more appropriate way to handle the situation. There have been many occurrences where medical students have caught something that a MD might have missed because we have such a rigorous and through approach drilled into us that wanes with years of practice. Also we get to spend 40min doing a interview instead of ten.h34r:

 

[jrm818]

Being a medical student myself, its not fair to make that generalization and frankly I am a little offended by the way you handled that situation. Obviously it depends on how far through medical school he was but once we have gotten thru the first year we have hit anatomy, phisio, pharm and Physical Diagnosis (Basic Clinical Medicine type stuff History, BP, Cardiac, Respiratory Exam, Iv's etc.) as well as many more. At that point we have more training then an EMT. If he was any further through like say 3rd year he would be well beyond a paramedic training wise.[...] Many of us including my self have BLS and ACLS certifications as well as WFR etc.

Eh....my entire 2nd year class just took ACLS a month or so ago, and I'm honestly skeptical that we even have 100% who can really do CPR, nevermind provide advanced care...I'd say really no one is actually qualified to run a code unless they had some previous experience. There isn't even basic first aid material built in. I'm sure that improves by 4th year, but I bet there's still something very different about being on your own vs. being supervised.

No reason to be rude to a med student, but if it's obvious they don't have the experience to deal with an emergency on their own - which the majority will not have - it makes sense to ask them to step aside.


Interesting topic...I just got off a plane myself and at one very bored point was wondering to myself if I can even volunteer myself anymore now that my medic has lapsed and I'm just a student. I guess the answer is yes...