I was the only physician on a flight when a passenger needed help. Even with two nurses and an EMT student on the flight, it was still very scary being in that situation

My father, a retired MD (DEA/ME Current), was the only physician on a flight from Albany, NY to Fort Lauderdale, on SouthWest. He answered the call, he was an incredible diagnostician and my Mom was with him a retired Pediatric RN. He immediately told the crew to continue the flight, he spoke with and ultimately hung up on an EMT in Atlanta who was called by the crew. He told the Pilot to have EMS at the gate, and they did. We were lucky, and so was the patient to have my Dad, who was in his 80's at the time. With a Stethescope, with his skills, he determined that the elderly gentleman (my father's words) did not require urgent care. He was educated and Trained in Edinborough, Scotland. My Dad would also stop on the Northway 87 in upstate NY when he saw an accident, he saved a baby once during his career driving from Glens Falls To Albany daily. My point is, during my fathers time, and in the beginning of my time as a HM1 (USN) and a LPN current, we all took the call, we always wanted to help, we stopped for accidents (my last one was in Florida a motorcycle crash, I was in my white uniform, stockings, (military) and I held the young man until paramedics let me leave. I know I know, people sue, people suck, but that all being said, isn't it why we became Doctors and Nurses? We help. Death to the Lawyers Death to the All, Shakespeare said it best.

As a retired cardiac surgeon/emergency room physician, I do consider myself competent to answer emergency request on airlines and have done so in the past. One of the most glaring deficiencies in airline equipment for managing medical issues is the absence of a simple pulse oximeter. In the case presented, the young nurse's initial episode was most likely small emboli. A pulse oximeter would have most likely documented a lower than average saturation dictating an immediate need to land the aircraft. unfortunately, the ultimate outcome may not changed. If there is question as to whether A low oxygen saturation is simply do to the cabin altitude, the patient's saturation can be compared to one or two others nearby. Pulse oximeters are very inexpensive and I always carry one with me on airline trips. It has been useful on more than one occasion.

This happened to me pre-9/11 (actually 2/2001) on a Continental flight from Newark to San Jose, CA. A man went in to rapid A-fib on a plane. I am an ER RN in a major trauma center also flying with my best friend of the same background. Thankfully at the time AED's still had a screen that actually showed you a rhythm. The patient was vomiting, diaphoretic and mildly hypotensive. My friend was in the cockpit communicating with the pilot and a medical team in AZ while I cared for the patient. (there is actually a command center in AZ manned by EM physicians) making the decision to land or continue on our way. There were unfortunately no IV supplies to start an IV. We decided to speed up and continue on to San Jose as we were more than halfway there. We had the situation under control... the patient lying flat on the ground , O2 in place, BP holding. A woman identifying herself as a PA comes forward and usurps what she believed to be her superior position to us. We queried her as to her background and discovered this: She is a PA that works for the Pentagon. Essentially she is an occupational health provider not at all skilled in Emergency Medicine. She begins doing bizarre things like attempting to sit the patient up and give him water which he of course vomits up and becomes more diaphoretic. The flight attendants at this point are trying to firmly but gently assist her away from the patient but she won't budge! We essentially had to save the poor patient from this crazy PA who had no idea how to care for an emergent patient. She couldn't even read the monitor! I have to thank you Z Dogg for putting this video up because honestly, we as health care providers do have to understand our limits. I will add that there was an MD on the flight but he was not familiar with an emergent case like ours. He deferred to our expertise which was the right thing to do. Sometimes health care workers get caught up in titles. Deference to expertise does not always mean the expert will have had more titles than you. This is important and I am so happy that this is featured on your show.

A critically sick patient in tight quarters with a minimum amount of equipment. This is what hospital providers call a nightmare scenario. For Paramedics it's a Tuesday.

My dad's an airline pilot and at his airline they have medical professionals that they can contact over the radio. Of course they can not actually physically treat the patient, but my dad can at least tell them what is going on. Of course, there have been times when my dad has had to call for medical personnel as well. My dad tends to try to be as specific as possible with what is going on. I.E. he does not just say that we need medical personnel. He says things like, "We have a passenger that is having chest pain."

