We were still climbing from the airport tarmac, and the movie on my iPad, “Star Trek II: The Wrath of Khan,” was at an exciting point where Klingons are attacking the USS Enterprise when it came: “Is there a doctor on the plane?”
If you talk to your physician and healthcare colleagues who fly, you’ll hear about this scenario enough to know that it is not a rare event. Healthcare providers who fly routinely are more likely to tend to a sick airline passenger than they are to diagnose pheochromocytoma in their day jobs. Pheo is a two-in-a-million disease, but getting ill on a plane happens to one to two people in every 20,000. In fact, the sick airline passenger is relatively common, with an FAA study estimating 13 events per day in the 1990s (Anesthesiology. 2008;108(4):749-755). There have been a number of interesting articles written about the doctor-on-the-plane scenario. Our own Bob Wachter, MD, MHM, blogged about it in his usual humorous and insightful way a few years ago here, (http://community.the-hospitalist.org/2010/08/22/if-there-s-a-doctor-on-board-please-ring-your-call-button), and The New England Journal of Medicine published a perspective on it at www.nejm.org/doi/full/10.1056/NEJMp1006331?query=TOC (NEJM; 2010;363(21):1988-1989).
My most recent experience happened on a flight just before the New Year, and because many of us will be flying to and from the annual meeting in Las Vegas and it seems to fit naturally (in many cases) with what we do as hospitalists, I thought I’d put pen to paper regarding the sick airline passenger in flight.
Fasten Your Seatbelt
As I was walked up to the first row, the flight attendant said a passenger had almost passed out. A doctor was tending to the sick woman already, as were two very concerned flight attendants. I have been through this before, so I knew I couldn’t go back to my seat just yet. I asked the physician if everything was OK and if he needed help. In my previous experiences, the initial doctor was often a specialist, or retired, or both. They often were relieved to see a hospitalist and happily handed over the care of the airline patient once they heard I’m a hospitalist. Sound familiar from your day job?
This episode was no different: Although pleasant and concerned, the initial doctor was retired, and he made it clear this was outside of his area of expertise. He didn’t exactly sprint back to his seat, but you get the picture.
The patient was pale, looked ill, and was semi-conscious. She was about 70 (later confirmed at 73) and was sitting with her son, who worriedly showed me the auto-blood pressure cuff they had brought with her; it read 81/60. She denied chest pain or shortness of breath. Her pulse was 65, and her breathing was not labored.
For a hospitalist, attending to the ill airline passenger can be quite rewarding. Most diagnoses are those we see every day: syncope/pre-syncope, respiratory, and GI complaints make up more than half of the calls. Death is rare (0.3%), and other “big” decisions, like whether to force the plane to land early (landing a plane still full of fuel or at a smaller airport is not to be taken lightly), are uncommon (7.3%). Still, the illnesses can be real, and more than a quarter of aircraft patients are transported to a hospital upon landing (N Engl J Med. 2013;368(22):2075-2083). Our skills at diagnosis are undoubtedly valuable in the air.
Also, as Dr. Wachter said in his blog on the subject, tending to the ill airline passenger is “one of the purest expressions of our Hippocratic oath, and our professionalism. We have no obligation to respond, and no contractual relationship. It’s just you, armed with your wits and experience, a sick and scared patient and family member, and about 200 interested observers.”