We broke open the aircraft medical kit, which was surprisingly well supplied, complete with a manual BP cuff and medications any registered respiratory therapist or code responder would find familiar. Bronchodilators, epinephrine and lidocaine, the usual aspirin, even IV tubing and needles. The one thing I was shocked to find was that there is limited supplemental oxygen: only enough to supply a nasal cannula at 4L max, and that for only a few hours.
As with the vast majority of medical cases, a thorough history of my 73-year-old air traveler proved invaluable. She felt light-headed but never lost consciousness. She had no other symptoms. Her past medical history was significant for hypertension but no heart disease. Was there anything else? She had been discharged from a hospital three days before for severe hypertension. Her ACE inhibitor and beta-blocker doses had been doubled and HCTZ added (her hospitalist had done an excellent job educating her on her disease, her medication changes, and possible side effects).
Anything else? She had been traveling more than 12 hours with little to drink, but she had taken all of her meds just before boarding the flight. After some oral rehydration, leaning back, and elevating her feet, her blood pressure increased to 125/71. I checked on her frequently for the rest of the flight, and she was talking happily to neighbors and her son long before we deplaned. They were en route to Boston, where she was moving and had no doctor, but she had an appointment scheduled with a new one soon. I gave her my card and my cell number and instructed them to call me if there were any problems. She and her son were thankful (and her neighbors were too!), and I was glad to have helped.
The Aftermath
The only thing left was the administrative paperwork for the airline. Would I please sign here? What was my license number (they were confused as to whether to take my NPI, my state license number, or DEA number, so I gave them all three), and where was I employed?
After getting home and recovering from my jet lag, I did some research on this topic. Colleagues of mine expressed concern over the legal liability of providing assistance in flight, but, compared to our day jobs, that concern seems to be unwarranted. The Aviation Medical Assistance Act of 1998 (www.gpo.gov) protects healthcare providers who render care in good faith.
As of the 2008 article by Ruskin, no physician providing care for an airline patient had been successfully sued. I learned that the medical kits are fairly well stocked and are set up for the physician/medical professional. I also learned that supplemental oxygen, so ubiquitous in the hospital, is more limited on an airplane. And, I found out that, while airlines contract with ground-based medical services, half of all emergencies are cared for by Good Samaritan doctors, licensed providers, nurses, and EMTs.
So, before my next flight, in addition to packing my iPad and thumb drive, boarding pass, and ID, I plan to pack those reference articles by Ruskin and Peterson.
Dr. Howell is president of SHM, chief of the division of hospital medicine at Johns Hopkins Bayview in Baltimore, and spends a significant part of his time and research on hospital operations. Email questions or comments to [email protected].