I had a medical emergency happen on an international flight from LA to Sydney while we were in the middle of the ocean. Young woman with chest pain. The medical kit was larger than I expected, but lacked a critical tool-a pulse oximeter. This young woman felt short of breath and was tachy, but had few risk factors for blood clots other than our current trip, I spoke with the airline staff after we landed safely and expressed my concerns and recommended adding (the very cheap) and important tool to the kit, but they said that it had been an issue in the past and the difficulty in getting it passed through the red tape had prevented any action from being taken. Being without your full equipment (EKG, 3 leads, full vitals) and in the middle of the ocean was an eye opener and certainly not an experience I want to relive.

I was an EMT-SPEC but had been working in a clinic lab for 16 years, I kept my license up. On a Delta flight heading to meet my new grandson. Noticed a young man shortly into the flight suddenly stand up and start fumbling in the overhead, glassy eyed, you know the look. I’m two seats away, I unbuckled my belt because I knew this kid was about to go down like a prize fighter. Sure enough he passed out and landed across the two people in the row. The women in the seat started screaming and an older woman across the isle stands up, mom. The flight attendant got on the over head and asked for any medical persons on board,............crickets. I raise my hand and the relief from the attendants was palpable, I told him my level of medical knowledge and asked if I could help. I got up and grabbed the boy putting him on the floor, I then asked the overly dramatic persons he landed on if they were injured, “no.” Then please be calm because screaming will only cause panic, they acted like someone with Ebola just landed in their laps. I checked ABC’s, all normal but pulse was a bit fast. I was firing question quietly to mom as I raised his legs and asked for some orange juice. Healthy 17 year old males don’t pass out for no reason, mom says happened twice in the past and everything came back normal but was scheduled for cardiac work up AFTER vacation. 🙄. He wakes up quickly a bit embarrassed and I have him drink some oj, asked him if he had any pain or headache, SOB, dizziness etc etc, nope. Captain wants to know if they need to land the plane, at this moment I feel terror. I truly don’t think it’s necessary as his vitals were all normal and as mom had mentioned all his tests had come back normal...... if something happens in the air my ass is on the line, We only had 30 minutes left in the flight so I told them I didn’t think that landing now was needed. Told mom this really should have been worked up prior to a trip to Aruba. After drinking the juice I have him sit up for a bit to see how he feels, no issues so back into his seat and had the attendant give him some peanuts and more juice, I return to my seat but leave my belt off just in case. As we get off the plane mom gives me a big hug, captain comes out and tells me thank you. I hurry on to my connection.

Hey ZDogg, my wife and I watched this yesterday. Just got off a flight where there was a medical emergency, and I was hoping there was a real doc on the plane (I'm a hand surgeon). mangled limb=I'm great. syncope=blame anesthesia. Your video was amazingly helpful and timely.

You don't have to worry about a WOW, COW, or even using a cell phone to document. Every phone on the plane will be recording your every action anyway!

Thank you so much for this info. I am a RN i have been in orthopedics, pediatrics, med/surg, and now in ER. I worry about these things when I come across a car accident or eating out and someone chokes, I am 5ft 2in and 110lbs I have never been physically able to do certain things with my size. But I still always try. After the fact when I debrief in my head I think I should have done this or that but in reality I did what I could. I am always communicating my actions out loud. That helps with everything. I tell my title and abilities but I also know when to step back. It’s very hard because I play it in my head what if I am wrong and hurt them worse, or what if the family blames me or takes me to court. In our ER I have a team behind me in these situations you are often alone and that scares me. But as a RN you already know I am a caring, loving person that always wants to help others so naturally we jump into action and think about it later. I have been in some crazy situations outside of work and I am thankful it has always been a good outcome, I was not always able to save the person but there families know I gave it my all, so that’s a good outcome in my opinion. We are also trained to do all life saving skills until we are told differently and with documentation to back it up, example we do cpr until we see a dnr signed by a doctor. This is a wonderful video about a subject we worry a lot about. Thank you

