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Wednesday, November 18, 2015

A Call to Integrate Commercial Airline Emergency Training in Medical Education

I totally agree. I remember the first time I was summoned to an in-flight medical emergency. It was a transatlantic flight--equal distance forward as backwards. Yes, I was prepared by knowledge but I was entirely unprepared proceduraly. I did not know what was available resource wise on the aeroplane. I quickly found out the stethoscope was useless because all I could hear was the drone of the engine and cabin noise transmitted through the patient's body as he laid on the galley floor. I could not determine heart sounds or breath sounds. Checking a blood pressure by auscultation was likewise fruitless. There was an automatic electrical defibrillator (AED) which worked well. With self-relief I was able to start an arm IV with the first stick. I had not started a peripheral IV since medical school so this was a win for me. But, quickly followed by a "loss" as I didn't realize I had to throttle the saline flow rate with the in-line clamp. The consequence, was that the patient, who appears to be having an acute heart attack, received an entire liter of saline in minutes. There was a 2nd liter of saline available-and no more-with 4 hours of flight time to go. There were no medications. So I had to ask the passengers on the flight if anyone had aspirin, nitroglycerine and a beta-blocker. Luckily, passengers volunteered both. I think at a minimum, medical providers may benefit from an in-service regarding the emergency medical resources available (and not available) on an airplane and whether these resources are standardized across carriers domestically/internationally. I attended to the patient and stayed steadfast at his side for the remainder of the flight. I hope he did well.
from Rajesh Harrykissoon, MD