Although many orthopaedic surgeons may never encounter an in-flight emergency or call for assistance, William C. Watters III, MD, MS, of Houston has been involved in no fewer than four incidents, including one in which he was the stricken passenger.

The first occurred in the 1970s, during his time as a medical resident, on a Pan Am 747 flying from Puerto Rico to Philadelphia. Dr. Watters was the lone physician to respond to a request for medical help; a nurse on board also came forward. The passenger in distress had acute chest pains. On the spacious jumbo jet of the era, Dr. Watters was able to lay the passenger down and, with the aid of the nurse, attend to the patient, who had a history of heart problems but had packed his medication in checked luggage. Dr. Watters made a plea for nitroglycerin, which several passengers were able to supply, and he and the nurse were able to stabilize the patient.

Although cardiac arrest was the concern, diversion of the plane was not an option, possibly because of its size and geographic position. So the flight proceeded to Philadelphia, where it was met by emergency technicians, who took over the patient’s care.

Dr. Watters says the fortuitous presence of a nurse was valuable, because flight attendants then “really had no medical training.” He recalls that after the incident the airline sent him a letter of thanks and a bottle of Champagne.

His second in-flight incident was less dramatic: a patient with nausea and vomiting. He responded to the call for assistance and attended to the patient to ensure that the problem was no more serious than the symptoms indicated.

The third event occurred about 3 years ago on a domestic flight and involved an urgent situation—a passenger undergoing an asthmatic event. Responding to the call for help, Dr. Watters found that once again his unexpected patient had packed his medication in a checked bag. He put out the call for an emergency inhaler from passengers—as he recalls there was nothing applicable in the medical kit on board—and several came forward.

During the incident, another passenger grew faint. With the help of flight attendants, Dr. Watters tended to her as well; he suspects her syncope was a panic reaction.

Although this incident was similar to the Pan Am event, Dr. Watters notes a few contrasts between the two. First, that 1970s’ airplane cabin was much more spacious than today’s cramped quarters. “Now it can be very hard just to find the room to lay out the patient where you can attend to him,” he says. More positively, today’s flight attendants are well-trained and knowledgeable about how to respond to a medical event and assist the physician volunteer. However, instead of Champagne, the airline sent him three pages of paperwork to complete.

Dr. Watters was himself the passenger in need of assistance during the fourth incident. He was on a flight to Paris with his wife, when she noticed he was in distress, with seizure-like activity for about 5 minutes. An internist on board responded to the call for assistance.

“I awoke with a friendly passenger physician hovering over me, taking my blood pressure,” recalls Dr. Watters. The apparent seizure was deemed serious enough to divert the airplane to Cleveland, where Dr. Watters was taken off and put in an ambulance.

His event turned out to have been an allergic reaction to a new medication. He made an additional discovery: “It costs $40,000 to divert a flight.”

Dr. Watters says he will continue to volunteer if called upon during flight and encourages other orthopaedic surgeons to do so, even if they have qualms about their familiarity with emergency medicine.

“Even as a specialty physician, you have the most knowledge and you are still the most qualified person to help and should do so,” he says, adding, “Now, if there is an emergency doctor there, I would step aside and say, ‘Go ahead. I’ll do whatever I can to help you.’”

Such was the experience of J. Tracy Watson, MD. As the orthopaedic trauma chief at St. Louis University, he has seen his share of emergencies, but has encountered just one in-flight incident in thousands of miles flying. “It was an apparent heart attack,” he recalls. “There were three other doctors on board. One was a cardiologist and another was an anesthesiologist. So all I did was monitor vital signs and take blood pressure. I basically sat that one out.”

Terry Stanton is the senior science writer for AAOS Now. He can be reached at tstanton@aaos.org