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Responding to in-flight medical emergencies
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Responding to in-flight medical emergencies

Bangalore-based Dr Sankaran Sundar talks about his experience of dealing with in-flight and mid-air medical emergencies 

From less-complicated cases like anxiety attacks and dehydration to more serious issues like strokes, seizures and in some rare cases, even childbirths- medical emergencies on board aircraft are more common than one might think.

On a recent flight from Delhi to Toronto, I responded to the call for a doctor on board for the third time in my career.

We landed in Delhi from Bangalore around 1 am and our connecting flight to Toronto was scheduled to depart at 3 am. The boarding was nearly complete, and the captain even announced that we would be taking off very soon when I heard the familiar in-flight announcement – “Is there a doctor on board?”

A radiologist from Canada and I immediately rushed to the back of the aircraft where a female passenger, in her 50s who was reportedly having seizures and looked disoriented was seated. She was not talking, was foaming at the mouth, a typical sign of a seizure.

She appeared to be travelling alone and her neighbours informed us that she had shown signs of convulsions.

One of the immediate first steps when it comes to dealing with an in-flight medical emergency is to check the passenger’s vitals- we checked her pulse, observed that she was breathing normally and understood that there was no immediate danger to her life.

Within ten minutes, she started talking- she opened her eyes and began responding to commands.

Since the flight had fortunately not taken off yet, we had to take a call here on whether to evacuate her or let her travel on the same flight. We felt that this was a scenario of a ‘stroke in evolution’- a phase where one can experience altered speech, slurred speech, does not respond to commands etc. If treated within the golden hour, we can prevent the occurrence of an impending stroke. We decided to evacuate this passenger based on our medical knowledge.

Seizures on board flights are common. Sometimes, even diabetics who have not eaten properly before a flight could have low blood sugar levels and experience convulsions. This is one of the most common causes of seizures on flights, it is common in people who have not eaten properly, who are dehydrated etc.

Fortunately, in this case, her co-passenger reported the medical emergency before the flight had even begun cruising. Had this occurred mid-air, the scenario would have been very different, we would have had to make an emergency landing at the nearest airport, a call that the pilot usually makes.

Something similar happened on the return flight from Toronto to Delhi, few hours into the flight, I was called in to see an elderly man with palpitations and sweating – classic symptoms of low sugar or Hypoglycemia. He had taken twice his usual dose of anti-diabetic pills by mistake. With a little reassuring, a bar of chocolate and some salt and sugared lemon juice, he became well.

The first time I responded to the call for a doctor on board was on a flight to Bangalore where an air force officer on board developed chest pains mid-air, in late 1980s. I could administer him with some Morphine (pain management medicine) on the flight and then the pilot got in touch with the nearest Command Hospital Air Force, which dispatched an ambulance to the HAL airport. Within half an hour of landing the officer was shifted to one of the hospitals in Bangalore where he underwent an angioplasty. The heart attack was treated on time, and he survived.

Post the incident I received two personal letters- one from the Chief of Air staff, thanking me for saving the life of the officer and one from the wife and daughter of the officer. For a young doctor who had just started my medical practice, these letters meant a lot- I treasured them for a long time.

The second incident happened on a flight to Korea and was much less complicated. A female passenger on board, who had a history of psychiatric illness and was on medication, experienced a panic attack mid-air. It was not a critical medical emergency and I was able to calm her down by talking to her. In this case, there was a family member on board who was able to tell us about the woman’s medical history.

In the most recent case, however, we struggled since she was travelling alone and did not have any next of kin listed as her emergency contact. I would suggest that all airlines make it mandatory for people to list someone- a friend, a neighbour or even a colleague- as their emergency contact person.

Another useful piece of information I have gathered over the years is that if you’re a doctor responding to a call on a flight, do not take any remuneration for your service. Do it purely out of good will. Accepting token gestures such as a box of chocolates or a bottle of wine from the airline as acknowledgement of your efforts could mean that the Good Samaritan Law, which protects those who provide assistance in a medical emergency, will not apply.

As a doctor, if I refuse to treat a patient going through an episode on board, that may also be considered unethical. If I’m a qualified, certified doctor on-board, I will have to treat the person. I would recommend that everybody, even those who are not medical professionals, should also get trained in how to provide Basic Life Support (BLS).

As told to Swathy R Iyer

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