edical emergencies occur on about 50 commercial flights a day in the United States. Many are minor — a passenger feels faint or becomes anxious. Others are life-threatening, like a heart attack or difficulty breathing. An article in the New England Journal of Medicine offered doctors and other health care professionals advice for handling a variety of situations. That prompted us to ask physicians for their stories. Here are a few of them. If you’ve ever provided medical care while flying (or rising a bus or train), tell us your story.
Gregg Greenough: An Ebola scare
Keith Van Meter: A long CPR session saves a life
Darria Long Gillespie: “Do I need to land this plane?”
Wanda Filer: A woman was going in and out of consciousness
Parveen Parmar: An older man, ashen gray, lying on the floor
By Gregg Greenough: One of my most memorable calls was on a flight from Europe to the United States during the Ebola outbreak last fall. It was soon after Thomas Duncan, who was infected with Ebola, flew from Liberia to Dallas.
About 90 minutes before we were scheduled to land, there was a call for a doctor. A man traveling from Liberia was saying he needed to vomit. With his eyes tightly closed, he told me he felt like the plane was spinning around — even though there was no turbulence. He didn’t want to open his eyes because he knew if he did he would vomit.
I had just been through Ebola training at Brigham and Women’s Hospital, so I went through the checklist: fever, diarrhea, vomiting, abdominal pain, unexplained bleeding, exposure to someone with Ebola, and the like. He didn’t have any of these warning signs. I also asked what he had been doing in Liberia, and he didn’t seem to have engaged in anything that increased his risk for being infected. His symptoms were classic for positional vertigo, which I had seen many times. This sensation of spinning, often caused by an inner ear problem, can make you feel awful, but it isn’t transmissible.
People on the plane, including the pilots, were getting anxious, since Ebola was fresh on everyone’s mind. With the flight attendant’s permission, I barricaded the man and myself into one of the plane’s bathrooms. There I was able to take his temperature and give him a medication to ease his symptoms.
Despite my assurances that this was a form of vertigo and not Ebola, the pilots insisted on calling the CDC officer stationed at the airport. When we landed, the jet bridge wasn’t even extended to the plane. It was as if the entire plane was infected.
After about an hour, the CDC official boarded, wearing the spacesuit-like gear required for health professionals taking care of someone with Ebola, along with two security guys in full hazmat gear. Now the other passengers were really getting nervous. There was a flurry of texting, taking photos, and posting to social media.
The CDC representative checked the man and escorted him into a waiting ambulance. The rest of us were then allowed to disembark but were quarantined in a holding area for about four hours before the CDC let us go. People asked me if the man had Ebola. It presented a quandary: Do I ease their fears, or protect the man’s confidentiality? I told everyone that I wouldn’t have barricaded myself in the bathroom with the man if I thought he had Ebola.
After arriving home, I received one last text, from the CDC: The man did not have Ebola.
Dr. Gregg Greenough is an attending physician in the emergency department at Brigham and Women’s Hospital in Boston and an assistant professor of emergency medicine at Harvard Medical School.
By Keith Van Meter: In 1999, I was flying from New Orleans to Boston with two colleagues, Nelson and Starr Page, a husband and wife who were both highly skilled respiratory technicians. I was startled to hear the captain announce, “Dr. Van Meter, please come to the front of the plane.”
As I approached, I saw my colleagues setting down a man in the aisle. He was ashen gray, not breathing, and had no pulse. Nelson started doing continuous chest compressions. Keep in mind that this was many years before continuous compressions were recommended for cardiac arrest. It was also before automated external defibrillators were required on board airliners. After a few minutes, I started mouth-to-mouth breathing.
We checked the man’s pulse every so often, and it was nonexistent or very feeble. After 10 to 15 minutes, one of the flight attendants showed Starr the medical kit. In it were a syringe and some concentrated epinephrine. Almost immediately after giving the man some epinephrine, we got a powerful pulse with a nice strong bump, bump, bump.
All this time the pilot had been bringing the plane down to a lower altitude. That may have helped some by increasing the oxygen level in the cabin, but it also made us bounce around more.
The man’s pulse faded away. Nelson continued to do powerful chest compressions, but was getting tired and sweaty. I kept doing rescue breathing. At one point, I looked back down the aisle. Everyone was quiet and almost everyone was watching us. I said to Nelson and Starr, “We can’t stop now even if this is fruitless.”
So we kept at it.
Since we still had some epinephrine left, we gave the man another injection. Again his pulse returned.
After about 30 minutes, we landed in Boston. The pilot had radioed ahead that emergency help was needed. Paramedics met us, gave the man antiarrhythmics and other medications, strapped him onto a board, and carried him off the plane. Everyone started clapping and cheering for us. It felt great.
I got off with the patient and rode with him in the ambulance. After making do with almost nothing in the plane, it felt like I was back in the modern world.
The man’s heart faltered again in the ambulance. We used the AED to shock him back into a persistent bounding rhythm. When we arrived at Massachusetts General Hospital, the emergency department staff stabilized the man.
About a month later, I got a call from the patient. He was as crisp as a bell, was feeling well, and was most grateful for what Nelson, Starr, and I had done. A few months after that, I went to a meeting in Boston. The patient visited me and invited me to join him for a Red Sox game.
So many things went right that day. All helped save a life.
