In response to the cover story “On Call at 30,000 Feet” and the editorial by S. Terry Canale, MD, “Is There a Doctor on Board This Flight?” in the September 2013 issue of AAOS Now, several readers shared their own stories of treating in-flight emergencies.

David W. Polly Jr, MD, is no stranger to flying or flight emergencies. Dr. Polly, chief of spine service at the University of Minnesota, wrote that he has about 1.75 million miles of flying and has responded to 12 calls, two of which were life-threatening.

“One was a case of food aspiration while we were flying over the Pacific Ocean,” wrote Dr. Polly. “The flight attendant did the Heimlich maneuver and saved the person’s life.”

The second life-threatening incident occurred on a Minneapolis-to-Chicago flight. A passenger with chest pains indicated he had stents and started passing out. Dr. Polly recommended that the plane land as soon as possible, and it was diverted to Madison, Wisc. As the plan started its descent, the passenger began improving, presumably because the partial pressure of oxygen was better.

“All the rest have been the usual things as described,” said Dr. Polly. “It would be interesting to see what the rate of calls is per miles flown.”

Part of who we are
Answering the call is “part of who we are and what we do,” said Carl L. Stanitski, MD, of Charleston, S.C., who has answered the call six times. Two cases were syncopal episodes that rapidly resolved; one case was abdominal pain in a pregnant woman in whom the pain spontaneously resolved over 20 minutes; and one case involved tachycardia, nausea, and sweating in an elderly Eastern European passenger who had “a bucket of pills,” according to Dr. Stanitski.

“Using my Polish language skills (limited as they might be) I got through enough words to have her indicate and tell me in her non-Polish, non-Russian responses how many of each pill type she took and that she missed taking one of her cardiac medications. After taking it, she got well enough to meet the emergency medical technicians (EMTs) when we landed,” said Dr. Stanitski, who admits to spending “much time in the Atlanta airport with his work with the Accreditation Council for Graduate Medical Education” as a field representative.

He also recalled an elderly female passenger, “a cardiac patient who needed intravenous (IV) access and atropine to be stabilized enough for the plane to divert and get her into the hands of airport EMTs. This was especially exciting because we were providing care to her in an entryway floor. It was the only time I landed not seated and buckled in.”

Quick thinking
Although R. Maxwell Alley, MD, clinical assistant professor at Albany Medical College, Albany, N.Y., has responded twice to in-flight emergencies, both involved noncritical issues. However, he wrote, “A local thoracic surgeon had a great save several years ago. He responded to the call to find a woman in fulminant pulmonary edema, very short of breath, with pink foam coming from her mouth.

“He had no proper medications available, but did have supplies to gain venous access. He proceeded to phlebotomize several units of blood from her, letting it run right out onto the airline carpet! She encouraged him with reports that she was feeling better, with increasing ease of breathing,” reported Dr. Alley, who also noted that the flight did divert and the patient did survive.

Am I glad I read it!
According to Charles H. Brown Jr, MD, medical director of a sports medicine center in the United Arab Emirates, the article was an impetus for him to respond to a call that came shortly after he read his September issue.

Originally a sports medicine specialist at Brigham and Women’s Hospital in Boston, Dr. Brown assumed his current position in 2006. “Since my family did not move to Abu Dhabi with me, I spend a lot of time on airplanes,” he wrote. “I have been traveling to Abu Dhabi once a month for the past 7 years, and it was with much interest that I read your editorial and the article in AAOS Now.

“I actually read the article right before my most recent trip to Abu Dhabi. Boy, I am glad I read it! On the return flight from London to Boston, we were about 2 hours from Boston when the call came over the public address system asking if there was a medical doctor on board.

“In the past, like many orthopaedists, I have been apprehensive about responding to these calls, always hoping and figuring that there must be another doctor on board with more appropriate skills to handle such emergencies. I worried about potential litigation, the equipment on board, and making the decision about diverting the aircraft. After reading the article in AAOS Now, I did not hesitate to answer the call. This article put my mind at rest,” wrote Dr. Brown.

Another doctor also responded—a former vascular surgeon who no longer practices and now works in the investment industry The passenger was a 65-year-old man who had a syncopal episode and was diaphoretic but was not having any chest pain or shortness of breath.

“He was white as a sheet, his blood pressure was low, and his pulse was thready. We elevated his legs, and he started to feel better,” said Dr. Brown. “We decided to start an IV and hydrate him. The medical kit contained only a 500 mL bag of normal saline. We gave him a bolus of 250 mL and his color came back and he immediately felt better.”

At this point, the captain, who had already contacted medical staff on the ground, called Dr. Brown. “I told him about the patient’s condition and that, in my opinion, he was stable and there was no need to divert the aircraft. He relayed this information to the medical staff on ground and they agreed. I can’t remember the last time a medical doctor agreed with my medical opinion!”

The two doctors took turns sitting with the patient for the remainder of the flight. They kept him supine with his legs elevated, even during the landing. Afterward, the captain asked all of the passengers to remain seated, which they did, until the EMTs boarded and evacuated the patient and his wife.

“As I left the aircraft, all of the flight crew and many of the passengers thanked us for helping out. The lead purser for the flight even gave me a bottle of champagne,” said Dr. Brown. “They were all incredibly grateful that the two of us volunteered. It made me proud to be a member of the medical profession. Given the mess going on in Washington, I am not sure I would have received the same kind of response from the flight crew or passengers if I were a U.S. senator or representative. Thank you again for the most informative article, which in my opinion should be read by all orthopaedic surgeons.”

Share your story of responding to an in-flight emergency and watch for an online extra in an upcoming issue. Send your story to aaoscomm@aaos.org