4 ms·

Okay, 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 va

Okay, 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 ago
It's a little surprising to me they didn't even attempt CPR.
- niekmaas 14y ago
  Out 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 ago
    This +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.
    - jlgreco 14y ago
      Is CPR done on people with wounds like that? I would think the chest compressions would mostly just be pushing blood out, but I guess doing that is better than doing nothing?
      - rdl 14y ago
        The new protocol (at least for military, or at least serious trauma) is to treat massive bleeding above airway/breathing/circulation. I guess what you'd do is have someone applying pressure (or strap an israeli bandage around the neck, but not tightly in a way which would cut off circulation?) while someone else does CPR and then AED. The goal is to never have more than a 10sec break in chest compressions.
    - thematt 14y ago
      Maybe I'm missing something, but even if there's only a 10% chance of survival I'd still want somebody to give it a shot. What is the downside -- somebody has to do it for 30 minutes until the plane lands?
      - JshWright 14y ago
        That's 10% for someone who had access to advanced care within a few minutes. If CPR goes on for more than 10 minutes or so in a non-hypothermic patient (with no other interventions), your chances of survival are basically nil. This is is especially true if you have a limited number of people doing compressions. Effective compressions are extremely hard work, and rescuer fatigue is a huge issue with CPR (we switch every two minutes no matter how 'fine' the person doing compressions claims to be). I doubt you could maintain effective CPR on an aircraft for 30 minutes (I suppose you could get a couple dozen people involved, but that seems unlikely). If I'm not back in 15 minutes, please stop... At that point enough damage has been done to my brain that I don't want to come back...
  - FireBeyond 14y ago
    Depends where you are - In the area around the Mayo Clinic in Minnesota, or in the Puget Sound, return of spontaneous circulation rates can approach 40+% for witnessed treatable arrythmias.
    - phxrsng 14y ago
      Likewise in Pittsburgh, where the paramedics have been given protocols for hypothermia, ROSC outcomes for arrests are much higher than the national average.
  - TheAmazingIdiot 14y ago
    My dad had a massive heart attack December 2'nd. My mom and I were at the house when my dad had it. Having no medical training, I know how to perform CPR and was able to resuscitate him to get to the local hospital and then to Methodist in Indy. Every doctor attributed to him living past 30 minutes to my efforts . Outlook looked somewhat good for the short term, but the longer he was in ICU his chances worsened. Due to longer term massive organ failure, he passed on 12/12/12. My dad was Wilbur Harold Crawley III: automotive, electrical, and acoustic engineer.
- ubernostrum 14y ago
  Remember that CPR will not restart a stopped heart. CPR's only use is to maintain some blood/air flow until you can get to a defibrillator or life-support machinery, in hopes of preventing damage to the brain or other vital bits. And unless it's started pretty much immediately, it won't even accomplish that, which makes it futile.
  - FireBeyond 14y ago
    It won't, but there are several shockable rhythms that present as "pulseless" that can indeed be converted. AEDs will shock VF and VT, and manual defib can help with others.
  - carbocation 14y ago
    This type of situation is exactly the reason AEDs are now found all over in public places. Sure, CPR for several hours does not yield positive outcomes. But if this guy is slumped because of a shockable rhythm, that AED in the field is not at all useless - it will likely save his life, and minimize the deficits he experiences afterward. Especially on a plane, where the person was likely noticed down minutes after his problem started.
- snowwrestler 14y ago
  Or hook up an AED.
carbocation 14y ago
He absolutely deserved to have an AED hooked up to him, and CPR in the time it took to hook up the AED. If he was pulseless because of, say, Vfib, the AED could very well have saved his life. If he had pulseless electrical activity, then there is an algorithm for that, too. Some would say that you aren't dead with PEA until you've got a needle in the second intercostal spaces bilaterally and one penetrating the pericardium.
- miles_matthias 14y ago
  Do they have AEDs on planes?
  - carbocation 14y ago
    According to the article and to other discussants, yes, AEDs are provided on planes. I haven't personally seen the medical loadout on a plane.
    - dlgeek 14y ago
      Every plane I've flown on has an AED symbol or mention of AED (as well as medical kit) marked in one of the reserved overhead bins near the front of the plane - I'm pretty sure they're standard issue on every commercial airliner.
felideon 14y ago
> 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? Not to sound insensitive, but I wonder what the alternative would be? Declare him deceased and then do what? See this comment elsewhere: "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." http://news.ycombinator.com/item?id=4973578 http://news.ycombinator.com/item?id=4973578
- miles_matthias 14y ago
  Well like my friends experienced, apparently they divert your flight to land and get the person to a hospital (to officially declare him I bet - or maybe just a mortuary?) as soon as possible.

