The Sad Truth About Flying
If you suffer a cardiac arrest during a long-distance airline flight, oxygen isn't going to save you. Airlines don't always have medical personnel aboard, unless a Good Samaritan physician happens to be on the flight and agrees to come forward and help (hopefully it's not a Dermatologist or Pathologist). A defibrillator might buy some time, but not in every case. Even if the AED happens to restore a functional heart rhythm, it still cannot treat the underlying disorder, which is often fatal despite the most appropriate land-based treatment in our modern emergency departments.
Airlines do not carry a full complement of ACLS drugs or, to Nurse K's chagrin, cath labs. The 30,000 feet-to-balloon time is completely unacceptable. They can't check an ECG or monitor the cardiac rhythm, and they don't even stock thrombolytics.
I'm sure a lawsuit will be brought against American Airlines in this case, but the sad truth is that if you have a cardiac arrest when you're 30,000 feet over the ocean, then you are likely going to die whether the oxygen tanks are working or not.
Labels: Carine Desir, medical
posted by scalpel at 1:31 PM
15 Comments:
I was of the impression that many of the systems they're using now *can* in fact transmit rhythm strips to ground-based advisors, who can help coordinate diversion and EMS on arrival. Specifically, Medaire in Phoenix has the ability to read ECG data in-flight and has had for at least five years.
In any event, yes, people have a completely unrealistic expectation of what can be done for them in-flight. I was shocked when I worked for an airline as to how little useful stuff was in the kit. The situation has improved some: here's a list of the basic kit contents from Medaire and the expanded ones. Not much help.
I looked at the MedAire site, and I can't find any mention of transmission (or even determination) of cardiac rhythms. Maybe they do that for some private medical flights, but I'm not aware of any widespread use of that technology on commercial flights.
I'd like to have some amiodarone in the kit, myself, but the advanced kit they offer is at least a good start.
The last time one of our ER docs did a good samaritan airline resuscitation (they had an AED with pacer capabilities apparently), he was on the same plane as an intensivist at a hospital down the street from ours...so the guy had an ER doc and an intensivist work on his heart rate of 30. An ICU nurse was also in attendance and did some recording of rhythms and basically "charted" on the patient. They all got free round-trip airline tickets.
They hooked him up to the pacer pads, which is about all they could do. I'm not sure what drugs they had on board, if any.
I've seen symptom onset to balloon times in under 1 hour for patients who had chest pain/acute MI in-flight, BTW. They land the plane and whoosh! off to the cath lab. We get a lot of airport patients.
Whoosh!
OK.
Hey, my comments have sound effects built right in for added intrigue.
Medaire uses the Tempus gadget for at least some of their customers.
It's incredibly impressive.
Here's what it is.
Here's who uses it.
Her sx's sounded more like CHF after a Big Mac attack to me... But other options abound, like afib with rapid ventricular response in a lady with mitral stenosis, etc., etc. Florid pulmonary edema, irrespective of cause, is gonna get you at 30,000 feet and noone on the ground is gonna make a hill-o-beans difference if you can't adminster any effective therapy.
My sympathies to the flight attendants and doctors who were caught in this no-win situation.
No offense, but it reminds me of the effectiveness of seatbelts when a plane crashes from 30,000 feet....
* Splat *
(Sorry, I HAD to get my sound effects in, too!)
Okay, so let's say the airlines have a fully stocked array of meds to deal with whatever ails whomever. If there's no one on board who knows how to use any of the stuff (besides basic AED and O2 training which flight attendants all get if their plane is big enough to be required to have an AED), then what? Do we sue the airlines for not having trained medical professionals on board as well?
I feel badly for this family, but sometimes there's just not anyone to blame.
I took care of a patient once who got very ill on a trans-Pacific flight. He was lucky. There was an American doctor and nurse on board as well as a very well stocked medical kit. Even then, they had to call Medaire to have them find out what the meds were they had to work with as they were not by American makers and had different names than the Americans were accustomed to. The patient survived and recovered.
But there's always going to be something...
The Tempus equipment looks pretty handy, but as Dr. Wes mentioned, without the proper meds there wouldn't be much anyone could do in some situations, unless the plane happened to be flying over Nurse K's hospital (heh). You've only got 20 mg of IV lasix and some sublingual nitroglycerines. Then you're reduced to a hand-holder.