"Is there any doctor on board? If so please come to the front" "Yeah hi, i'm a doctor, how can i help?" "This lady passed out and is not responding" " _Oh, i'm sorry, i have a doctorate on law_ "

I had a PE from flying home for Christmas, I went to the ER with shortness of breath and because I was only 24 at the time, and also basically happy that I was on vacation, I wasn't taken seriously. 4 hours later I got my VQ scan and they were like OMG you should have come in sooner! LOL Lesson learned to actually look sick when going to the ER =) Fun Fact, my whole experience with this lead me to change careers and now I am an ICU nurse =)

I really love this format - great exploration of this topic. Thanks.

Just my two cents....I'm a 20+ year Paramedic who works for a busy urban 911 system in the Houston area and we regularly have Air Marshalls who ride with us monthly to maintain their EMT-B skills. It is my understanding that they maintain fully stocked medical bags and operate under medical direction. I do not know if all flights have Air Marshalls on them or if they are all EMT certified but we see quite a few of them. In my opinion If they are on every flight and are all at least EMT certified that seems like a practical option. Although I am fairly certain that this situation would be completely in my wheel house, I am not sure what ramifications I would encounter due to lack of protocol that allows me to practice and lack of appropriate equipment. I believe that regardless of the interventions performed or the lack thereof the outcome may very well have been the same. The only chance that this young lady had would've been rapid definitive care.

Great report. As a paramedic now in premed I thought about this from several different issues. HI to Dallas is roughly a 6-8 hour flight. PE I thought was an obvious differential for many reasons. Great discussion and I really enjoyed the thoughts in the beginning about competency.

Thanks for giving us the MD breakdown on this case.

Thanks, Z!

Thank you for a great discussion.

I went to nursing school in a very rural area with limited resources and the medical professionals there were really good at coming up with temporary solutions to stabilize patients before sending them to a facility better suited to treat them. Obviously an emergency on an airplane is a completely different setting than a rural hospital/clinic but I'm really glad I was able to be involved in that kind of problem solving.

As an intensivist, I have to preface that everything about I'm going to say is purely monday-morning quarterbacking what this doc did, who most importantly of all, reassessed the patient, changed his/her initial assumptions and made the right call to get the plane down ASAP. While I wasn't there, I have to guess that the BP cuff reading "error" was because the pressure was too low for it to measure. If you were able to get enough of the history and exam to diagnose PE, there are a few things medically that could be done to treat this patient with the tools and medications on board which I won't get into, as I wouldn't expect a doc who doesn't work in ICU to do those things. Ultimately the most important thing was done, which was get the patient to definitive medical care ASAP.

Good news is, as a medical student, there is zero percent chance I could afford to fly so it wouldn't be an issue.

Thank you

FYI The FAA has not updated the minimum requirements for the medical kit on commercial flights since 2001! That is a little scary.

Thank you!!! I watched your video about a month ago and this just happened to me while I was flying back from Hawaii a couple of days ago! I am a respiratory therapist and would not have even known there was a medical kit on the flight without watching your video! Very scary situation! Luckily armed with this knowledge, everything went well!!! (It seemed the crew did not know about the medical kit.......they had to call the captain to find out where it was after I insisted they had one.....)

Great information! Reminds you to reassess you competency at that moment to determine where you are best to serve the needs of the patient and those making the decisions.

Loving this content! Keep it up!

I am not a physician, but as I traveller, this is a most informative video for passengers and clinicians. Thank you!

I wish I could CE’s for this; I’m learning so much! Such a tragic case and I am so sorry to hear this nurse died. My absolute sincerest condolences

Nice one doc

Excellent discussion of an issue that could happen to any medical professional with a very helpful dress rehearsal of what kinds of things to anticipate. Well done!

You don need the machine or sound, you can do a manual over palp.

I found your comment about her being a woman and the implicit bias very interesting. I immediately thought of a PE. As a third semester nursing student I've seen at least two women in the hospital with thromboembolitic events that were initially misdiagnosed, one in the ED and the other in urgent care.

