May 24, 2011

USA: When Doctors Are Called to the Rescue in Midflight

NEW YORK, NY / The New York Times / Health / May 24, 2011

By Katie Hafner

Dr. Matthew Rhoa is still haunted by one of his lowest moments as a physician. Several years ago, on the first leg of an international flight, he was just settling in for a nap when a flight attendant came on the public address system to ask, “Is there a doctor on the plane?”
Dr. Rhoa, who lives in San Francisco, didn’t push his call button. “As a gynecologist, I always waited for another doctor,” he said. “There’s never a need for a Pap smear at 30,000 feet.”

Illustration: Leif Parsons

He fell asleep, only to be awakened an hour later by a second call for medical help. This time he answered, and at the back of the plane he found two anxious parents with their 18-month-old toddler, who had a cast on her broken leg and was crying inconsolably.

The girl’s toes were blue. Limbs can often swell in flight, and it was clear that the cast was much too tight. Dr. Rhoa slit the cast and pried it open. The girl stopped crying at once.

“I have been riddled by guilt to this day,” said Dr. Rhoa, who now promptly answers every call for medical help on a plane. “I never want that feeling again of a kid suffering like that when I could have done something sooner.”

Since the earliest days of commercial aviation, airlines have coped with medical emergencies in flight by calling on physicians who happen to be passengers. And as more people travel by air, the number of emergencies has risen accordingly.

“Passenger health is becoming more and more of an issue, because of increased life expectancy and more people flying with pre-existing conditions,” said Dr. Paulo Alves, a vice president at MedAire, a company that provides crew members with medical advice from physicians on the ground.

MedAire, which advises more than 60 airlines around the world, managed about 19,000 in-flight medical cases for commercial airlines in 2010. Although few were life-threatening, 442 were serious enough to require diverting the plane — and 94 people died onboard.

The numbers reflect a fraction of the actual number of in-flight emergencies. The Federal Aviation Administration does not track in-flight medical episodes, and airlines are not required to report them.

Airborne calls for medical assistance pose a singular challenge for physicians, who find themselves suddenly caring for a stranger whose history they don’t know, often with a problem well outside their specialty, in a setting with limited equipment but no shortage of onlookers scrutinizing their every move.

And they do this for no compensation. (The fact that Good Samaritan laws generally protect them from lawsuits is a small saving grace.)

So it is little wonder that many physicians hesitate before responding to an emergency call. Illustration: Leif Parsons

Three years ago, Dr. Peter Freed, a psychiatrist in Manhattan, answered a call for a physician during a cross-country flight. A passenger had just had a seizure. Dr. Freed told the flight attendant he had not practiced general medicine since his residency. Still, he was the only doctor to respond, and the flustered crew member told him she was grateful for any help at all.

The passenger, a woman in her 30s traveling from Europe, told Dr. Freed she had a longstanding seizure disorder. He had her take her medication and remained with her, hoping she would be fine for the rest of the flight. But after another 20 minutes, she developed the uncontrollable shaking of a grand mal seizure and fell unconscious.

He asked to speak to a neurologist on the ground, and within minutes the pilot was able to get one on the radio. But as Dr. Freed recalled, he was barred from the cockpit for security reasons and could not speak directly with the specialist.

“I talked to the flight attendant, who talked to the captain in the cockpit, who talked to the doctor,” he said.

Next came the question that many physicians who answer in-flight emergency calls face: Should the plane be diverted to a nearby airport? Ultimately, the decision rests with the pilot, but the pilot looks to the medical expert for guidance. And it is a decision that other passengers await most anxiously.

After calculating that it would take as long to divert the plane as to reach their destination, Dr. Freed decided against it.

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