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What happens when you are the doctor on the airplane?
- rangibaby 14y agoAn interesting interview. I wonder if he gets upset if people call him Shirley?
- melvinram 14y agoI'm confused. Why is this on HN?
- serf 14y agoYou and I both, brother.
- daeken 14y agoTo paraphrase the rules, if you see a submission that doesn't belong, just flag it and move on. If enough people agree, it'll go away.
- constatino 14y agoI for one find glimpses into other fields fascinating.
- cynwoody 14y agoBecause hackers use their wits and experience to deal with strange circumstances under less than ideal conditions. As do docs on planes. It's a first-rate submission.
- ilamont 14y agoIf you are interested in medical "hacks" on long-distance flights, the award has to go to two doctors who were on a 1995 British Airways flight from Hong Kong to London when a patient had trouble breathing. They determined that the patient suffered a collapsed lung, so they made an incision in her chest, and used a coat hanger, brandy, and a tube from a medical kit to drain the lung. As I recall the story, there was also a nurse who assisted but I can only find the AP story which references the two doctors.(1) I also have a relative who is a doctor/med school professor who does a lot of traveling, and has had to assist the crew three times with in-flight emergencies. One was a heart attack, one was deteriorating condition of an unknown cause (the flight was diverted to evacuate this man) and the third was a guy who had intense bladder pains mid-flight which turned out to be the result of downing a huge quantity of beer before the flight and being unable to urinate. 1. http://news.google.com/newspapers?id=ZBxOAAAAIBAJ&sjid=pOwDAAAAIBAJ&pg=3211,3732374&dq=hong+kong+doctor+flight+collapsed+lung&hl=en http://news.google.com/newspapers?id=ZBxOAAAAIBAJ&sjid=p...
- citricsquid 14y agointense bladder pains mid-flight which turned out to be the result of downing a huge quantity of beer before the flight and being unable to urinate was that due to the altitude or something else?
- ilamont 14y agoThe stricken passenger had the option of using the restroom, but for unknown reasons could not urinate. They stretched him out on a row of seats which seemed to help the pain, but from what I recall was unable to go until they reached the destination airport. The total trip time was about three hours.
- niels_olson 14y agoBeyond a certain capacity the bladder is no longer contractile and must be catheterized to urinate. Happens every day in the OR or PACU.
- maaku 14y agoReally? What happened before modern medicine? I'm not being snarky: I believe you.. but a burst bladder would be lethal without access to modern medical knowledge. That seems like a epic fail by evolution.
- niels_olson 14y agohttp://en.wikipedia.org/wiki/Tycho_Brahe#Death http://en.wikipedia.org/wiki/Tycho_Brahe#Death
- bosch 14y agoNow I have something to be paranoid about and will be going the bathroom as much as possible.
- mahmud 14y agoEverytime I have seen a doctor call on airplane it was either an allergic reaction to food, or some guy who opened his duty-free bottle on the plane and had a little too much fun.
- yycom 14y agoUnreadable on mobile (pre text or something preventing reflow). And no byline or date, so completely useless. Fuck off basically.
- pc86 14y agoI upvoted the article just because of your ignorant comment.
- lessnonymous 14y agoiPhone? Hit the 'Reader' button in the URL bar. Anything else? Get the Readability or 'Instapaper Text' bookmarklet installed. Then quit posting your personal problems here.
- joezydeco 14y agoArticle looks just fine on iOS, no Reader necessary.
- Cor 14y agoFuck off? There's no need to be so rude. In the future, use ihackernews.com. It provides a mobile friendly link to stories using viewtext.org. The viewtext.org link for this story (http://viewtext.org/article?url=http://www.cockeyed.com/personal/doctor_airplane/doctor_airplane.html http://viewtext.org/article?url=http://www.cockeyed.com/pers...) works perfectly on my phone.
- moconnor 14y agoReadability is your friend.
- aleyan 14y agoOutside of the parent's bad attitude, he does have a good point. No timestamp on the article makes it hard for me to place the story in context. It is one of my pet peeves when I come across some morsel of information online but I can't evaluate if it is still applicable because there is no timestamp anywhere.
- Hawkee 14y agoMy wife was on a flight from Taipei to LAX when they called for a doctor. She didn't see whether or not a doctor responded, but there were no further calls or announcements after that. Later when she went to the bathroom she saw a body bag on the floor near the bathrooms. When the flight arrived there were police waiting. Nobody could leave the plane until they were done with the body. No details were given to any of the passengers.
