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DOCTOR ON BOARD: Now What?
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
T
he Christmas Day Journal of the
American Medical Association re-
minded us of the all too familiar
intercom call:
“Is there a doctor on board?”
A November 2013 New England Journal
of Medicine article by Drew Peterson et al.
noted up to 10 percent of all commercial
flights feature this inquiry. Few among us
have not responded at least once. The im-
portant question is, how? What is wrong
and what have we got to work with?
The December JAMA review article by
Christian Martin-Gill et al noted that only
4.4 percent of the estimated 250 to 1420
daily medical in-flight emergencies (IME)
require diversion for rapid landing (cumu-
lative data from 14 publications). About 4
billion people fly each year, and many of the
intercom calls are for minor incidents and
may not be reported, so the range of esti-
mated IME is quite a guesstimate. Syncope/
near-syncope lead the list for the stricken,
followed by GI problems, breathing prob-
lems and heart problems (thankfully the
reviewers found that cardiac arrest occurred
in only 0.2 percent).
I first experienced this as an almost-do-
ne PGY3, flying back from a June 1987 fam-
ily reunion in San Diego. I had five books
in my backpack in preparation for long,
luxurious reading sessions in my blissfully
un-pageable surroundings. I had See’s candy
bars, almonds, tangerines and kiwi my sis-
ter had cut up for me that morning. It was
gonna be great.
We were over the Arizona desert when
the overhead page came. I leaped up and
ran forward, colliding in the aisle with two
other doctors, both of whom looked older
and smarter than I was. We quickly deter-
mined that they were OBs and the man in
first class with his shirt open, pale and sickly,
was my guy. He looked old and grey. We
laid him down, they brought oxygen, and
he pinked up slowly, barely able to speak.
He had rapid atrial fib and the first officer
said, “We’re about to Phoenix, land in a few.”
I said, “Yes sir, good.” I could get a palpable
blood pressure only and one OB guy did a
great jugular IV, which got his SBP up to 95.
We knelt there and watched him until the
ambulance met the plane. His wife thanked
us. When I returned to my seat, I was bom-
barded with medical questions. The crew
noticed, and promptly moved me up front.
I went back to my books, shaky after it
was over. What if we had been mid-ocean?
In a terrible storm? As it turns out, turning
around is not always the safest choice for the
patient. Planes may need to dump fuel or
“land heavy,” which is necessary for regional
jets (Boeing 737s, DC-9s, Airbus320s for
instance), which do not have fuel dumping
systems. The captain will consult with the
on-ground medical team and the airline
ops center before deciding to fly on or turn
around, since flying on may be the safest
choice for all aboard. The captain makes
the ultimate decision about diversion or
continuing.
The other memorable time this hap-
pened, my husband Goetz and I were fly-
ing home together. It was a pre-9/11 flight
back from Munich to JFK, and we were
over France, approaching the Channel. We
heard the page, and both ran forward to first
class, where a young, pale, puny looking
female flight attendant was being supported
by her crew, on the floor. She had chest pain
and some difficulty breathing. The cockpit
door was open, and the flight crew could
hear what we said. She had a thin pulse
and looked hungover and dehydrated. She
whispered to us that yes, she had been par-
tying, it was the holidays, and that this was
her first international flight as a crew mem-
ber. “Please,” she said, “please do not make
the plane turn around.” She was afraid it
would be her last international assignment.
There was no stethoscope. Goetz listened
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