Is There A Doctor Onboard?

I am a physician. I may have retired and changed careers. But I was, I am, and I will be a doctor until the day I die.

The morning started with notification from Delta that our 12:40 pm flight was delayed. On some level, this was actually a relief since it gave us some breathing room for the trek from Irvine to LAX. With five lanes of bumper-to-bumper traffic, driving to LAX is always an exercise in frustration and patience.

Dropping off our rental car and checking our luggage could not have been more seamless. We checked into the Terminal 2 Delta SkyClub lounge and took advantage of some tasty tidbits.  Ugh—our flight was delayed, delayed, and delayed. Afraid that our flight would be cancelled, we looked for alternate flights. Finally, we breathed a sigh of relief when they announced boarding for our flight. Four hours after our original flight time, we were in our seats, ready to take off for New York’s JFK airport. 

The flight attendant had just poured my first glass of wine when there came a call for any doctor aboard the plane. My husband, Alex, who is also a doctor, and I gave each other the knowing glance that 35 years together brings. We raised our hands. I would love to tell you that it’s the first time this has happened but sadly, it’s not. 

A 61 year old, oxygen-dependent woman in the back of the plane was having crushing chest pain that started less than 15 minutes ago.  She told us that she had incredible pressure in her chest that radiated into her left arm, left neck and jaw.  If you Google these symptoms, you will see that there are the classic symptoms of a heart attack.  You don’t have to be a doctor to recognize someone in distress.

We discovered that there were 13 family members traveling together from California to New York for a family vacation. Before calling the flight attendant, the woman’s son had already given her two of nitroglycerin tablets that belonged to someone else in the family. Ms. Shirley clutched her chest as she labored to breathe. We asked all of the typical medical history questions. Struggling to hear her faint voice from under the oxygen mask, we quickly understood that she had all the classic symptoms of a heart attack. 

The flight attendants brought us a kit with basic but primarily non-useful medications.  Surprisingly, Alex and I were the only doctors (or the only ones who came forward) on this flight. We gave Ms. Shirley another nitroglycerin tablet and her chest pain improved for 10 minutes before coming crashing back. We diligently recorded Ms. Shirley’s vital signs and reported them to the flight attendants. The information was, in turn, shared with the captain who then discussed it with a medical triage service on the ground. One of the flight attendants told us that the captain was reluctant to land because the crew would have timed out and the flight would be cancelled. The whole plane of people would be stuck wherever we landed. Unfortunately, I don’t know how to fly a plane or I would’ve have landed at the nearest airport. Neither Alex nor I were given the opportunity to discuss the situation with the physician on the ground. 

Over the next hour, Ms. Shirley has a total of 6 nitroglycerin tablets, a baby aspirin, dilaudid and antacids in an attempt to control her symptoms. Finally, her symptoms started to subside. We would have to muddle along for the next two hours until we land.

About 45 minutes before landing a flight attendant asked us if we really needed EMTs to get Ms. Shirley off the plane. I was shocked by this question. We had just spent more than five hours stabilizing someone with all the symptoms of a heart attack. I had repeatedly told the flight attendants that we had every expectation that an ambulance would meet the plane and immediately transport Ms. Shirley to the hospital to be evaluated. Apparently the only way to get an ambulance to meet a plane at JFK is to declare an emergency. In that case, the plane stops short of the gate on the tarmac and the EMTs board the plane and remove the patient. The flight attendant asked if we really felt that was necessary because everyone else would have to wait to get to the gate resulting in a further delay for us, and possibly all flight operations at JFK. She assured us that if we didn’t declare an emergency that EMTs would meet us at the gate. After spending the flight monitoring Ms. Shirley, we felt that, at this point, she was stable enough to be the first one off the plane and be met by EMTs. In anticipation of that, Ms. Shirley was transferred to an aisle chair and moved to the first row of the plane. 

When we arrived at our gate at JFK, there was no one to meet the plane. The passengers, including us, got off the plane. I asked the gate agent where were the EMTs. He said he had JUST heard that there was a need for EMTs, and that he called, and they were on their way. They had more than three hours in which to orchestrate getting emergency services ready. 

We hung around, waiting for Ms. Shirley to be brought off the plane. When she was finally wheeled off, accompanied by a police officer there still were no emergency personnel in sight.  The captain was also waiting. We introduced ourselves as the doctors onboard who helped, and told him we were incredibly frustrated by the entire experience. The captain told us that all of this was beyond his control. He said he notified air traffic control and JFK of the situation hours earlier. The appalling lack of appropriate response was plainly evident.

We don’t know what happened to Ms. Shirley—whether she sustained a heart attack, or angina that was perhaps prevented from developing into a full-blown myocardial infarction by nitroglycerin, narcotics and oxygen. The only thing that I am sure of is that the response by the agencies involved fell well far short of reasonable expectations. While the captain and Delta have responsibilities to more than one person, there needs to be better coordination between the captain, airline, air traffic control and the emergency services in the event of a passenger experiencing a health emergency in flight. Furthermore, we believe that if there are health professionals, particularly doctors assisting with the medical emergency midflight, the system/protocols should allow direct communication between such doctor and ground based triage service. Such communication can result in less distortion of information as opposed to it being passed sequentially from the doctor to flight attendant, to the cockpit, and finally to the ground triage consultant.

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