Wow at the final cause. Thanks for sharing this with us, Dr. Z. We really need more education on implicit bias in healthcare, I would love if you continued to talk about this.

So many questions...Dammit, Dr. Z...

You are a good doc

Birth control, DVT, PE, PEA

Tough situation....

There is a PBS documentary on Netflix called "City in the Sky" and the second episode of that series actually shows how physicians on ground coordinate with the pilot and other medical personnel elsewhere in world for in-flight medical emergencies.

Do a BP by manual palpation, I knew it pulmonary embolism, was she on birth control pills, I dont think anything could have been done if she had an embolism

This is good to know.

The folks who did CPR on the Southwest flight with engine failure are heroes for sure, but.... If somebody arrests in the field after trauma, it's ridiculously unlikely they will survive. Buckle up and save yourself.

To help with charting later, you might start the audio recorder on your phone so you can record the events as they happen.

I wonder if a point of care ultrasound machine would have been useful in this situation. Some of these machines are pocket sized and relatively cheap but increasingly useful in emergency diagnosis using the eFAST protocol. The massive PE would have shown as right heart strain/dilatation on the ultrasound. This may have influenced the decision to land now rather than 90mins later. Of course, I'm not sure that heparin is one of the standard meds in flight or tPA but at least a diagnosis is available for the med team on the ground.

Here via Dr. Hope's Sick Notes, now following:)

Depending on the situation.

Truly a daunting prospect, being perhaps the only healthcare person available on board. I would hope there was someone else available, but would step up if I was the only person there. However, for me, this will likely not be a problem. I haven't flown since 1986 (having flown frequently up till then for business trips) and have no intention of ever flying again if I can help it. I have the irrational fear that a hole will open up in the plane and I will fall through. I DO have panic attacks on board, only controllable by medication and/or alcohol. But this is definitely this is something I will share with my less irrational friends. Thanks for your vids, always engaging and informative.

A long flight, possible BCP's (?smoker) if overweight-decreased venous return- any young woman on a plane should be considered for DVT/PE.

Does anyone know what her activities had been during the previous 24hours? Wondering if she had been scuba diving.

I know I am two years late on this. For background that I am honestly not sure if this relevant or not. This was at a Chili’s, Austin, Texas - - March 2021. My husband and I were sitting down, enjoying each other and lunch. Then we hear: “Is there a physician here? (Pause), Parametric (pause), pharmacist (pause), nurse, MA (medical assistant)?” Side note: I went to school to be a medical assistant back In 2011. I worked at a doctor’s office, but had to quit because I found out I was having surgery to remove a pituitary tumor. “Brain surgery” (they go through your nostril and upper gums to remove, but the gland is still in your brain hints the quotations.) Normally these type of tumors are not removed, until they are. My tumor was found in 2004, right after I graduated hs, but still 17. I had mine removed because it started secreting growth hormones, and was dxed Acromegaly. So I worked in the “real world” as an MA for two months after I graduated. When they asked for an MA, which I thought was a weird ask, I knew I didn’t have the qualifications to help. The only things I still know how to do is take blood pressure manually (not stupid machines.), pulse and give injections (Always the one thing I excelled at. Lol). In Texas we have the Good Samaritan law www.texasonsitecpr.com/resources/texas-good-samaritan-law.html They ended up calling EMS, so I am not 100% what happened. No one tried to help/stood up as a medical professional. It wasn’t an emergency, she was laying down on the booth for people waiting on tables. There was a trash can beside it. Even if someone was able/voluntarily helped, EMS would have still been dispatched and the outcome would be exactly the same. It was a very weird scenario.

Office practice PA on UA international flight somewhere over China in 2017 when an elderly man had a syncople episode. Notable hx of HTN, stents. Taking multiple BP meds not in the prescription bottle. I never did hear anything from the $2 stethoscope on board. The BP cuff was hardly better and we measured diastolic under 60. Patient doubled up on BP meds prior to take off because he didn't want to drink anything in hopes of limiting his midflight bathroom trips. Plus he had his first ever Ambien a few hours before. You need to tell to be heard and it's and incredibly draining experience. Admittedly that experience tempered my enthusiasm to help even though everything turned out fine.

