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Wednesday Sep 02, 2015

In an Emergency, Family Physicians Have it Covered

We were six hours into a transatlantic flight when the call came over the plane's intercom that a passenger needed medical assistance. I responded, as did another family physician and an emergency room doctor.

Fortunately, the plane was well stocked with oxygen, a pulse oximeter, a blood pressure cuff and more. We worked as a team to determine what was wrong with a woman who had collapsed on the floor. A few minutes in, another woman appeared, identified herself as an OB/Gyn and asked if she could help.

I replied, "Well, we're two family physicians and an emergency room doctor."

She said, "Oh, you've got it covered then."

So I suggested that this fourth physician try to calm down our patient's hysterical teenage daughter.

About 15 minutes later, yet another physician appeared, identified himself as an orthopedic surgeon and asked if we needed help. I repeated that we were two family physicians and an ER physician.

He said, "Oh, thank God, we have real doctors. My wife made me come up here."

I appreciated that he understood our level of expertise.

The flight crew was prepared to divert the plane for an emergency landing, but we were able to stabilize the patient and determine that her condition did not require urgent measures. She had a history of heart problems, had been sitting for hours, stood up too quickly and passed out.

The breadth of our training makes family physicians well-equipped to react to these types of situations, which is good because they seem to be happening to me with increasing frequency.

I was in the Denver airport last year en route to Boise for the Idaho AFP meeting. But I wasn't in the airport long because I had landed at Gate 6 and had about 10 minutes to run -- literally -- to Gate 70 to make my connection.

I made it on the plane, along with several other passengers who had made the 64-gate sprint. We were about 30 minutes into the flight when I heard someone say, "There's a pair of legs sticking out of the bathroom."

A woman had lost consciousness in the bathroom and had forced the bathroom door open when she fell. I volunteered to help the woman, who was ashen and diaphoretic. She had hypoglycemia and was in and out of consciousness, but I was able to deduce what had happened.

She was one of the passengers who had hurried through the airport to make the connection. She was diabetic, had taken insulin but had not had time to eat. Her condition was exacerbated by the plane's air conditioning, which was not working properly.

I asked the flight attendant to bring her orange juice with extra sugar in it, and we packed ice on the woman's neck and under her arms. Within 20 minutes, she was doing better. A little later, she was fully awake and able to eat.

A couple who had been watching this scene unfold asked if I was a paramedic. I said no, I'm a family physician. They then said they were looking for a new doctor and asked if they could come to my practice. They were disappointed to hear that my practice is in Pennsylvania, not Idaho.

Sometimes, we can get called into action before we even get on the plane. On another trip, I was on my way to the Vermont AFP meeting when I saw an elderly woman in the bathroom struggling to get out of a wheelchair. And more importantly, she was struggling to breathe.

I told her I was a family physician and asked if she needed help. She was a tough older lady, and although she acknowledged having heart disease and lung disease, she said she was fine. In reality, she was in respiratory distress. We talked for a bit, and it turned out that we not only were going to the same place, we also were on the same flight.

So I walked her to the gate, identified myself to the gate agent as a family physician and asked her to move my seat next to this woman's so I could keep an eye on her. The woman had some rough moments on the plane, but we made it to Burlington.

When we got off the plane, she wasn't interested in a ride or calling a family member. Instead she insisted on driving herself home. But first I made her promise that she would call her family physician the next day, and she gave me that physician's name.

At the Vermont chapter meeting, I got the contact information for the woman's FP, called the practice and suggested they follow up with their patient. That doctor did call her, and she was admitted to the hospital.

A month later, I received an email from the woman thanking me after she was at home recovering.

A New England Journal of Medicine study(www.nejm.org) looked at nearly 12,000 in-flight medical emergencies and found that physician passengers were able to assist nearly half the time. I'd love to hear your stories of helping fellow travelers in the comments field below.

Wanda Filer, M.D., M.B.A., is president-elect of the AAFP.

Posted at 09:26AM Sep 02, 2015 by Wanda Filer, M.D.

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