What doctors need to take care of sick airline passengers.

Health and medicine explained.
March 6 2008 11:00 AM

Is There a Glucometer on Board? How About an Oxygen Tank?

What doctors need to take care of sick airline passengers.

Airplane.
Are airplanes properly equipped for medical emergencies?

Last week, a woman died suddenly on a flight from Haiti to New York. She reportedly began to feel lightheaded, thirsty, and short of breath midway through the flight; soon after, she collapsed. This story recalled my own experience trying to help a sick passenger on a cross-country overnight flight three years ago. The difficulties I encountered in trying to provide good care came down to an unglamorous but crucial concern: how medical equipment is organized in a setting where volunteers are working in an unfamiliar environment with limited supplies and no back up.

My wife and I are both physicians, and on this flight from Los Angeles to Pittsburgh, we responded to an announcement asking for medical assistance for a middle-aged man who had passed out. The passenger was awake but looked quite ill: He was breathing rapidly, with cool and clammy skin. He said that he felt very lightheaded. For a while, we observed him, at the same time coaxing him to drink some juice and checking and rechecking his heart rate. But his symptoms persisted: He continued to look pale and ashen, and we became increasingly worried. It was hard to assess the cause of his condition, but it certainly could have been life-threatening. I was particularly worried about the possibility of a blood clot in his lungs or a heart attack.

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And so we asked for more help from the flight attendant. My wife wanted the plane's overhead lights turned on so we could see better. At first, she got nowhere: The flight staff didn't want to wake the passengers who were sleeping on the red-eye. Next, the flight attendant handed me a kit that had some, but not nearly enough, medical equipment: a blood pressure cuff, a stethoscope, a mask and tubing for oxygen, IV catheters, and a bag of saline fluid to administer intravenously. I asked for a glucometer to measure the patient's blood sugar level, and the flight attendant shook her head that she didn't have one. Another passenger, who was a diabetic, came forward with her own device, and I used that to confirm that the patient's glucose was normal. Finally, we were given a small oxygen tank that was close to empty.

The details about last week's Haiti-U.S. flight have yet to be completely reported. So far, the news reports include accusations of medical equipment that malfunctioned and airline staff who didn't respond to the passenger's requests for help. On our flight, mean attendants and broken equipment were not the problem. The flight attendants weren't uncaring, just slow to realize the seriousness of the situation. Once they understood that we were dealing with a potentially real emergency, as opposed to an anxious passenger (I recall my wife's less-than-subtle explanation), they were quick to help, including switching on the lights.

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