You can't shock asystole so the AED won't deliver a shock.

Thank you for this. I will be using it in my prelicensure RN nursing class that I teach online for GCU. It will be great for the Ethical Issues Topic week. Jacy H. MSN, BSN, RN. Wearer of many hats in a Critical Access Hospital in Nebraska. PS. I got it correct why the AED said No Shock Needed!😁🏩🙏 I loved your comment about jumping out if they brought you a computer 😂 A cell phone could act as a dictation device to document. Keep on ZZZZing!!

Short of emergency embolectomy or aggresive thrombolysis, the patient didn't have a chance at survival. Condolences to the family. I lost a young colleague to PE a few years ago. I still sometimes feel sad when I remember.

I also, although not on a plane, had two PEs less than 24 hours s/p abd surgery. I was still in nursing school at the time. 24, no prior health history other than acl replacement. ... heart pounding out of my chest (I literally looked down and saw my heart beat through my shirt), ~200bpm, couldn’t breathe, impending doom, I suffer from panic attacks and this was no panic attack, no birth control, nothing.. Fainted. Came to and EMT was at my house. They advised- no treatment necessary, anxiety, I insisted it’s likely a pe (recent surgery, abd at that, no other issues, hello EMT..) had mom rush me to the ED, Happened again in the car. Rushed into ED, confined ASAP. The PA said,” you seem to know a lot; what do you do?”...me, “just a nursing student”... hill-“well good thing you got here; if you had stayed home, we may not have saved you”..(due to the recent surgery, Coumadin, and subQ blood thinner.... massive intra-abdominal hemorrhage, belly full of blood, t tube, numbers doing like flies, 4&4 of prbc’s, ffp, finally emergency surgery to cauterize Abby bleeders, followed by an ivc... needless to say I’m always paranoid about flying now, knowing if I had been on a plane, there’d be nothing anyone could do... definitely sounds have more medical equipment on planes. Note that I’ve been ~3 years Cancer free, which was way after this event, I’m at super risk... and no clot busters ahhhggg

While it’s certainly noteworthy that she may not have been taken seriously because she was a young woman, it should also be noted that there is a compounding bias being that she is BLACK... there are many sources that acknowledge black women are more likely to not be taken seriously in health care encounters, have poorer health outcomes and have higher mortality rates than other patients.

I was an RN for over 36 years and was flying to see my daughter in California. A woman had passed out and staff asked if there were any medical professionals aboard. I raised my hand. My specialty was in Oncology. This lady was out like a light. They brought me a BP cuff, did NOT work, lousy stethoscope, when I asked about the medical kit, they had NONE!!!! So personally I was very anxious but I did feel we did not have to land. There was an ambo when we landed!! The staff were so grateful they gave me 4 bottles of wine. When I got my luggage I saw this lady walking around the airport with her boyfriend and laughing. I was never so angry about what happened on the flight. Did she do this purposefully for the attention or what???? To this day about 20 years later I still have questions. Loved your show ZDogg :)

And for all the doctors/nurses who think we'd have been able to change the outcome. We're surrounded in hospitals by other medical professionals, equipment, everything we need... You think they have that on a 747 to Hawaii?

I was an RN on a flight from Atlanta to SMF. I was talking to people sitting near me and we were discussing what we do. I said I was an RN…. An hour later that announce came over the loud speaker about a medical emergency…. A 24 year old guy was standing in the back waiting to use the bathroom and he passed out. Everyone near me immediately yells “she’s a nurse”! Just great…. So, I went back there and he was starting to come around after I put his legs higher than his head , checked vitals etc…. Which were wnl. The guy had been drinking before and during the flight and took cold medicine and just passed out.. he was ok, moral of this story, keep your mouth shut unless you’ve already decided you’re that person that wants to be called on! Delta gave me a $50 flight credit. I’m Ann RN workers comp case mgr…. With prior ICU experience…. I felt totally incompetent walking up to see what happened to this guy. Thank God it was a no brainer!

It is alarming to me that any of the people that could potentially find themselves in these situations may not know this.

