Last week I was renewing my Basic Life Support (BLS) certification. As we were reviewing the 2010 American Heart Association Cardiopulmonary Resuscitation (CPR) guidelines for adult and pediatric emergencies, the instructor asked if anyone had to perform using a defibrillator or perform CPR on anyone in the community. Although there were 20 of us in the class, only a few raised their hands. I was one.
While I was on a plane flying from Fort Lauderdale to Newark, a woman collapsed. She was exiting the restroom shortly after takeoff and fell to the floor. The woman was returning to her home in Europe after a seven-day cruise. Her family took her on the cruise after she finished another round of chemotherapy for metastatic pancreatic cancer. I had no knowledge of her medical history because the family did not speak good English. I didn’t have her medication list. But I did know that her blood pressure was 70/40, and she had been complaining of abdominal pain moments before. Now I was charged with directing her care as the only medical professional on a plane full of 160 passengers. No pressure.
Airplanes are like taxi cabs. They are meant to transport people, but not necessarily to transport sick people. As such, airports are common places for medical emergencies. People are often in poor health, yet want to visit family or return home just one more time. Cancer patients are specifically at risk for blood clots from inactivity, breathing issues with lower cabin pressure, and generalized fatigue from lifting heavy suitcases and navigating the airports.
Now back to the emergency. What happened?
Administering emergency care in a cramped cabin at 37,000 feet is unlike any other experience you will have. There is a lack of space and privacy. Despite these challenges (and a flight attendant who was freaking out), I checked her blood pressure every two minutes. I am not sure if it was the lousy stethoscope or progressive tachycardia (pulse was in the 140s) but after forty minutes, I had a hard time finding her blood pressure. Her pulse was fast but becoming weak. I couldn’t get an IV line into her. She had a Mediport, but I did not have a Huber needle to access it. She was barely responsive, but all I could do was watch.
As the flight attendant called the in-flight medical emergency physician to report the patient’s status, the family became more and more worried. There was nowhere to direct the family on the full flight. I was working in the galley area of the plane and wondered how long it would be until we would land. I wondered what the defibrillator looked like, in case I needed to shock her. Do I turn it on, and then plug it in? Would one of the flight attendants help with two-man CPR? Is it 15:2 compressions to breaths ratio? So many questions ran through my head.
I asked the family about her code status. She was a full code at 76 years of age and with metastatic cancer. I wondered about legal implications should I need to resuscitate her at 37,000 feet, or if there was a lack of consensus among the family about her code status.
As we approached Washington air space just minutes from Newark, the captain asked me if we should land the plane in Washington or if we could make it to our original destination. I thought of the 160 passengers who would miss their flights. Many had International flight connections. Could this lady hold on for 20 more minutes? Spontaneously, the sick lady asked, “When are we landing? I don’t want to miss my flight home." I realized she knew where she was and made the executive decision to land in Newark. Luckily, we landed 15 minutes early.
Upon landing, the flight attendants asked the passengers to stay seated until this particular passenger was safely off the plane. No one moved. It was the first time I saw such respect and patience from passengers on a plane!
While getting off the plane, the pilots, flight attendants, and several passengers remarked on how calm they thought I had remained. Some added that I must do this all the time. Not a chance. This was the first medical emergency I had been in charge of in years.
During my CPR class, I wondered what happened to that lady. Did I make any decisions while onboard that would negatively affect her in the future? Did she make it home? Is she still alive?
As we were leaving the classroom to take a written exam, the instructor reminded us of the new CPR guidelines: A ratio of 30 compressions to two breaths to achieve 100 compressions per minute. To remember the pace for compressions there are two songs you can use. If you are optimistic, perform compressions to the song, "Stayin’ Alive" by the Bee Gees. If you are less optimistic, then perform compressions to "Another One Bites the Dust" by Queen. I will always choose the Bee Gees.
I am curious. Have any of you been in a medical emergency at a grocery store, in the airport or any place outside of your own medical facility? What would you have done differently?