- damian2000 14y agoHere's the google cache version (site is under heavy load) ... http://webcache.googleusercontent.com/search?q=cache:www.cockeyed.com/personal/doctor_airplane/doctor_airplane.html http://webcache.googleusercontent.com/search?q=cache:www.coc...
- kokey 14y agoI can't find it now, but my favourite 'doctor on a plane' story was from an anesthesiologist who struggles to sleep on a plane, so on a long haul flight took something to help him doze off. He woke up to the 'is there a doctor on the plane?' call, and called the flight attendant over. It turned out that he was the person that they wanted to attend to, they were concerned since he was passed out and drooling on the passenger next to him.
- JshWright 14y agoThe medical director of my paramedic program used to work for a hospital that provided medical control for a number of major airlines (generally speaking, even when they ask for a physician on a plane, they're also calling the airline's 'on call' doctor as well). His scariest stories weren't due to the criticality of the patient, but rather the incompetence of the provider on board the plane (to the point that he, on several different occasions, had to instruct the flight crew to 'please keep him away from the patient for the rest of the flight'). Just because someone is a 'doctor' doesn't necessarily mean they're well equipped to handle a medical emergency (note: the physician interviewed here managed the patient perfectly appropriately). It's possible he was just pandering to the room of soon-to-be paramedics at the time, but he said he generally instructed the flight crew to ask for a paramedic before a physician, simply because they're generally more comfortable working in the 'austere' medical setting found on a plane.
- btilly 14y agoMy wife told me about a famous dermatologist who flies in dread of getting that call and there being no other doctor available. When med school was 40 years ago, you're not necessarily going to be comfortable handling, say, a heart attack.
- supwiggles 14y agoOne of my paramedic instructors told me a pretty funny story. Apparently they were on shift one Saturday afternoon, when a call came through for a Code 2 (Cardiac Arrest) at a local racecourse. Anyway, it was about 15 minutes away so they took off in a hurry, all the while receiving notes on their terminal regarding the job. Apparently it went along the lines of this: Initial: Unknown Age, Cardiac Arrest, Racecourse etc Update: CPR in Progress Update: Doctor has self accounced at scene. Update: Doctor has called patient as deceased. CPR ceased. It took another 5 minutes for the paramedics to get to the racecourse, and they still unloaded their gear and made their way to the patient. When asking for the doctor, they found that it was actually the racecourse veterinarian who had made the call.
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- joezydeco 14y agoI'm curious if insulin is a standard part of the medkit. I was on a transatlantic crossing once with a coworker who went into diabetic shock (that's another long story). A nurse was onboard the flight but no insulin. We had to divert and my coworker was laid up in a Newfoundland hospital for 3 days.
- pavel_lishin 14y agoWhy would a diabetic person not travel with insulin?
- TylerE 14y agoMany diabetics don't KNOW that they are.
- phxrsng 14y agoThat's not at all true - at least, not for diabetics that will go into shock or experience acute symptoms. Diabetics experience a "honeymoon" period where they will experience some symptoms - almost always enough to trigger a trip to their PCP, urgent care, ED, etc. where they will be diagnosed and put on a treatment plan. At most they will experience one event of being "very sick" if they don't get checked out at all during the months-long honeymoon before its found. If most diabetics didn't know they were diabetic, most diabetics would be dead.
- joezydeco 14y agoPretty much a collision of unfortunate events. We were at a work function until 2am in London and returned to our room to find it had been robbed. The thieves took his bag which contained his insulin kit. So now it's 3am GMT and he can't reach his doctor in the States. We're supposed to leave at 8am for the flight home. No pharmacy is open and even if they were, they wouldn't help him. Nurses at Heathrow couldn't help him either. So he decided to risk it and see if he could make it all the way home without having any trouble. He went into shock 4 hours into the flight.
- omegant 14y agoI have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible. For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the necessary action (Is not going to be easy with such limited capabilities, sometimes is just impossible, but is better an overreaction), is important because commercial planes fly at 8 NM/minute, and depending where are you flying ( flying over the ocean or africa) 10 minute delays could mean another 30 extra min to land or even several hours if you have passed a no return point in the middle of the ocean. Don´t hesitate to take control of the situation regarding the patient, stewardesses and other passengers: - Ask for the medikit (only physicians are allowed to use it). I have seen some chief stewardess resisting to bring it, just to avoid having to write the compulsory report. - If it is necessary to lay the passenger on the ground or other seats, bring him water or any other thing, just give the needed orders and ask for help. - Ask the stewardesses to keep other passengers away if they are interfering too much. - As soon as practicable give a report to the captain and if necessary ask him to land the plane. He will be waiting for it. - If possible never declare a decease onboard , first you could be wrong!, and it is a bureaucratic mess. Is better to keep trying CPR till the emergency team can take care of the patient. We apply this in Europe although it is not a written rule, I don´t know how it works in USA. -Remember when in doubt it is better to ask the captain to land. Everybody will lose an hour or two but a live will probably be saved.