So here’s what I’m thinking. What if one of the passengers had their own bp monitor? Would it have been worth it to ask the cabin if they had anything? I have a PICC line and get 2 liters of LR everyday, and I always have a bunch of supplies with me, including a bp monitor. But if there’s a medical emergency I wouldn’t want to get in the way! Can you imagine how annoying (if not dangerous) it would be if a passenger inserted themselves into that situation with no medical training? Also if the pt has blood volume depletion, using (some of my) LR to boost the blood volume could be better than nothing in some situations, right?

Ethical and moral obligation

As a doc, I can say even as a hospitalist the every day person down in the field is going to be incredibly hard to manage from my standpoint (think "I may know why this happened, but I have almost none of my usual resources to deal with it"). BUT I do have EMT friends that could easily help in these situations because of their specific training and experience. Their whole job is walking into tight spots with emergency equipment to be the first responders. That said, does anyone have any idea how many flights per day occur in the US, N America, etc and what logistics would be needed for one flight attendant, maybe on flights of a certain distance or number of passengers to actually be EMT trained? They could even be specifically "aerospace EMT" trained. Of course that plus working equipment is an idea that would probably help alot of people but cost minimal money by comparison to the usual daily workings of the airline industry. I'm sure they wouldn't want to waste the money and time :-/ .

I have taken an aspirin at the beginning of long flights several times in the past to avoid DVT or PE etc. i have never read that this is recommended but it makes sense to me. does anyone have info on this?

Any syncopal episode is an emergency, even those caused by panic attacks. LOC with abnormal respiration is rare for anxiety. It is however very common for PE. Damn shame...

Lol the part about taking a manual blood pressure on a loud ass plane is real like it’s hard to take with any noise especially plane noises. Taking a manual blood pressure is hard. And definitely one of the hardest things to master in my opinion

Flight medic here. Thats a bad situation. Plane can make auscultation tricky some times but the ecg usually works pretty good. Some things can help like paying attention to what you or your stethascope is touching. If you still cant get a manual take one by palp. One thing to consider i didnt see anybody say is most aed algorithms have rate criteria for delivering a shock so they wont shock a slow v tac. I recall the rate having to be above 150 for most units. They are good at detecting vf (95% to 100%) and rhythems it wont shock (sinus, a fib, svt, etcetera) but only 63 to 83% at vt. And that can be exaggerated by turbulence and other artifacts from the plane.

The only thing I don’t like about responding to emergency events is people panicking or worse criticizing you that you’re not doing what they watched on Grey’s Anatomy or Code Black. Umm, you do this will you?

Seems the biggest issue being is there were two blood pressure cuffs which did not work. The error message may possibly have not registered a Bp that was as low as hers might have been at that point depending on how decompensated she was. Can’t prove that though, only that they didn’t function when needed.

Thank you for raising the issue of "hysterical woman syndrome" I recently had covid (I live in New Zealand we have very inadequate care for dealing with the pandemic) which caused me to have heart palpitations, chest pains high bp and tachy I take a betablocker which normally treats my tachycardia, I have a genetic condition that puts me at high risk for cardiac abnormalities and aortic dissection. ED doctor gave me a Stemetil IV to treat this and the headache I was getting from the high bp (160/100) ..... when I explained I had a huge panic attack as soon as the IV started (it was contraindicated for the effexor I take and reaction to having the IV at the same time ) Wish he had actually listened to what I was telling him it was one of the worst experiences of my life

"checking in" (over the 'spurious' products...in the community)

I have a couple of questions actually. Number 1 would be, use of an AED on a Plane, could the movement of the plane i.e. Turbulence effect the analysis of the Defib? Not necessarily in this case, just curious for future reference. And number 2 I'm not a Doc but wondering if you would advise an EMT step up in that situation if it came over the tanoy that they were looking for a Doctor or HCP? And nobody else stepped forward, like most HCPs I'd find it difficult not to step forward if nobody else did. Appreciate any comments or thoughts.