Dr. Keith Van Meter is a clinical professor of medicine and chief of the Section of Emergency Medicine at Louisiana State University School of Medicine in New Orleans, as well as clinical professor of surgery at Tulane University School of Medicine.
By Darria Long Gillespie: My husband and I were flying from Las Vegas to Boston when we heard a flight attendant ask, “Is there a doctor on board?” I stood and saw a gentleman in his 30s having a grand mal seizure in his seat. His traveling companions didn’t know him very well, and had no idea if he had a history of seizures or other medical conditions.
I was delighted to see four other physicians also step up to volunteer — a neurologist, a urologist, my orthopedic surgeon husband, and a surgical intern. It was a moment of camaraderie to see physicians from multiple specialties united.
The first three eventually went back to their seats, but I asked the surgical intern, who was a former paramedic, to stay with me in case I needed and extra hand.
The flight attendant opened up the airplane’s medical kit, and I quickly realized how sparse it was. What I most wanted to know was this man’s blood sugar, a potential cause of seizures, but there was no glucometer. Fortunately, the surgical intern was also a diabetic, and he was able to use his personal kit to check our patient’s blood sugar, which turned out to be fine. He also helped me place an IV and give our groggy patient some fluids.
At that point, the flight attendant asked me to come to the in-flight phone to speak with the pilot.
As an emergency doctor, I’m used to colleagues asking me a lot of things. Do you want to give medication? Do you want to deliver the baby here? Is the patient having a heart attack? I was not prepared for the pilot’s question: “Doc, I’m circling Omaha, just waiting to hear. Do I need to land this plane?” I judged that the man’s seizures had abated and he was stable enough to make it to Boston.
The two hours until we landed, with me watching my new patient, were two of the longest in my life. I’ll never forget the relief when we landed.
I got a few glares from other passengers because the flight attendants weren’t able to do their typical in-flight beverage service. The man I helped, however, was very appreciative. When we landed in Boston, we were met by an emergency medical team. The man was doing well by this time, and didn’t want to go to the hospital. I told him he needed to go so he could be evaluated by a doctor. As he was being wheeled away, he flashed me a peace sign and said, “I don’t need to see a doctor. You’re my doctor.”
Well, yes. Yes, I was.
Darria Long Gillespie, MD, is a fellow of the American College of Emergency Physicians, an assistant professor in Emory University School of Medicine’s Department of Emergency Medicine, and “chief doctor” and executive vice president of Sharecare, Inc.
By Wanda Filer: En route to a meeting of the Idaho Academy of Family Physicians in Boise, I needed to catch a connecting flight in Denver. I had about 10 minutes to get from Gate 6, where we landed, to Gate 70. That meant I needed to hustle. I boarded the small turboprop plane just in time, along with a handful of others who had made the 64-gate sprint.
About 30 minutes into the flight, a woman in the bathroom collapsed, crashing open the door and falling into the aisle. Two men sitting nearby picked her up and laid her in their seats.
As a flight attendant rushed past, I grabbed her sleeve, identified myself as a family physician, and asked if they needed help. She gratefully said yes.
The woman was pale and sweating heavily. I had trouble communicating with her because she was going in and out of consciousness, and also because she spoke Spanish. From her symptoms, I guessed that she had very low blood sugar.
I asked the flight attendant to bring her some orange juice with extra sugar. She was able to drink some of it. We also packed ice on her neck and under her arms. Within 20 minutes, she was doing better. A little later, she was fully awake and able to eat.
Knowing a bit of Spanish, I was able to figure out what had happened. The woman, who had diabetes, was one of the passengers who had hurried with me through the airport to make the connection. She had taken insulin at the end of her prior flight, planning to get something to eat between flights. That didn’t happen and she had to sprint to get to the gate.
A couple who watched this drama unfold asked if I was a paramedic. I told them that I was a family physician. They smiled, since they were looking for a new doctor. Unfortunately, they live in Idaho, and my practice is in Pennsylvania.
Wanda Filer, MD, is a family physician in York, Pa. She is also the president-elect of the American Academy of Family Physicians.
By Parveen Parmar: My work in global health requires me to fly a fair amount. I’ve provided medical care in the air several times. In one memorable instance, I realized there was some chaos forward in the plane and heard someone ask (more like scream), “Is there a doctor on the plane?”
I went up to find an older man, ashen gray, lying on the floor. One of the flight attendants started doing excellent chest compressions. It looked like she had been through this before. The plane was carrying an automated external defibrillator. We placed the pads on the man’s chest.
The defibrillator detected organized heart activity, so we didn’t deliver a shock. Shortly after we placed the device on the man, his pulses returned and he began to move and open his eyes. The medical kit contained what we needed to start an intravenous drip through which we gave him IV fluids.
As we were resuscitating and stabilizing the man, the pilot was diverting the plane to a major metropolitan airport. Emergency medical service personnel greeted the plane and transported the patient. He was awake and talking and able to follow commands. The entire process was incredibly efficient.
Working in a tiny, cramped space with passengers looking on is difficult. It’s even worse when there is turbulence and the plane is bumping around. Thankfully, this patient was able to be seated and secured, but I can imagine instances where, if a patient is still requiring active CPR, this wouldn’t be possible for the patient or care team.
Dr. Parveen Parmar directs the international emergency medicine fellowship at Brigham and Women’s Hospital in Boston and is an assistant professor of emergency medicine at Harvard Medical School.