It had been an ordinary morning coming off the extraordinary experience of attending the presidential inauguration.
My fellow passengers, mostly other inauguration attendees, had been seated and were waiting to return to Los Angeles. Takeoff had been smooth and the first of the refreshments had been served. Then came the announcement that if there were any medical personnel on board to please push their call light.
The flight attendant acknowledged me and my seat number but said that everything was under control. I saw no activity anywhere down the aisle and I became concerned. So, despite the seat belt sign, I got up and walked to the front of the plane where there was obviously a woman in distress.
The flight attendant had made a phone connection with a long-distance medical advice center, but could not answer the questions asked of her. Clearly, the passenger was having trouble breathing, was diaphoretic, with thready pulse and too difficult to assess breath sounds. Even though I have spent the last 18 years in breast oncology, it is amazing how your mind will take you right back to basics and I jumped into action.
Blood pressure was 160/94, pulse 100 (apical), and the passenger was also experiencing shortness of breath. She was 79 years old, asthmatic, diabetic, hypertensive, and had no medicine in her carry-on.
It seemed that she had placed her medications in her checked bag. No hard candy in her purse. The flight attendants brought me their on-board medical kit, which contained a great number of medications, IV start kit, and first aid supplies. No pulse oximeter, and no glucometer for a blood sugar assessment. Her own portable oxygen was about to run out, so we marched down the aisle with the usual heavy green canister and moved two liters as quickly as we could.
A few caveats about traveling:
- This patient should have had medical clearance to travel. It is not a bad idea to discuss travel plans with a healthcare professional before you leave.
- Always carry medications separately in a carry-on. You may not expect a need during flight, but you never know.
- Bring extra medication just in case. If traveling for three days, for example, bring six days' worth of medication. Keep extra medication in a separate bag, if possible. This way, if one bag does get lost, there will be back-up medication.
- Write out a medication schedule and bring this in a carry-on bag. Routines can change while traveling. The written schedule will help you keep track of when to take medications if there are time changes during travel.
- Compile a list of each medication. Write down the medication name and the dosage. If you do end up needing emergency medical care during your travels, this information will be necessary for the doctor you see.
- Compose a list containing the names of your doctor and pharmacist and their contact information. If there is a need to contact them during your trip, this information will be useful.
It is important to advise your patients about the travel tips mentioned here if you are aware that any will be embarking on air travel. Whether your patients are taking pain medications, anti-emetics, or using an inhaler for shortness of breath, none of these should not be packed in their checked luggage.
Paramedics met the passenger and her friend at the conclusion of the flight. She seemed stable and alert. I'm glad to have been of service, and happy that my nursing skills were with me during a crisis at 35,000 feet. I plan on writing to the airline carrier with suggestions for its on-board medical kit so it is ready for the next passenger/patient situation.
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