EMS at 35,000 Feet: Part 2

Last month, I shared stories of two ALS calls I had responded to while flying to and from China in 2002. While both patients recovered fully en route, it became clear to me that resources, in terms of personnel and equipment, are very limited on aircraft. Though many flights travel each day over vast expanses of water, most airlines carry only minimal medical supplies: an AED with no screen, 500cc of normal saline, a few IV catheters, limited drugs, an OB kit and minimal airway-management supplies. So what does one do when faced with a true emergency at 35,000 feet?

One of the most important tools paramedics have is their heads. Our training has provided us with the ability to rapidly assess a situation, determine a plan and put it into effect. We are trained to ask for help when we need more resources or equipment. But what happens when there is not enough equipment and no help available?

Cyclist Down

In August 2002, I was returning from a business trip in China when, shortly after takeoff, a call was made asking for a doctor. We had just left Shanghai’s Pudong Airport and were still climbing when the call went out. I rang my call bell and identified myself to the flight attendant as a paramedic. She told me a patient had passed out and was seizing in the coach section of the aircraft. I made my way back and found a 30-year-old Caucasian male, supine, pale, diaphoretic and semiconscious. He was being attended to by his father, who was a general physician from Connecticut. I introduced myself as a paramedic and asked what had happened. The father told me that the patient was talking normally prior to takeoff, though feeling somewhat sick to his stomach, and as the plane took off, he became unresponsive and seized. At that time the doctor had laid his son down on the floor and called for help.

The plane was still climbing, which resulted in the patient’s head being elevated several inches above his feet. I first suggested we remove him from the narrow aisle and elevate his feet. As space was limited and the patient was unresponsive, we found it easier, given the circumstances, to elevate the patient’s feet where we were until we leveled off and could determine what was happening. The patient had shallow respirations and a heart rate less than 60, and was hypotensive. The father told me that the lower-than-normal vitals were not unusual, because the patient was a long-distance bicycle racer and was in good physical condition. Acknowledging this, I asked if the patient had a seizure history, how long they had been in China, if there was any relevant medical history, etc. The father stated they had been in China on vacation for several weeks and that the patient was healthy with no meds or allergies. I asked about the patient’s most recent meal, and his father said it had been in Shanghai the night before, nothing unusual, and he didn’t recall if the patient had eaten breakfast. It was clear the patient had voided both bladder and bowel. After being on oxygen by NRB and having his feet elevated for a few moments, the patient became conversant and filled in some holes in his history.

It turns out the patient had not been feeling well since the night before. He had eaten a normal dinner, but afterward, while walking down the street, he’d consumed a Chinese drink known locally as sour milk. The patient had purchased this beverage from a street vendor. Within hours of consuming the beverage, he’d developed stomach cramps and endured several bouts of nausea. He’d slept a few hours before having to wake for the flight home. He had not had breakfast and had suffered a stomach ache all morning, with a few more loose bowel movements prior to boarding the aircraft.