One of our ER nurses and her paramedic husband were on a flight toward there honeymoon destination. A man on board did have an MI, they did try to help and he did not make it.
Sad about the miscarriage too. I can't help but wonder if she was allowed to rest if maybe she would've kept the baby because of my own personal experience.
I almost miscarried 1st son and bled some with the second.(the 1st worse then the 2nd) but both times bed rest and my OBGYN said if it's gonna happen it's gonna happen. I was bleeding heavily for almost 24 hours with 1st one. I stayed in bed except to use the bathroom at which point the bowl was bright red. Any time I was upright i felt a huge warm gush of seemingly nonstop blood. Not good.
The next afternoon a friend (pastor's wife) came over and helped me get a sponge bath to help me get ready to go to the dr. She also took my hand and prayed a really powerful prayer for us...the baby and me.
By the time I got to the doctor that night...there wasn't a drop on the pad and he said my cervix was closed, but he also said because that happened that I had a 50/50 chance that I kept the baby.
The next month he thought I lost it because my cervix wasn't as large as it should be and sent me for a pregnancy test.
Jonathan (means gift of the Lord)weighed in at 10:10oz and 23 inches long. :)
Scalpel delete if you wish...not sure appropriate here...just made me think what if I didn't get immediately into bed and had even more psychological stress besides fear of losing the baby.
I think they absolutely should have gotten her medical attention and shame on them for not...even if it wouldn't have made a difference. Any woman who is happy about the pregnancy and has ever felt the gushing of blood and fear of losing the baby knows exactly why i feel this way.
On the way to (of all things) the ACLS National Meeting, 1 Peds ED attending, 3 Peds ED fellows, and 1 Peds ED nurse found ourselves swapping flights midstream.
We arrived at our first class seats on the later (actually NOW) flight to find that my seatmate was purple and not breathing...seizing, in fact.
We removed him from his seat to the aisle, assessed him and found his HR to be missing as well. An AED, an O2 tank, and a full drug bag (including IVs, ETTs, bags of NS, and amps of destrose, epi, and other resuscitation drugs were handed to us).
We put these tools to good use. The patient's airway was secured. Chest compressions were continued until the AED required them stopped in order to shock. IV access was obtained for medications to be given (epi, I believe, initially).
The patient recovered spontaneous heart rate and respiratory rate both prior to the arrival of EMS to the plane to remove him to the hospital.
We later heard back that he did well, despite multiple medical problems that had caused his initial concerns. Of course, we did start on the ground.
I've also had a very scary emergency in the air, one of those where you're woken up over god-only-knows-where by the page, "Is there a doctor on the plane? PLEASE!" and you know it's not the first time they've asked.
A mid-30s healthy woman who had had a headache that morning now had lost all speech and control of half of her face midway across the country on what was supposed to be a non-stop flight. As I watched for a minute, she began losing control of her right arm and stumbled on her right leg.
She had an evolving stroke...one of those few things for which nothing in that mythical drug bag (the one I'd pawed all over just a few months ago) was really going to help.
I had her sit down and put an O2 mask on her for some increased flow to the brain, then talked to MedControl. We were right overhead of Kansas City at that moment.
I've had few flights that were as much fun as dropping 36,000ft to ground in "immediate-now" mode when I'm not belted because I'm holding the patient from crashing and falling, keeping her O2 mask on, and making a few random chart notes as it went on.
I believe she was to Interventional Radiology getting fixed for her embolic stroke within 60 minutes of when I got woken on the plane. And today, she's almost 100% back to normal.
Right time, right place can make all the difference in the world sometimes.
I got bumped to first class after assisting a passenger in distress many years ago. I don't remember the specific patient complaint or what I did for her, only that it was a benign situation.
All I remember was the real silverware, cloth napkin, gourmet food, and bigger seat in first class.
I did it once, and all I got was a complimentary bottle of the wine from first class. The one thing that can make a difference is clearing the airway on an apneic patient or starting CPR timely on a patient with asystole. When everyone waits for the EMT's, or to wake up the dermatologist, it may be too late. Whether there is a doctor on board or a boy scout with training, or the flight crew, the main thing is the timing.
Do they know for sure it was cardiac in nature? She was on a long flight after all. Could it have been a massive PE?
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