- niels_olson 14y agoAs a physician, thank you for this. Is there a standard medkit load out?
- omegant 14y agoThere is an ICAO recomended kit list, but usually is more extensive than that, I have our company list (I'll search it and post it later) but trying to find if there is a more general one. Now a days there are also automatic defribilators (spelling?) in transoceanic planes. There should be some kind of general briefing for physicians, from airlines and medical asociations.
- miles_matthias 14y agoOkay, I'll share random doctor flight story - last week some family friends were flying to Hawaii for vacation, and a man across the isle said he had been on vacation for several weeks and didn't bring enough heart medicine. He said he would just get some more when he got home, but halfway through the flight he slumped down in his chair, unresponsive. There was a doctor on the flight that used a stethoscope to find there was no heartbeat. (Not sure if the doctor had his own stethoscope or if it was in an on board kit.) The doctor just looked up at the flight attendant and shook his head. Luckily, this flight was not to Hawaii. It was just a layover from Houston to LAX, so they were able to land in Phoenix to have a medical response team take the passenger off. Apparently when they took him off, they didn't use a board or anything - one man grabbed his wrists, another his ankles, and they carried him off, but they couldn't completely lift him so his butt was dragging on the floor down the isle. I thought that was a little weird. Also, is it legal to just put a blanket on the guy, pretend he's sleeping, and then deal with it when you get to your destination? Our friends missed their connecting flight to Hawaii in LAX because of this ordeal.
- e40 14y agoIt's a little surprising to me they didn't even attempt CPR.
- niekmaas 14y agoOut of hospital CPR has very slim survival chances. Being on a plane will result in at least 30 minutes of CPR even before an ambulance can take over. Chances on surviving that are extremely low. Therefore I can see why the doctor on the plane decided not to perform CPR. I have a medical degree myself btw.
- supwiggles 14y agoThis +10. Out of the 11 out of hospital arrests that I went to as a Paramedic (in a 6 month period), only 1 of them survived. Ironically, the one who survived was a prisoner who had cut his own throat. He had pretty much bled out by the time we got there, with a tiny little junctional on the monitor. Today he has 0 deficits, and it is like the event never occurred.
- donretag 14y ago"The medikit was actually really comprehensive ... that contained ... even morphine." I am surprised that it contained morphine. Pain killers would not help much in resolving whatever medical issue is occurring. Besides, is it not dangerous to report the fact that morphine is available on a flight? Some medkits are easily accessible and can be taken when the flight attendants are not looking.
- moioci 14y agoWhen you have a myocardial infarction or acute pulmonary edema inflight, you'll be glad there's morphine available.
- supwiggles 14y agoIt is amazing how well morphine can work, and how utterly useless it can be at other times. I found it to be incredibly helpful during the AMI cases, especially for putting the patient as ease, especially when they understand the gravity of the STEMI that they are currently experiencing. We went to a fractured tib/fib (Football injury) and we loaded him up with the maximum dose over the course of treatment (50 minutes or so) and it didn't even touch the sides. Looking back we probably should have called for the IC guys and done some ketamine + realignment.
- FireBeyond 14y agoAs an opioid in rapid sequence induction, potentially used for tracheal intubation.
- JshWright 14y agoOpioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sedative like ketamine or etomidate. Morphine would be a _very_ poor choice for a sedative in an RSI protocol.
- FireBeyond 14y ago
- davidmr 14y agoThis happened once to my father on a flight. He's an orthopedic surgeon (the woman in this story really hit the jackpot with an a anesthesiologist--the only thing better would be an ER doc, I think), and someone was having chest pains. He determined very quickly that it was not a heart attack or other critical condition, but through the whole ordeal, the passenger next to the patient (who did not know the patient and had no medical training) kept second guessing my dad's requests and diagnosis. The flight attendants ended up "asking" this other guy to move several rows back to an empty seat. Everyone's a critic.
- nvr219 14y agoI just want to tell you both good luck. We're all counting on you.
- stephencanon 14y agoMy wife is a surgeon; while we were flying to Morocco last spring, a man on the plane accidentally put himself into a diabetic coma. A nurse was sitting next to him and thought that he was having a heart attack. The attendants called for a doctor; my wife recognized the actual issue, and revived him by rubbing honey on the inside of his mouth and gums (the onboard medical kit had nothing of use beyond rubber gloves). The other passengers on the flight actually did applaud her, which was cute, but I think they mostly did it because it meant that the flight didn't need to be diverted to Heathrow.
