How doctors and medical pros handle in-flight emergencies
A few minutes after drifting to sleep, Paulo Alves was awakened by a call from the plane’s PA system: “If there is someone with medical training on board, could you identify yourself to a flight attendant?”
The request came four hours into his 12-hour flight heading from Texas to São Paulo about a decade ago. His eyes jolted open, and he eventually found the man drenched in sweat and wincing in pain.
As global medical director of aviation health at MedAire, which provides remote medical assistance to airlines, Alves has coached hundreds of medical practitioners and flight attendants through medical emergencies. Navigating in-flight medical situations has become his life’s work.
“I fly quite a lot, and when I’m flying with one of our clients, I offer my card upfront if something were to happen,” Alves said.
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On this flight, Alves determined that the man was suffering from inflammation to his genitals that was life-threatening. The pilot eventually diverted the plane to the nearest landing spot in Puerto Rico.
The Centers for Disease Control and Prevention estimates medical emergencies occur on about one of every 604 flights, with 10 percent diverted for severe cases such as cardiac arrest. With an average of some 45,000 flights in the air on a daily basis in the United States, according to the Federal Aviation Administration, airlines are required to know how to respond and prepare for potential incidents.
Flight attendants are required to undergo medical training for handling situations. Airlines are prohibited from departing unless there is a sealed emergency medical kit on board, the FAA said. Even then, aircrew will often call on medical practitioners who might be on a given flight, in hopes they can lend a hand.
There has been no shortage of bizarre, tragic on-flight medical emergencies over the decades, such as the 2015 death of American Express President Ed Gilligan aboard a corporate flight. And just last year, a flight attendant who was formerly a nurse helped deliver a baby during an 11-hour flight.
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Though licensed medical practitioners are permitted to treat patients on flights, thanks to “good Samaritan” laws that are protected under the Aviation Medical Assistance Act, some physicians might also be hesitant to raise their hand because of fears of potential medical and legal complications, although Alves said he hasn’t seen this over the course of his career in aviation health.
“It’s an uncomfortable situation to put yourself through, but these doctors are not alone in these cases,” he told The Washington Post. “If there’s any fear, they can talk to the flight attendant or ground-based support, where we can work with the doctor to relay information and guidance. Their input is paramount for us.”
Here’s how three doctors answered the bat signals from flight crew and saved the day.
Cardiac arrest without a defibrillator
Keith Van Meter thought the biggest problem on his New Orleans-to-Boston flight in 1999 would be the shrimp-filled ice chest a fisherman placed in the overhead bin above him that began dripping onto his center-aisle seat.
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Upon asking a flight attendants to help alleviate the pungent smell, another call came through the PA system asking for Van Meter, who is section head of emergency medicine at Louisiana State University. He was instructed to go to the front of the plane, where a man was without a pulse.
One of two colleagues, both respiratory technicians on the flight, began performing continuous chest compressions on the man, who appeared ashen-gray and was cold to the touch.
“Like much of emergency medicine, we all work symbiotically in how we handled the situation,” he said. “Even though there is a team leader, everybody works almost equally in importance. We just signal each other what to do to keep the show rolling.”
This incident occurred five years before the FAA required airlines to carry automated external defibrillators. This made it difficult to assess the patient’s heart rhythm. He resorted to mouth-to-mouth breathing while he waited on the emergency medical kit, which took about 10 minutes to locate and was relatively sparse.
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His saving grace was a bottle of highly concentrated epinephrine, which Van Meter diluted with the patient’s blood because there wasn’t any saline to do so. The man’s pulse soon began to come back at a strong and steady rhythm, but faded away again.
As Van Meter and colleagues worked on the patient, the pilot descended to a lower altitude, which increased oxygen levels, but also resulted in turbulence. A second epinephrine kept the man stable for another half-hour until the plane landed in Boston, where paramedics were present to take him to a hospital.
As the patient was carried off the plane, the three physicians were met with a standing ovation.