All care seems to appropriately have been given. PEA is a non shockable rhythm so appropriately following resus guidelines of non shockable is appropriate, if a shock had been delivered then I would be more inclined to think the AED was not working. The only question is could they have landed safely quicker if not then unavoidable event. If yes then the pilot and carrier have something to answer for.

Bahaha!!!! Flight attendant brimg that WOW up here ... Like now...

I an internist and have responded to 4 inflight emergencies in my career. None as sad as this. Only United asked for my credentials and asked me to complete a form after. The most interesting was on a dark and stormy night flight from Amman to Frankfort. Called to the back of the plane where a young lady was lying on the floor awake, had vomited. No English but stewardess said she is pregnant. I rushed back to our seats and aroused my wife, a nurse midwife, and said "this one is for you". When we landed the let us off first and the passengers cheered. Dick Sudmeier, MD

Doc, How would the machine know if it's PEA? Thanks, -Mike

Asystole would have “no-shockable-rhythm”. Maybe put on AED at first faint. Why not? Is someone else using it?

You know how there are sometimes sky marshals aboard aircraft? I wonder if it would be worth having an ED-type physician aboard long flights. I don't know if it would be financially feasible, but it's just a thought I had.

It sounds like there wasn't an awful lot put into differential diagnosis originally. I've heard she also originally presented with fatigue and epigastric pain which automatically makes me at least consider a coronary or pulmonary event unfortunately we are missing quite a lot of detail that might prove educational in these situations.

Not ideal, but not much different than what I’m used to on my ambulance as a paramedic.

my question is did the doctor obtain a medical hx from the pt? as an MA one of my first questions to a female patient (of childbearing age) non emergent or otherwise is are you in on birth control, and if they didn't WHY NOT?

I actually had to take a manual BP on a plane after responding to a passenger traveling alone who had a witnessed seizure. It sucked. Couldn’t hear a thing and the stethoscope quality was that of a child’s toy doctor kit.

This is all catch up for me but I’m confused. If communication is always primary why did the doctor not ask where they had been and what they had done. Perhaps they were sky diving or scuba diving or whatever. In that case a PE would have been a more likely choice plus ruled out that she was panicking on a plane. My years in ER taught me to look for the most common but not to RO the uncommon. What a shame they didn’t land that plane.

Just curious if the doctor on the plane was also named in the suit.

As an MS3, i barely fly, but i'm terrified that that call might come on and that i could be the most capable person... not that i'm a doctor, but between layers, office workers and MS3 i'd pick the ms3 to treat my own mother or me. I dread it....

On BCPs?

A blood pressure cuff is nice but isn’t necessary to assess when someone is shocky. If needed, you can tell by pallor, diaphoresis, change in level of consciousness, perfusion of extremities, pulse rate at radius or carotid, nausea. Time wasted on a trying to use a device when the patient’s presentation was clear and required swift action of fluid resuscitation, o2.

I don't live in the US so my main concern if something like that were to happen to me is that medical kits in the airplanes I fly on carry next to nothing

Maybe the birth control regimen makes her prone to have embolisms. Just my opinion.

There had to be a breakdown in communication. I see no reason a professional pilot would not divert over a serious medical situation like this. They do all the time. ATC will clear out any airport and airspace that's busy for an emergency and there were plenty of airports closer. I fear the flight crew communicated a 'panic attack' to the pilot and then when it turned out to be more serious, either they assumed it still was a panic attack or forgot to update the pilot. Would be interested to see the flight plan.

I am a paramedic, flight nurse and ER nurse and I also work for MedAire. This company contracts with many airline and general aviation aircraft to supply medical kit and also medical advice. We have contact with ER MDs 24/7 and they have data bases that help them decide the need to divert. I can explain this more in detail if you wish to contact me.

because she didn't have a shockable rhythm

So how do we solve this? Would it be so difficult to have one flight attendant per flight certified as a Paramedic and get the FAA to mandate a full crash cart complete with a 12 lead capable monitor on every long distance commercial flight? I'm not saying a short jump from Washington-Dulles to JFK needs this but if you're over the water coming from Hawaii back to CONUS it may be necessary. The aviation industry takes every other sort of in flight emergency very seriously and trains their people accordingly. Why are medical emergencies planned for in such an aloof fashion relying solely on the passengers to be licensed or certified and respond accordingly?