- ibejoeb 14y agoWow, shocking that the plane did not have glucose tablets. I carry the gel in my luggage just in case since it's particularly common and so simple. I guess sugar is sugar, but manipulating gooey honey sounds a lot harder that squirting gel pack. (Don't want to rant too much, but it irks me that TSA has, once or twice, confronted me on the things.)
- walshemj 14y agoyes back when I helped organize a medium sized (1200-11300) camping event we always had plenty of sugar and mars bars to cater for diabetics that went out of balance this is in addition to what the on site St Johns team had. Only had one close shave where some one diabetic had become and unconscious and thrown up in there sleeping bag - let me tell you seeing someone being carried towards you on a stretcher certainly gets rid of the hangover quick - this was pre mobile phones so i had to sprint to the public call box to call 999 (911)
- lurkinggrue 14y agoOh stewardess, I speak jive.
- Dove 14y agoMy dad, an electrical engineer, was once on his way back from a conference with a Concorde flight full of other EEs. In the air, the stewardess asked, "Is there an engineer on board?" Everyone responded enthusiastically. She was forced to clarify, "Is there an aeronautical engineer on board," to disappointment all around. I must admit, some secret part of me always hopes I'll be in a situation on an airplane where they need an emergency perl script written . . .
- JshWright 14y agoThat story seems _really_ fishy to me... Why would electrical engineers fly to a conference on a Concorde? What good would an aeronautical engineer be _in flight_?
- deleted 14y ago[deleted]
- pavel_lishin 14y agoIf I'm on a flight and they're asking for aeronautical engineers, I'll be asking for their strongest and most expensive drinks.
- deleted 14y ago[deleted]
- lotharbot 14y ago(Disclaimer: I'm Dove's husband. The man in question is my father in law, and I've heard the story from him firsthand, apparently much more recently than my wife did.) > "Why would electrical engineers fly to a conference on a Concorde?" The airline was moving a Concorde to a different facility (ie, it wasn't part of regular scheduled service). They decided to "upgrade" a bunch of passengers who were scheduled to be on a different type of aircraft. They moved the whole group of engineers together. The stewardess asked for a "Concorde engineer", who was needed for after landing. It had something to do with the way the Concorde hooks up to the loading bridge at the terminal (it may have something to do with the unusual height of Concorde?)
- umsm 14y agoI have one question regarding the question: "Did you end up getting sued?" Why would the doctor get sued? Why would that question even be asked? I didn't feel like any type of catastrophic event happened to merit a lawsuit.
- lostlogin 14y agoYou'd be surprised. A course was held recently on in air medicine here in NZ. The airline running the course said that they would foot any resulting legal bills that resulted, from anywhere on earth. However there was one condition - medical staff called when on a plane will give their time for free. The airline had received invoices for medical staff time in the recent past.
- logjam 14y agoI was half-dozing on a Southwestern flight when a stewardess came on the PA system calling for any physician to identify themselves. I spoke up, and the crew directed me toward the back. They already had this incredible medical kit opened in the aisle. I mean they had everything....ACLS drugs, defibrillator, suction, a complete mini-pharmacy, and what looked like a few plastic-7 wound and/or trauma kits at the least. I mean, I was practically drooling over this high-tech kit. Of course, it was also at that moment that I started frantically running through cardiac code algorithms in my head, and pondering exactly how long it had been since I'd actually dealt with a code in a hospital, with plenty of trained staff, lab support, etc. Of course, it wasn't any kind of life-and-death situation at all - a young person very stressed and anxious about relocating and the actual conditions of the flight, who'd been hyperventilating, hadn't eaten or had anything to drink for many hours, near-syncopal, etc etc. I tried my hardest, but couldn't think of a single thing to use out of the medi-kit. I wanted to use it. I just sat down next to her and listened, which is 90% of medicine anyway. Southwest was great - gave me two round-trip tickets to anywhere for taking a few minutes to talk. A colleague at University of Hawaii wrote a paper about dealing with psychiatric emergencies in the air. One thing that stuck out in the paper was the interesting phenomenon of what he called "honeymoon psychosis", with one of a young newly married couple away from home for the first time, possibly on their first flight, all leading to some interesting disturbances on those long pan-Pacific flights.
- walshemj 14y agoWould not they check the passenger list for Dr's first? I remember being told that this was an occupational hazard for Phd's that you might be assumed to be a MD Dr.
- randomchars 14y agoI think that's the reason why. Also if there's no physician on board but there's an EMT/nurse, you wouldn't know that from the passenger list. Plus it's entirely possible that even if there's a doctor, she isn't listed as one.