Van Meter drove with the man in the ambulance. When his heart faltered yet again, doctors used an AED to bring his rhythm back.
The man recovered, and they reunited two months later after the man called Van Meter. He suggested they attend a Red Sox game if Van Meter returned to Boston to thank him for saving his life.
Was it a stroke or dehydration?
Five hours into a San Francisco flight headed to D.C., where she was completing residency training at Children’s National Hospital in 2018, Cherilyn Cecchini was at peace.
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She’d just finished reading a 400-page novel when she noticed passengers around her were turning their heads toward the back of the plane. Soon after, flight crew began screaming.
“Is anyone here a doctor?” an attendant wailed. “We need medical help.”
Cecchini, who now runs her own practice in New York, quickly put her shoes back on and walked down the aisle. Her mind raced with the various scenarios that could have been awaiting her.
“What if he has an arrhythmia? Maybe he has a preexisting heart condition? How on earth do you check a rhythm strip on a flight? Could he have had a stroke?” she asked herself.
The man was lying by the flight attendant’s station, and she quickly asked for a medical kit while she assessed his pulse, breathing and heart rate. He had fainted, but couldn’t remember the fall. He was drenched in sweat.
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All eyes were on Cecchini and her patient, as they tried to parse out his medical details as quietly as possible, “but patient-doctor privacy is hard to establish when you’re in the middle of a plane,” she said.
Cecchini and the flight crew were able to slowly prop the man back up and move him to a nearby seat, where his blood pressure started to improve. She determined that his blood pressure had dropped because of dehydration and not having enough food in his system.
By the time he was stable, there was an hour left on the flight. Paramedics were waiting when they landed. As they exited the plane, the man waved and smiled at her.
“I haven’t heard from him since, but I hope that he is doing well,” she said.
A seizure and a decision on whether to divert the plane
When Darria Long Gillespie heard cabin crew ask whether there was a doctor on her Las Vegas-to-Boston flight, she marveled at the hands that were promptly raised.
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Four medical practitioners, including herself and her husband, who works as an orthopedic surgeon, volunteered. Long Gillespie, an emergency room physician who was faculty at Harvard Medical School at the time, offered her expertise. The rest of the physicians sat back down, save for the surgical intern who was a former paramedic.
The man, in his 30s, had suffered a grand mal seizure in his seat in the middle of the plane. He had lost consciousness, and his muscles were violently contracting for less than a minute, which proved to be an alarming sight for those around him.
“Seizures are very visually dramatic, especially for somebody who’s not used to seeing it,” Long Gillespie said. “It can be very scary.”
After opening the airplane’s medical kit, she realized how sparse it was. She needed a glucometer, a device to measure the man’s blood sugar, because low blood sugar could have potentially caused a seizure. The surgical intern was diabetic and had an extra in his personal kit. Long Gillespie then placed him on an IV and began delivering fluids to the patient.
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That was when Long Gillespie was called by a flight attendant to speak with the pilot through an in-flight phone, where she was asked whether they should land the plane to take him to a nearby hospital.
“I’ve been hit with life-or-death questions before, and they’re always tough to answer,” she said. “But so much goes into that decision, and it’s a lot of pressure, since that ultimately fell on my guidance.”
She determined that he was stable enough to endure the rest of the flight. For the remaining two hours, she stayed by his side and monitored his symptoms. They shared details about their lives and families, all while she paid attention to his breathing and pulse.
The two tried to ignore a few dirty looks from passengers who were upset that flight attendants had paused in-flight beverage and food service because of the situation.
As they landed, an emergency medical team was waiting to take care of him. It took a few words of encouragement from Long Gillespie before the team wheeled him away for additional examination, and she recalls that he didn’t want to be seen by a doctor who wasn’t her.
“I don’t need to see a doctor. You’re my doctor,” she recalls him saying. Before he left, he smiled and motioned a peace sign to her.
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