As I am currently scraping the bottom of the barrel in terms of travel blog content, I thought about writing up a short post about my past resort vacation to Punta Cana, Dominican Republic. However, whilst pondering that post, I remembered that my experience on the flight there was perhaps a lot more ‘exciting’ than the trip itself, as far as travel stories go.
Imagine that you’ve boarded an international flight and are just about to doze off to sleep, when you are jarred awake by a voice on the intercom: “Is there a doctor on board?” and realize that the doctor on board is…you! As I progressed through medical school and residency, this is the moment that I dreaded someday happening. Since I didn’t travel much while in school, there was virtually no chance of me ending up in this position at that time, but once I started independent practice and began indulging in my wanderlust, I knew that it was bound to happen.
YVR (Vancouver) to YYZ (Toronto): A plane full of doctors
The first time I witnessed an on-board medical emergency was in late 2016, on a domestic flight from Vancouver to Toronto. Coincidentally, I was returning home after a medical conference and my flight was in fact filled with other doctors who had also been at that same event. I was sitting in an aisle seat and just about to close my eyes for a nap, when I detected some commotion ahead of me. A woman who had been walking down the aisle toward the bathroom suddenly collapsed and was lying flat on her back on the floor. Fortunately, she regained consciousness almost immediately and was able to sit herself back up, right beside a cardiologist! Two rows beyond that were a couple family medicine and surgery residents, and then me. What are the chances? It turns out that she was diabetic and had low blood sugar, so just got a bit woozy from that. Easily cured with a glass of apple juice.
YYZ (Toronto) to LGW (London): The overnight call
The next time I heard the dreaded intercom call asking for a doctor on board was in January 2017 when I travelled to London, England with my sister. It was an overnight flight and I was fast asleep, when I was awoken by the voice of a flight attendant asking for any doctors or nurses on board to identify themselves. I pushed my call bell but there was already someone else available to help, so I didn’t even find out what the situation was. While deboarding, I did spot a woman at the front who appeared to be waiting for emergency medical personnel. She looked alright on my general inspection, so hopefully everything turned out fine for her!
YYZ (Toronto) to MSP (Minneapolis): Fainting in the bathroom
A few months later in 2017, I was on the way to Hawaii with my mom. We flew with Delta Airlines, taking us from Toronto to Minneapolis, where we would have a brief layover en route to Honolulu. About halfway through the Toronto-Minneapolis flight, I was again about to doze off when I heard someone yell from the back of the plane. An older man had passed out in front of the bathroom, but had gotten up by himself within a few seconds and went right in, closing the door behind him. There was some confusion about what had happened as I headed toward the back and knocked on the door to check on the guy. He came out looking completely fine, with no recollection of the event, and was able to walk back to his seat. At this point, a couple other doctors who also happened to be on board showed up and took over the assessment, so I just headed back to my seat. The incident seemed a bit concerning to me, but I assumed he turned out okay when I later spotted him in MSP on the way to his connecting flight to Las Vegas.
EBB (Entebbe) to AMS (Amsterdam): The sick baby
Later again in 2017, I travelled to Tanzania for a volunteer medical mission and capped off the trip with a few adventurous days in Uganda. On the way home from Entebbe, Uganda, my friend (and fellow doctor) and I became immediately nervous when we saw a woman come on board with a tiny baby who we overheard was being medically evacuated. This was followed by immediate relief when we noted that mother and baby were accompanied by a physician, who I assume would have been fully competent to manage any emergencies that arose in-flight. I guess this incident doesn’t really count as an experience of my own, since I ended up having zero involvement. However, I am immensely grateful for this, as my knowledge of paediatric medicine is very rusty these days and my worst nightmare, even in the best of times, is taking care of a sick child.
YYZ (Toronto) to PUJ (Punta Cana): Fainting before takeoff
This is probably the most eventful thing that happened on my trip to the Dominican Republic in early 2018. Mr. Chuckles was attending a work conference at the Hard Rock Resort and invited me to join him for a couple days afterward, so I took the flight from Toronto on my own to meet him. Usually, this is a quick three hour flight that would have landed me in Punta Cana in mid-afternoon, but I didn’t arrive until late evening on account of the in-flight medical emergency. As we were about to take off, we heard some commotion from the front of the plane, and the dreaded announcement came over the intercom: “Would a doctor or nurse on board identify themselves?” I pushed my call bell and got up to see a young man lying on the floor in front of the bathroom, illustrating yet again that the airplane bathroom is the spot to pass out. He had apparently fainted as he was standing up, but regained consciousness quickly. A nurse on board actually got to him before I did and was already checking his vital signs, which were stable. Because we were still at the gate, they got the guy out quickly and he was taken to a Toronto hospital immediately. For the rest of us raring to start our island vacation, the incident led to a delay that required the entire cabin crew to be switched out, so we ended up sitting in the plane for about an hour more until we were finally ready to go.
Observations and lessons learned
In-flight medical emergencies are common.
No kidding. Considering that I was at least peripherally involved in five in-flight medical emergencies within little more than a year, I’d say that they do happen often. Fortunately, I think the majority of incidents are fairly benign, most commonly vasovagal episodes from people who have not had enough to eat or drink, or who strain a bit too hard on the toilet. 🤭
There’s a decent chance that there are other medical professionals on the plane.
My most dreaded scenario is being the only medical person in an emergency situation, but thankfully this has not yet happened. As you can see in my stories above, there were at least 2-3 healthcare providers on board and available to assist in every scenario I’ve been in. Between you and me, I think that the best medical personnel to have around in situations like these would probably be emergency medicine doctors, anaesthesiologists, general surgeons, paramedics, nurses, and maybe even just a couple large bodied personal support workers trained in basic CPR. You want the ones who are confident enough to escalate care to the level of performing procedures like putting in an airway or inserting an IV line, if it comes to that.
It’s good to know what is provided in the in-flight emergency medical kit.
After encountering my fourth in-flight medical emergency, I decided to do some research on what could be reasonably done on an airplane. It turns out that the medical kit on most planes is fairly extensive, including medications for Advanced Cardiac Life Support. Apparently, automated external defibrillators are not mandatory, but most reputable airlines will voluntarily stock them. Most medications in the kit can also be given intramuscularly, so fumbling to insert an IV line can hopefully be avoided in an already stressful situation. This article from the CMAJ was very enlightening. At a whole other level, there are the wild stories of doctors McGyvering medical devices, like this one who created a makeshift catheter by literally sucking urine out of a man’s bladder with a straw. 😯
There is medico-legal protection for physicians who assist in an emergency.
This will vary between jurisdictions, but for Canadian physicians in general, there is no legal obligation to assist in a medical emergency outside of the clinical setting. Of course, most of us will, in order to honour our ethical obligations. You know, the Hippocratic Oath and all. The question that arises is whether we may put ourselves in a precarious medico-legal situation if we step up. It turns out that the Canadian Medical Protective Association does provide legal protection to both retired and practicing physicians who act as good Samaritan. As long as the physician provides care in good faith, the probability of being sued successfully is very low. Good to know!