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- herdrick 14y agoI'm a former ski patroller, which is a kind of outdoors EMT / paramedic. Once, on a flight from Seattle to Boston (for a YC interview!) I walked to the aft bathroom only to find a young woman who had collapsed there, still prone and lethargic, with a stewardess standing over her with a look of annoyed disgust. An evaluation indicated she was probably just dehydrated, so I had the still-annoyed stewardess bring her water, which revived her. (Of course I recommended that she see a doc when we landed just in case, but I doubt she did.) After an hour or so we were able to get her back to her seat. The rest of the flight was uneventful. The only thing that never added up was the bizzare attitude of the stewardess. (edited: semi-conscious -> lethargic)
- JshWright 14y agoHow did you get the water into someone who was semi-concious?
- herdrick 14y agoSemi-conscious, if I recall correctly, covers a wide range of responsiveness. She was unable to stand and slow to respond to questions but was well-oriented w.r.t. person, place and time. Drinking water wasn't a problem. The possible danger is that they'll vomit it up after passing out, or that they have some issue that requires emergency surgery. Now you've put something in their stomach that they might vomit during surgery, which is somewhat dangerous. But she had signs of dehydration so I did it. In retrospect I should have given her honey or the like just in case she was having her first ever diabetic shock.
- JshWright 14y agoNo, the possible danger is that they'll aspirate the water and you'll compromise their airway. Sounds like she wasn't semi-concious though, just tired, and maybe a little lethargic.
- herdrick 14y agoOf course, if they are that badly out of it - I decided she wasn't. It sounds like I used the wrong term, thanks. Fixed.
- _wesley_ 14y agoThis was a very interesting article, given that I just experienced something similar. Flight from SFO -> IAD last week. As soon as we took off, they asked for a doctor. He spent 2 hours treating the patient before they started drink service, and continued until we landed. We were all quite worried about the person, but found out at the end of the flight that they had overdosed on NyQuil. That made the whole ordeal fairly frustrating.
- JshWright 14y agoOverdosed on NyQuil? How much NyQuil did he take? I have no idea how big a typical bottle of NyQuil is, but assuming it's somewhere in the ballpark of 10oz (we'll call it 300ml to make the math easy). NyQuil has 325mg/15ml, so our hypothetical 10oz bottle has ~6,500mg in it. That's certainly a respectable dose of Tylenol, but it's not likely to be fatal in a couple hours for an average sized adult...
- carbocation 14y agoI'd guess that the problem was excessive sedation due to the antihistamine, rather than acute liver injury from acetaminophen toxicity.
- SeanA208 14y agoAn uncle of mine was in a situation like this once. He was sitting in first class and had to tend to someone in economy class. He decided that it would be best that he stayed by the man he was tending to so my uncle swapped seats with the man's wife. They gave him a bottle of wine for his help but I would have expected something more.
- ww520 14y agoWhat airline was that? They should have at least given him a round-trip ticket since he missed a part of flight he paid for.
- vacri 14y agoI used to work with a consultant paediatric neurologist who had the call go out on a trans-pacific flight for a heart problem. She was hesitating before responding because the last time she had anything to do with hearts or adults was in medical school 20 years earlier, and was frantically running through what she could remember of cardiac medicine. Just as she made up her mind to respond she was beaten to the response... by a cardiologist.
- jeroen94704 14y agoI was flying transatlantic with a friend who has a medical degree when they called for a doctor. There was an older fellow who had a heart condition for which he was taking medication. His reasoning had gone something like "I need to take one of these pills four times a day, but I'll be traveling, so I'll just take all four of them right before checking in". Needless to say, this didn't work very well, and he was having sort of issue with his heart as a result. The poor guy was so scared he literally shit himself. My friend actually had to make the call whether we needed to land on an airport in Greenland to get the guy to a hospital. He thought about it for a minute and decided that the guy was going to live, so we continued to Amsterdam, where an ambulance was waiting. As a "thank you" from KLM, my friend was allowed in the cockpit during landing (this was before 9/11), and he got a bag full of little bottles of alchoholic beverages. Unfortunately, he's a teetotaller.
- viame 14y agoCool story.My girlfriend is a flight attendant. I hear a lot of stories from her and it is very common to ask if there are any doctors on the plane. What crazy is that people in-flight non stop (we just don't hear about it). Anything from heart attacks to other health problems, even just because they are old. Sometimes they will put a blanket over the body, sometimes they will pretend that the person is sleeping. Depending on the situation. I don't really get into the details but that's the scoop. =)