As a licensed aircraft dispatcher (FAA Part 121) and a paramedic, I can sit on both sides of this issue. As hard as it is, from being in the medical community, a medical emergency is essentially a request. It is not an in flight emergency. An emergency is defined under the FARs as an event which the safety of the aircraft or manifest, which immediately impacts the ability to continue a safe flight and/or safe landing. In other words, a person dying does not affect the safe operation of the aircraft. If a person goes into cardiac arrest, the air carrier can consider a nearby airport is a suitable and adequate airport is available (runway length, necessary services available, blah, blah, blah). Say this character was on a 737-800, with 189 passengers aboard, crew of say 7. Pilot in command and his dispatcher's job is the safety of all 196 souls on board get on the ground safely. Not the one dying one. No room for heroics. Sorry. It sucks. My full time job is a air ambulance dispatcher. All of their patients are life/limb emergencies (or should be) but at any rate we will call it specialty/critical care transports. Try to tell ATC you are having an emergency and let me know what your response is. They are thinking something like, did your engine fail? Are you on fire? It is normal for us to have medical emergencies on board everyday, they assign us a "medevac" call sign when dealing with other traffic so that we get priority handling. I personally doubt the family actually has a case, I feel sorry for their loss.In reality, the time it would take to get on the ground, get the casuality of the aircraft and in an ambulance would be so long that in many, in fact, emergencies could very possibly result in if not brought back to life prior to landing. What I am referencing in medical emergencies: time critical diagnosis stuff, strokes, heart attacks, major bleeding, cardiac arrest, etc.

Certainly a tragedy. But as always hindsight is 20/20 and typically the best efforts were there at the time with the info available. I have responded to care requests while flying although no such terrible outcomes. Of note is limited info on clotting risk, although flying is one. The old stasis, injury and hypercoagulability. Another consideration although unlikely would be some sickle cell trait hypoxemia issue. I do feel the legal system is not going to help other than somebody getting money to go away. Nothing will fix this newlywed and family’s loss!

My husband and I are ICU nurses and have responded to several in-flight emergencies while traveling. We always bring a pulse oximeter with us ($18 on Amazon). It provides a pulse and (very basic) EKG. This is important because the medical kit on the plane won’t include it, and the three O2 bottles on board only provide “free flow” 100% oxygen (20 min per bottle)...and you can’t titrate it. If you have an O2 sat probe you’ll be able to make the O2 last longer if necessary

As a doctor with combat experience in seven wars under the most adverse conditions I am more than qualified to assist any sick passenger. The most critical part of treating a patient is does the aircraft have the necessary medical equipment and supplies on board. In combat we are very concerned with THE GOLDEN HOUR. That means that we must keep the patient stable until advanced medical Personnel and Equipment arrive. The window for this type of medical emergencies is one hour. You can GOOGLE COMBAT MEDICS AND THE GOLDEN HOUR.

Vomiting & defecation showed loss of smooth muscle coordination. Pilot should immediately find the closest airport to land. Medical assistant on board should continue with CPR as nothing can be administered orally at that point.

I am amused... "had a sinkable event...". Rewind. "...sinkable event...". Rewind, turn up volume, set playback speed lower. "Sinkable event." Google "sinkable event". "Syncopal event." Schedule hearing test.

It’s important to know that the pilot isn’t the only decision maker. There is a service that airlines use to help work between the pilot and the medical professional in the decision making process. They are a team of doctors and other trained people on the ground. They are the ones who know where to land and if the required treatments will even be available at that site, and make the final decision as to what the pilot should do. It is possible that they decide not to land and to continue on to a larger city where a patient can be adequately treated and you as the medical professional on board will have to deal with their decision. For more information about contents of the EMK (emergency medics kit) visit: www.statkit.com/United-Airlines-Kit Or: www.ashp.org/news/2015/01/13/know_what_s_in_airplane_s_emergency_medical_kit__two_pharmacists_say