Panic at 10.000 meters in the air and 2500 kilometers to go

As most of you may know, going home for me means a 10-hour long 7000km trip across the ocean. Normally, the most exciting thing to happen is me snapchatting the fact that I am always lucky enough to be “randomly selected” for an extra check when going through immigration. However, this time, mid-flight an unexpected occurrence took place. A person fell right in front of me, and it was not a misstep that caused it. I almost immediately tried to jump out of my chair only to be stopped by my seatbelt. I unbuckled myself and went to the person and the first thing I did was check if air was coming from the mouth or nose and THANK GOD that there was. The person also luckily fell in what we are thought to be the stable side position, I checked for breathing and again, THANK GOD, that that was there. As I was done checking both airway and breathing, I went to circulation. I grabbed my phone to put a timer so that I could count the person’s pulse and as I was doing that I was ordered to go back to my seat. I looked up and saw that it was a lead stewardess, I got up and went back and went to my seat. 

As I was on my seat, I was thinking about what was going on, because they closed the curtain which blocked my view. This gave me a moment to think about what the reasons could have been for a person passing out on a flight. I grabbed a pen and paper and started making a list for reasons for syncope; I came up with the hypoxia/hypoxemia from air cabin pressure, standing up too fast after sitting for a long time, dehydration, or low blood-sugar. 

Afbeelding met lucht, buiten, water, natuur Automatisch gegenereerde beschrijving

A steward came to me and asked me if I knew what I was doing and if I could help them. I said that I am a medical student and can do my best. I showed both my student card and proof of enrollment card and suggested that it may be good to ask if there is an actual doctor on board. As I went to the person that fell unconscious with the steward, I noticed that the person was conscious and was sitting up in the flight-attendant chair. I started asking some questions to the flight-crew and they said that all they did till now was sit the person up and offer a glass of water. I asked if they have a glucose meter, sphygmomanometer and or stethoscope on board. As one attendant went to grab a kit, I was asking the person some questions with regards to their health. In the meantime, I heard the call of a physician and there was NO answer. I was at this point extremely happy that the glucose and blood pressure values were not at any alarming levels. The person was starting to feel better after having a glass of water and a small snack. The person was generally healthy and the main reason for syncope was most probably the fact that the person had not drunk or eaten anything the whole flight. 

I wrote down everything I measured and everything the person had told me on a form given to me by the head-flight attendant and left the person with the advice to drink regularly and press the ‘assistance’ button should the person once again begin to feel unwell. The head-flight attendant thanked me for the help, and I went back to my seat. 

After sitting down, the passenger next to me started asking me questions to which I politely answered with “I can’t say anything about the person that was just ill as that is private information”. The passenger next to me understood and followed up by asking me about myself, after a short and pleasant conversation I had a moment to myself. This was the moment that I started thinking “WHAT THE F*&# just happened?!”. My head was going crazy with all types of doom scenarios and how it could have all gone wrong, what if I had to reanimate someone, what if the person did have a super low blood sugar, what if the person’s blood pressure was super low…all these things were just running through my head without a single second of pause. At this point I was looking forward so much to landing that I started counting it down. I could not believe that I tried to jump out of my chair, I am thankful that I always keep my belt buckled as this allowed me to take a second to think and then approach the unwell person with a calmed mind. 

Just in case, to help you next time you are on a flight, and someone becomes sick here are a few things you should know. Firstly, people becoming sick on flights happens on about 1 in every 604 flights, so you almost need to be lucky to encounter this situation (1). Secondly, you are under no obligation to help (2, 3).  I could not find anything about medical students, but in the event of a doctor providing assistance the only duty the doctor carries is to not make the condition of the patient worse (3, 4). In clinical negligence, the doctor would however be judged by the specialty by which the emergency would have been treated should it have occurred on the ground, this regardless of the expertise of the volunteering doctor (3). Thirdly, you have a medical kit that has almost everything you need for emergency assistance, there is a sphygmomanometer, stethoscope, thermometer, basically almost everything you need for diagnosis. There is also a kit with intravenous supplies, medication that can be administered through intra-muscular injection and even airway equipment (5, 6). Lastly and certainly not least, there is always the possibility to be connected to a physician to be talked through everything you are doing and or must do (5, 6). 

To conclude, I have experience this twice in the past 3 years. This was a recollection of the first time 3 years ago. It ended well and with the crew gifting me a nice little package with my favorite ingredients, rum and coke. We landed about 2-3 hours later and I could not have been more relieved. Should you face this situation yourself, the first thing to do is calm yourself and then stand up to make yourself known. However, I honestly hope you never have to while on your way to a nice vacation. 

*DISCLAIMER*

This is a personal recollection of events and parts were deliberately left out to protect the anonymity of the other parties involved. 

References

  1. Peterson, D. C., Martin-Gill, C., Guyette, F. X., Tobias, A. Z., McCarthy, C. E., Harrington, S. T., … & Yealy, D. M. (2013). Outcomes of medical emergencies on commercial airline flights. N Engl J Med, 368, 2075-2083.
  2. Yuen Kun Yeu v. AG of Hong Kong [1988] 1 AC 175; Stovin v. Wise [1996] 3 WLR 388.
  3. Wong, M. (2017). Doctor in the sky: medico-legal issues during in-flight emergencies. Medical Law International, 17(1-2), 65-98.
  4. Op. cit (LJ Stuart-Smith).
  5. Howard, B. (2019, November 24). Is there a doctor [in training] on board? AAMC. Retrieved September 12, 2021, from https://www.aamc.org/news-insights/there-doctor-training-board. 
  6. Kodama, D., Yanagawa, B., Chung, J., Fryatt, K., & Ackery, A. D. (2018). “Is there a doctor on board?”: Practical recommendations for managing in-flight medical emergencies. CMAj, 190(8), E217-E222.