e40 14y ago

It's a little surprising to me they didn't even attempt CPR.

niekmaas 14y ago
Out 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 ago
  This +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.
  - jlgreco 14y ago
    Is CPR done on people with wounds like that? I would think the chest compressions would mostly just be pushing blood out, but I guess doing that is better than doing nothing?
    - rdl 14y ago
      The new protocol (at least for military, or at least serious trauma) is to treat massive bleeding above airway/breathing/circulation. I guess what you'd do is have someone applying pressure (or strap an israeli bandage around the neck, but not tightly in a way which would cut off circulation?) while someone else does CPR and then AED. The goal is to never have more than a 10sec break in chest compressions.
  - thematt 14y ago
    Maybe I'm missing something, but even if there's only a 10% chance of survival I'd still want somebody to give it a shot. What is the downside -- somebody has to do it for 30 minutes until the plane lands?
    - JshWright 14y ago
      That's 10% for someone who had access to advanced care within a few minutes. If CPR goes on for more than 10 minutes or so in a non-hypothermic patient (with no other interventions), your chances of survival are basically nil. This is is especially true if you have a limited number of people doing compressions. Effective compressions are extremely hard work, and rescuer fatigue is a huge issue with CPR (we switch every two minutes no matter how 'fine' the person doing compressions claims to be). I doubt you could maintain effective CPR on an aircraft for 30 minutes (I suppose you could get a couple dozen people involved, but that seems unlikely). If I'm not back in 15 minutes, please stop... At that point enough damage has been done to my brain that I don't want to come back...
- FireBeyond 14y ago
  Depends where you are - In the area around the Mayo Clinic in Minnesota, or in the Puget Sound, return of spontaneous circulation rates can approach 40+% for witnessed treatable arrythmias.
  - phxrsng 14y ago
    Likewise in Pittsburgh, where the paramedics have been given protocols for hypothermia, ROSC outcomes for arrests are much higher than the national average.
- TheAmazingIdiot 14y ago
  My dad had a massive heart attack December 2'nd. My mom and I were at the house when my dad had it. Having no medical training, I know how to perform CPR and was able to resuscitate him to get to the local hospital and then to Methodist in Indy. Every doctor attributed to him living past 30 minutes to my efforts . Outlook looked somewhat good for the short term, but the longer he was in ICU his chances worsened. Due to longer term massive organ failure, he passed on 12/12/12. My dad was Wilbur Harold Crawley III: automotive, electrical, and acoustic engineer.
ubernostrum 14y ago
Remember that CPR will not restart a stopped heart. CPR's only use is to maintain some blood/air flow until you can get to a defibrillator or life-support machinery, in hopes of preventing damage to the brain or other vital bits. And unless it's started pretty much immediately, it won't even accomplish that, which makes it futile.
- FireBeyond 14y ago
  It won't, but there are several shockable rhythms that present as "pulseless" that can indeed be converted. AEDs will shock VF and VT, and manual defib can help with others.
- carbocation 14y ago
  This type of situation is exactly the reason AEDs are now found all over in public places. Sure, CPR for several hours does not yield positive outcomes. But if this guy is slumped because of a shockable rhythm, that AED in the field is not at all useless - it will likely save his life, and minimize the deficits he experiences afterward. Especially on a plane, where the person was likely noticed down minutes after his problem started.
snowwrestler 14y ago
Or hook up an AED.

carbocation 14y ago

He absolutely deserved to have an AED hooked up to him, and CPR in the time it took to hook up the AED. If he was pulseless because of, say, Vfib, the AED could very well have saved his life. If he had pulseless electrical activity, then there is an algorithm for that, too. Some would say that you aren't dead with PEA until you've got a needle in the second intercostal spaces bilaterally and one penetrating the pericardium.

miles_matthias 14y ago
Do they have AEDs on planes?
- carbocation 14y ago
  According to the article and to other discussants, yes, AEDs are provided on planes. I haven't personally seen the medical loadout on a plane.
  - dlgeek 14y ago
    Every plane I've flown on has an AED symbol or mention of AED (as well as medical kit) marked in one of the reserved overhead bins near the front of the plane - I'm pretty sure they're standard issue on every commercial airliner.

felideon 14y ago

> 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? Not to sound insensitive, but I wonder what the alternative would be? Declare him deceased and then do what? See this comment elsewhere: "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." http://news.ycombinator.com/item?id=4973578 http://news.ycombinator.com/item?id=4973578

miles_matthias 14y ago
Well like my friends experienced, apparently they divert your flight to land and get the person to a hospital (to officially declare him I bet - or maybe just a mortuary?) as soon as possible.