Today’s TR Pearl was inspired by an actual in-flight emergency i helped out with last year.

The Case

You’re on a flight home from vacation, finally fell asleep only to be woken up by your girlfriend: “Wake up, that passenger is having a seizure.” You look across the aisle and just your luck

You ask the flight attendant for the medical kit and to find out if there are any other medical professionals on board. The patient continues seizing but has their seat belt on preventing them from sustaining traumatic injury. What do you do next?

 

But first, lets take a step back and review in-flight emergencies

Background:

In the study linked above Peterson et al reviewed 11,920 in flight medical emergencies from 5 domestic and international airlines between January 1, 2008 and October 31, 2010. This equates to 1 emergency per 604 flights.

The most common problems were:

Syncope/Presyncope – 37.4%

Respiratory Symptoms – 12.1%

Nausea/Vomiting – 9.5%

Cardiac Symptomts – 7.7%

Physician passengers provided medical assistance in 48.1% of cases

Aircraft diversion occurred in 7.8% of cases

 

What Can You Do?

First, if you decide to help, airline staff might ask you for proof you’re an actual doctor. The FAA suggests airline personnel make a good faith effort to “check the credentials of passengers holding themselves out as medical professionals.”

The FAA requires all airlines have some basic medical equipment (full list). This includes an AED, basic airway equipment, IV set up with IVF, tourniquet. Medications include ASA, atropine, antihistamines, ibuprofen, albuterol, dextrose, Epi, sublingual nitro. Of note there are generally no benzos (although some airlines do carry them)

Utilize the flight staff. All flight attendants are credentialed in CPR and the used of AEDs. However, the flight crew is not allowed to administer any of the medications in the emergency medical kit.

Many airlines have contracts with hospitals to provide assistance via air-to-ground communications.

The flight staff may ask you if the flight needs to be diverted or landed emergently. Consider making this decision in conjunction with the doctor on the ground.

 

Can I Be Sued?

Yes, of course you can be sued. This is America, anyone can sue you for any reason

The Aviation Medical Assistance Act of 1998 does provide some broad protections:

“LIABILITY OF INDIVIDUALS.—An individual shall not be liable
for damages in any action brought in a Federal or State court
arising out of the acts or omissions of the individual in providing
or attempting to provide assistance in the case of an in-flight
medical emergency unless the individual, while rendering such
assistance, is guilty of gross negligence or willful misconduct.”

Note that this law does not require you to act, but seemingly provides some legal protection if you do. The law also does not touch upon the subject of compensation for acting. I’m not going to get into the subject of Good Samaritan laws and post hoc compensation, but i’d recommend declining any type of payment for your actions.

 

Resolution of the case:

I managed this seizure as any of us would.

The patient continues to convulse as i comb through the medical kit and quickly realize there is nothing of use

He’s alone, there are no meds in his pockets, and no one knows which bag is his

An elderly GI doctor comes by, but promptly leaves after learning i’m an ER resident (thanks dude)

After what seems like forever the patient stops seizing, is post ictal but with normal vitals and otherwise nonfocal exam

His mental status starts to normalize, he tells me has a seizure disorder and hasn’t been taking his meds (surprise) as he has been boozing/doing drugs all weekend

I speak with med consult on the ground, who arranges for a paramedics to meet us at the gate. The rest of the flight was uneventful.