Airplane Medicine

I went to a Graduate Medical Education Grand Rounds on airplane medicine, which was really interesting. What do you do when an attendant asks whether there is a physician on the plane? What things are you likely to see? What equipment do you have?

First, there is a paucity of research, data, and information on this sort of situation; we don't even have accurate numbers on how common "in-flight consults" are. Common "emergencies" include neurologic problems (fainting, strokes), exacerbation of cardiovascular or pulmonary disease, and gastrointestinal symptoms. About 10% of the calls are for kids (often having seizures). Unfortunately, medical kits aboard U.S. planes are often woefully incomplete. The stethoscope (and blood pressure cuff) are limited by the loud ambient noise (imagine listening for wheezes over the noise of the engines). Equipment for an IV line is available, but the only bag to hang is 500cc of normal saline, hardly enough to do a resuscitation. Needles are present, but due to safety fears, scalpels are not. For pulmonary problems, there are oral and nasal airways along with a generic bag-valve-mask and oxygen. All planes carry an AED (defibrillator to shock the heart in case of a life-threatening rhythm) which can be used as a monitor and rudimentary EKG. The drugs on board are frighteningly limited: epinephrine, nitroglycerin, 1 amp of D50, diphenhydramine, atropine, and perhaps one or two more medicines.

Physician volunteers act as a consultant to the pilot. They can have the pilot do several things: continue the course, drop to a lower altitude (useful to increase the partial pressure of oxygen and decrease expansion of gases in a closed space), or divert. Diversions, as you would expect, are extremely expensive and still take a substantial amount of time. They're also limited; a transatlantic flight doesn't have that option. Planes often consult with ground medical staff who are familiar with the resources on the plane.

Legally, responders on a plane are protected by Good Samaritan laws. I think it's important to respond in such emergencies. It's scary, and the resources are limited, but as physicians, we carry our knowledge, skills, and responsibilities into different and strange settings.

Image is in the public domain.