Doctor Game: Is there a doctor on the plane?

By Medicine Hat News on April 9, 2018.

What is it that doctors worry about when they’re flying? It’s not fear of flying. They know that travelling by air is safer than driving a car. Rather, it’s the possibility that they will hear a sudden announcement, “Is there a doctor on the plane?” This is when the brain shifts into high gear.

Every time it happens to me, it reminds me of my days of internship at the Montreal General Hospital. Interns took turns riding in the ambulance on emergency calls. We never knew what we might encounter. But at least our feet were on terra firma, and we knew that on returning to the hospital specific expertise would be available.

But in the air, this announcement, particularly if it happens mid-Atlantic, is accompanied by a feeling of loneliness and isolation. You wonder what type of medical problem you will encounter, and will there be sufficient medical facilities on board to handle it. One thing is certain. Most doctors, unless they’re working in a hospital emergency department, do not receive training in medical school on how to handle air-borne calls.

I’ve found myself in this situation several times. The last time, on a flight from Toronto to Vancouver, the call happened within an hour of take-off. A male passenger with an allergy to peanuts had unwittingly eaten some, and was in dire respiratory distress.

Soon, you realize you are not quite alone. At my request, the flight attendant easily located a syringe with epinephrine. After I injected the medication, the man, an engineer, recovered. But it became apparent he required a second injection, so I was seated beside him for the rest of the flight.

A recent report in the Canadian Medical Association Journal states that every year 2.75 billion people travel by air worldwide. In Canada, 133 million, a 27.3 per cent increase since 2009. No wonder this emergency call is heard more often in the air. The population of flyers is also aging, and many arrive on board with pre-existing disease. As well, flights are often longer.

Another factor is sometimes overlooked. During a long flight, perhaps at 36,000 feet, there is slightly less oxygen in the cabin and lower relative humidity. This may affect those suffering from cardiovascular or respiratory diseases.

So how many people become ill while flying? Several North American airlines say one in 604 flights. Or, 16 medical events for every one million flyers.

So what medical therapy is available when doctors answer the call? In Canada, automated external defibrillators are not mandatory. But Air Canada and WestJet provide them on some planes. Several standard medications are also available in the plane’s medical kit.

One common complaint to Air Canada is that the stethoscope is either broken or does not work. This makes diagnosis more difficult with the background noise of the plane engines. And limited space in a plane for emergency care always hampers normal procedures.

Once, I felt even more alone when at sea I encountered a difficult diagnostic problem. Years ago on my first trip as a ship’s surgeon, I decided to remove the captain from command due to unusual circumstances. This was one of the most agonizing decisions I’ve ever had to make, considering the consequences to passengers and staff. And the possibility of having made the wrong diagnosis.

Later on, while employed as a hotel physician in an isolated area, I learned another important, but embarrassing, medical lesson. An elderly guest, a minister in his 90s, developed heart failure. Since he was reluctant to leave the hotel I treated him with the usual drugs. At one point I was convinced his death was imminent. I decided to discontinue all medication. To my surprise he rallied! A few days later, he left for his home in Texas.

So whether you’re in the air, at sea, or on the ground, facing a medical emergency always increases the adrenaline. I’m about to take the train in a few days from Toronto to Vancouver. So far I’ve never been called to take care of anyone on a train! I’ll keep you posted.