That was the page I heard on an overnight, transcontinental flight during a trip back to my home town. Most passengers were fast asleep or resting soundly.
The overhead page repeated, this time with more urgency, “A passenger is extremely ill.” I rose from my seat to offer assistance. This was not the first time I have helped in an in-flight emergency, having taught emergency transport classes to health professionals. Two rows ahead, flight attendants hovered over a man whose sister was lying down awkwardly.
She was in active distress, middle-aged, slightly overweight. Her brother was trying to revive her, in vain. Calmly, I stated that I was a nurse practitioner and could help. I instructed the flight attendants to bring their medical kit and oxygen. Luckily, another passenger came forward, a recovery room nurse, and without discussion we began to work as a team.
The passenger could not be roused, was obtunded, pupils fixed and dilated, carotid and radial pulses weak and thready. Her brother was becoming agitated and was resistant to our attempts to intervene. The patient vomited, contaminating the seats and floor around her. At this point I requested that the flight attendants ask the gentleman to stand back so that we could move the patient to the exit row floor to be able to properly attend to her.
Medical supplies were paltry and the ambient noise and vibrations made it almost impossible to obtain any physical assessments via stethoscope. Without needing to verbalize our roles, the nurse administered oxygen and I kept the airway open. As the patient regained gag reflex, I had her take an aspirin. Passengers on the plane were cooperative, but I kept hearing panicky questions, “Is it Ebola?”
“Tell me,” I asked the brother, “Has she been to Africa, had contact with an Ebola patient, or been sick with a fever or vomiting before this flight?” “No,” he answered, “Nothing. I’ve never seen her like this.” I told the flight attendants to let everyone know that this was not Ebola. We needed calm, not fear.
Pulse and breathing improved in the recovery position, or my next request would have been for the AED. Three bottles of oxygen were emptied before she stabilized. The airplane emergency kit only contained a barrier mask, latex gloves, blood pressure cuff, stethoscope, and one red medical waste bag. I asked the flight attendants to move other passengers out of the way, and requested blankets to keep the patient warm.
Becoming restless, the patient verbalized she had not taken any pill, but had a history of strokes. Her medication bag had all her medicines inside in labeled pharmacy bottles: Codeine pain medication, antihypertensives, diuretics, antacids, benzodiazepines, and glaucoma eye drops. Her brother insisted she had taken a pill, so we assumed she ingested something along with alcohol. My assessment was she had a CVA with aspiration as I could palpate rales through her chest and back.
Advised as to her condition, the pilot placed an emergency call to an aviation medical call center. The plane was diverted for an emergency medical transfer landing.
Sitting on the airplane floor I could sense the plane speeding up, then descending quickly, straight down, not concerned about smooth approach for passengers’ comfort. I remained on the aisle floor, holding the patient in the recovery position, my fingers on her carotid artery, monitoring her pulse; the other nurse checking her respiration and keeping the patient calm.
The senior flight attendant approached me, “I need you to sit in a seat and buckle up for landing. You have no idea the force of landing in one of these planes.” I just looked at her and said, “I’m not moving. She needs to be held so she can breathe.” I did assure her I would hold onto an under seat brace bar. All the flight attendants sat and strapped themselves in securely.
When the plane landed, the passengers were told to remain seated so the emergency medical personnel could board. On the in flight incident report, I noted the events, symptoms, actions, medications, and patient history to the best of our knowledge. A paramedic boarded, and the patient was removed for ground transport to a hospital.
No one was allowed to leave their seats; not one passenger balked. Surveying the area, the plane was a mess. Vomit was on the seats, floor, blankets, bags…everywhere. No one came near. To the best of my ability, I cleaned up, stuffing medical waste in the one red bag, and went into the first class bathroom to freshen up. Passengers were informed the plane would have to be decontaminated. When allowed, they disembarked, walking slowly over blankets brought on board by a cleaning crew.
All connecting flights were going to be missed, but the fact that everyone knew it was because of a medical emergency gave a sense of reason. So many passengers came up to me and thanked me, taking me by surprise. It is not often that we receive thanks for the work we do. It was twelve more hours before I finally made it home.
Just another day in the life of a nurse practitioner.