{"id":2757,"date":"2016-09-01T07:00:42","date_gmt":"2016-09-01T12:00:42","guid":{"rendered":"https:\/\/feminem.org\/?p=2757"},"modified":"2016-11-20T17:11:58","modified_gmt":"2016-11-20T22:11:58","slug":"doctor-on-plane","status":"publish","type":"post","link":"https:\/\/feminem.org\/2016\/09\/01\/doctor-on-plane\/","title":{"rendered":"Yes, There IS a Doctor on The Plane. What I Learned at 30,000 Feet."},"content":{"rendered":"

I am sharing this account of a serious medical emergency on a transoceanic flight because I hope it helps other health care providers assist people in the future and learn from the difficulties I encountered.<\/p>\n

About 8 1\/2 hours into a 17 hour flight, a gentleman had a syncopal episode in the exit row I was sitting in. His face was bleeding and he was having issues controlling his bowels afterwards. His wife said he was diabetic and had been anemic from a bleeding ulcer. He had already had a large amount of bloody stool which was on the floor of our exit row in front of the lavatory. My significant other ran get assistance from the flight crew.<\/p>\n

On arrival of the lead flight attendant, we had gotten the man to the lavatory and he was very pale, weak, thready pulses, and barely palpable BP. Myself and another physician (in ICU) asked for the emergency medical kit, but the attendant refused until someone showed a medical license. In the aftermath, I confirmed that this was not protocol, and should not be demanded if the person responding seems reasonably competent. Out of 4 physicians on board, I was the only one with a pocket license because I was on the way to a conference.<\/p>\n

The flight attendant then told the ICU physician that she needed to return to her seat because she didn’t have her license with her, but I insisted she assist. Initial BP on evaluation was 70\/palp, pulses difficult to appreciate, BS about 130. We were concerned the patient was having a myocardial infarction due to the gastrointestinal bleed and diabetes.\u00a0We transferred the patient to the floor between the lavatory cross-bridge area of the plane. We met an alarming amount of resistance to moving the man because the flight attendant was afraid we would disturb other passengers (as if having an aisle full of feces was not enough). We asked for the overhead lights in that area to be turned on so we could get IV access and place the AED, and were once again told that we could not because it might disturb other persons on the flight. My boyfriend then held his cell phone light over the site while I placed an IV. Another physician, an ophthalmologist, held the IV fluids under pressure. The IV blew after a few hundred ccs of fluid and a different IV kit was used to gain access. The AED indicated a normal cardiac rhythm. As the remainder of the fluids infused, I checked the medical kit for additional contents. There were no aspirin, no nitroglycerin, no masks, no body fluid cleanup supplies, no airways. There was a vial of epinephrine and D50. All of these items are required by the FAA for flights >35 people.<\/p>\n

The pilot then came back to inquire about diversion, and while I was speaking with him, the attendant took the emergency kit back to the back of the plane and we had to go retrieve it. She became angry with us for needing to have access to it in spite of our very clear explanation that we needed to have it available if any further deterioration happened. The patient’s blood pressure was slightly better at this point and his color was improving. He had no further active GI bleeding.. We discussed with ground control that if his BP continued to improved we could avoid diversion, however the medical kit needed to stay with us at all times in case of emergency.
\nI administered vitals every 20 minutes from that point on.<\/p>\n

I have learned a few important lessons from this that I would like to share with the Delta risk management and their safety team.<\/p>\n