“Is there a doctor on the plane; is there a doctor on the plane?!” The urgent sounding voice rang over the loudspeakers on the jet about thirty minutes into our flight from Frankfurt, Germany to San Francisco. My wife nudged me just as I was trying to arrange my body for sleep in preparation for the fourteen hour voyage. I pressed the call button unsure what emergency I was volunteering for. The next thing I knew I was face to face with the flight attendant who had recently served me orange juice. She explained to me that she was the one who needed medical attention, and she escorted me toward the tail section of the plane where we ascended into a private sick-bay alcove. She proceeded to tell me her story. A year prior to this, she had been hospitalized for a week with a kidney infection, and she was experiencing similar symptoms once again. She had back pain and urinary symptoms, and was desperate for help. I suspected that for her to have been hospitalized for so long previously, the kidney infection must have been complicated by septicemia (bacteria in the bloodstream). When she came to work this day, she had mild urinary symptoms which she thought she could ignore, but now she had a full blown problem. She handed me the emergency medical briefcase that airlines carry onboard, but all it contained were cardiac medicines and injectable opiate analgesics. No antibiotics. What was I going to do to help her? Soon we would be crossing the ocean and there would be no option for emergency landing.
In a New England Journal of Medicine study published on May 30, 2013, it was estimated that there is one in-flight medical emergency for every 604 commercial airplane flights, and overall, there are approximately 44,000 medical emergencies each year world-wide. Serious illness is infrequent, and death rare (3 per 1000 cases). The most common illness causes in order of frequency are fainting and near fainting, respiratory symptoms, nausea or vomiting, cardiac symptoms, seizures, abdominal pain, and infection (such as in my patient). Other in-flight emergencies include agitation or psychiatric symptoms, allergic reactions (better not bring peanuts onboard), stroke, trauma, diabetic complications, headache, arm or leg injuries, Ob-Gyn symptoms, ear pain, cardiac arrest, and lacerations.
You can never be certain that a physician or other medical professional will be on your flight if a medical situation arises. If you feel moderately sick before you start a long airplane trip, chances are that you will feel even worse during the journey so it would be wise to cancel and request a written note from your doctor. If you take medicines, bring them in your carry-on, not in your packed luggage. If you have a past history of a serious infection which required hospitalization, bring antibiotics with you. My flight attendant patient was totally unprepared.
For cardiac emergencies, the airplane I was on was well equipped. There was an automated external defibrillator (AED), oxygen, epinephrine, and a variety of other cardiac medicines. I was dismayed that there were no medicines for infections. In order to help my patient I needed a strong antibiotic that I hoped a well-organized passenger had brought along. I asked nearby passengers for Cipro 500 mg, and fortunately someone volunteered the medicine. All we needed were two doses. Meanwhile, my patient’s kidney infection was causing her significant pain, so I also asked if there was a nurse on board to administer an injectable narcotic. Luckily a kind Kaiser dialysis nurse offered his expertise.
The pilot of the plane spoke to me. We would be flying over Reykjavik, Iceland soon, and this would be our last opportunity for an emergency landing. The pilot put me in touch with a United Airlines land physician in Chicago. I explained to him that everything was under control now that a passenger had donated Cipro. Normally, when one presents to the ER with a serious kidney infection, IV Cipro is administered because it is a faster way to get the medicine into the body. Whether Cipro is given IV or orally, it should have equal efficacy which I discussed with the airline’s physician. I did not think diverting the plane for emergency landing was indicated, and the airline’s physician concurred. During the reminder of the flight I checked my patient every two hours to make sure her vital signs were stable and that she was comfortable. With the help of the narcotic, she slept most of the way to San Francisco. –at least one of us got some rest. – I always feel elated when airplane wheels touch land, and this time I breathed an extra sigh of relief.
I didn’t ask United Airlines for any compensation for volunteering my medical care, but they sent me a $200 voucher anyway. Two weeks later I received a wonderful thank you letter from my patient. It was reaffirming to know that she had completely recovered.
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Editing acknowledgement: Ellen Saliman
Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider