By Jennifer Larson, contributor
If you’re ever asked to help out with an emergency aboard an airplane, will you be ready?
Many nurses, doctors and other healthcare professionals will go their entire careers without ever having to respond to a panicked call over the loudspeaker. But it can happen.
It happened to Margaret Showalter, MSN, RN, on an overnight flight from Uganda to Amsterdam. And it happened to Amy and Curtis Warden, emergency room nurses who were flying to Thailand for their honeymoon.
In fact, in-flight medical emergencies happen more often than you might imagine; they are reported in approximately 1 out of every 604 flights, according to research published in the New England Journal of Medicine. However, reporting is not mandatory across the board, so researchers expect that even more incidents go unreported.
William Brady, MD, reminds health care providers of the limitations faced during in-flight emergencies, while offering suggestions for how to proceed.
Most of, if not all, the preparation that anyone could reasonably undertake for a potential event is mental. The first thing you have to understand is the reality of your situation, said William Brady, MD, professor of emergency medicine and internal medicine at the University of Virginia School of Medicine.
“You’re not in a clinic, a medical office, a hospital, the back of an ambulance,” said Brady, co-author of the New England Journal of Medicine study. “You’re not in a place that is configured, equipped appropriately, to manage any medical condition, really.”
Showalter learned that first-hand when the crew on her flight asked for someone to help a woman in labor. There was an emergency kit, but Showalter found herself wishing for more pairs of sterile gloves and other supplies. Fortunately, they did have a cord clamp for the infant’s umbilical cord. Showalter and the flight attendants spread blankets on the floor of the airplane’s tiny kitchen, where Showalter helped deliver a healthy baby girl a short time later.
When assisting a passenger in distress, it’s also useful to have a sense of where you are, explained Brady. You might feel it’s necessary to ask the pilot to divert to the closest airport for an emergency landing. But that might not always be possible, and ultimately the pilot has to make the final call. You may have to just make the best out of the situation–and the equipment–at hand.
Fortunately for the Wardens, they didn’t have to declare a major medical emergency while flying over the Pacific Ocean. Their “patient” was sweating and feeling very sick, but they were able to determine that her pulse rate and blood pressure were still in the normal range. Curtis Warden asked the crew to ask if anyone on the plane had a glucometer so they could check her blood sugar levels. The crew also fetched some orange juice for her to drink.
Ultimately, the calm presence of the Wardens–and the knowledge that they were nurses and were looking out for her–seemed to comfort her. “I ended up sitting with her the rest of the flight,” said Amy Warden. “She was very sweet.”
Experts suggest that you should not attempt to provide care if you’re impaired in any way. For example, if you’ve had a couple of alcoholic drinks or taken certain medications, you’re probably not in the best condition to make the best judgment calls. If you are ill or recuperating from surgery, you may also not be in the best condition to help.
But barring such a situation, it’s up to you to answer the call to help, if such a call comes while you’re on a flight.
“I say, go help and try,” said Amy Warden. “You never know if your knowledge could be of assistance.”
10 things you should do
When you’re mid-flight and someone becomes ill, you can help. According to research summarized in the September 3, 2015 issue of the New England Journal of Medicine, a generalized approach should include the following steps:
1. Introduce yourself and your medical qualifications.
2. If possible, ask for permission to examine or treat the person.
3. Ask to see the plane’s emergency kit.
4. In some situations, you may need to ask someone else to act as a translator.
5. Get information from the patient, perform a physical exam and get vital signs.
6. Administer treatment that is within your scope of practice.
7. Decide if you think the patient’s condition is critical enough to ask the pilot to divert the flight.
8. Communicate with ground-based medical resources.
9. Provide care until the situation is stabilized or another qualified medical professional can take over.
10. Document the experience.
Source: “In-flight Medical Emergencies During Commercial Travel,” NEJM
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