SATURNINO P. JAVIER, MD, FPCP, FPCC, FACC
Dr. Saturnino P. Javier is an interventional cardiologist at Makati Medical Center and Asian Hospital and Medical Center. He is a past president of the Philippine Heart Association (PHA) and past editor of PHA’s Newsbriefs
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I sometimes look forward to a long, uninterrupted direct flight because it gives me the opportunity to really relax and recharge. With a loose sweater on, comfortable slacks, shoes off, seat in full reclined sleeping position, and with the headphones keeping you temporarily sound-isolated from the outside world while watching a movie, it can be one of the fringe benefits and (not-so)-cheap thrills of a long trans-Atlantic flight via American Airlines from Los Angeles to Hong Kong (with a connecting flight to Manila).
Then, as you savor cashew nuts and hold your breath on this suspense-filled Steven Spielberg blockbuster, the movie takes a pause as an announcement comes on your headphone – “Is there a doctor on board.” This one is more emphatic than previous announcements I have heard before. “We request for urgent medical assistance in Seat 56C.”
This was not the first time I would have to respond to such calls. Several years ago, I distinctly remember a Philippine Airlines flight from San Francisco to Manila where I attended to an old man complaining of dizziness and weakness. He had a low blood sugar level since his last meal was eight hours ago and he was still given his medication for diabetes by his companion. He immediately responded to some crackers and juice. I had to check on him two more times before landing to make sure he was fine. Before we landed, I was handed a bottle of champagne for my efforts. I was hoping for a word of thanks at least from the family of the old man, but I guess that was asking too much.
When I responded to this call for medical assistance in seat 56C, two other responders were there – a Filipino nurse and a Caucasian radiologist who immediately gave way to me when he learned I was a cardiologist. The passenger was a 72-year old man travelling alone. He was pale, looked really ill, drowsy, but still conversant. A diabetic and hypertensive, he claimed some abdominal and back pains when he boarded the plane. His last meal was six hours ago.
From what I can feel, his pulse rate was around 50 per minute and was noticeably weak. I immediately took his blood pressure and got 80/50 mm Hg. The other physical examination findings did not suggest any evidence of heart failure or an acute abdomen. (My medical orientation already conjured several benign possibilities – Hyperacidity? Gastroesophageal reflux? A vasovagal reaction? Hypoglycemia? Or more ominous ones – like acute coronary syndrome, a dissecting aneurysm, gallstone?)
The courteous and professional crew updated me with what they had on board – a few medications like aspirin, metoclopramide. (I do not remember if they had nitrates.) I immediately requested the nurse to start an intravenous line. We brought him to a vacant three-seater readied for him by the crew – and put him on Trendelenburg position (feet higher than the head), loosened his shirt and immediately run 200 milliliters of intravenous fluid. I requested the crew to bring out the automated external defibrillator (AED) – just so we were ready if ever the need arose. I was told by the head stewardess that the pilot was informing me that the nearest airport was in Anchorage if there was a need to land.
Then it dawned on me the tremendous responsibility that rested on my shoulders. The pilot, coordinating with a medical crew on the ground, would make that decision to divert and land the plane. Up above at 37,000 feet, I ‘shared’ the ultimate responsibility to recommend to the pilot the immediate diversion of a US aircraft with more than 200 passengers to a nearby airport. I figured that the last thing a flight crew would want was a dead body on the plane. (Most airlines do not have a dedicated space for a dead body – an untoward sight for any passenger on any flight)
Fortunately, with the measures we instituted, he felt much better in less than thirty minutes. His blood sugar was on the slightly low side so we gave him something to munch. His vital signs improved. I told the crew to relay to the pilot my humble suggestions – one, no need for an emergency landing; two, to have a medical response team available on the ground at our destination so he could be immediately evaluated at the nearest hospital. I did a few more follow-up checks interspersed with my second Spielberg movie prior to our arrival to ensure that he remained fine.
Prior to landing, I was requested to accomplish a report. For my efforts, I was sent a travel voucher discount card worth 400 USD. Though it would really sound like a cliché, I was just too glad to be of help—and Spielberg could wait anytime.
Is responding to a medical emergency on board a flight worth it? (please see Part 2)
March 2018 Health and Lifestyle