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At the heart of general practice since 1960

'Help! Is there a doctor on board?'

Dr Darren Zurawel describes his experience of treating a passenger 30,000ft in the air 

I was falling asleep on my flight to London from Tel Aviv when an overly-calm voice came over the tannoy system: ‘If there is a doctor on board, would you please make yourself known to a member of the cabin crew?’ After declaring I was a doctor and asking how I could help, the steward pointed in the direction of the passenger and explained he was feeling breathless.

The gravity of the situation suddenly dawned on me as I could see that the patient was visibly unwell. We were 30,000ft in the air and I was alone with no support, but I tried to approach the clinical scenario as I would in hospital - with an ABC approach. I quickly ran to my backpack to grab my stethoscope and started my examination. His airway was patent as he could speak. However, he was very breathless, and needed several breaths to complete sentences. This patient needed high flow oxygen immediately. Fortunately, there were oxygen canisters available with non-rebreather masks – a piece of equipment I was familiar with. Unfortunately, this was the only medical kit on the plane. Even worse, as the passenger became increasingly breathless, it became very apparent that the oxygen canister was failing to provide oxygen. The tension of the emergency was growing as we had two further failed canisters. Finally the fourth tank worked, providing the passenger with some respiratory relief. His respiratory rate was worryingly 65. On auscultation he had mild bilateral wheeze and reduced air entry in the upper left zone. However, the loud noise of the airline engines made auscultating extremely challenging.

Could he make it to London in his current state without going into respiratory arrest? I was unsure.

I took a brief medical history. He was a 24-year-old British man who had been treated for pneumonia in an Israeli hospital that morning and had received two doses of oral amoxicillin. He had already contracted pneumonia on four previous occasions that year. The patient had left the hospital to fly to London because he had no health insurance and could not afford the medical expenses for further treatment. The most likely differential was pneumonia, however I could not rule of pneumothorax or pulmonary embolism.

With no investigations or any other treatment available, I could only help the patient by continually reassuring and reassessing him. To make matters worse, I was approached by a member of the crew who informed me that we were still 80 minutes from London and that if I felt it necessary, we could land in Brussels in 20 minutes.

It was at this point that I looked over at all the families on the plane waiting to arrive in the late hours of the night, followed by a glance at the sick passenger. Could he make it to London in his current state without going into respiratory arrest? I was unsure. I advised the crew that I would reassess him, and come to a final verdict. During my examination his respiratory rate and heart rate had increased to 80 and 125, respectively, which confirmed my decision - we were going to have to make an emergency landing. As we were making our descent, the passenger was very distressed. When we landed 20 minutes later, paramedics ran onto the plane and I gave a handover to the leading doctor. By now the patient was visibly exhausted and mumbling and I was sure I had made the correct decision.

The next day I contacted the patient, who was being treated for pneumonia at a hospital in Brussels. I did worry he would resent me for dropping him off in a foreign country. I was happy and relieved to hear that the passenger was extremely thankful for my actions. He has since flown home to London to get free treatment and is on the road to recovery.

Dr Darren Zurawel is an FY2 doctor in London who is planning to be a GP

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Readers' comments (5)

  • Well done to you for remaining so calm and responsible. I too have been in such a situation on board a plane but luckily the patient was not so unwell. However I do feel strongly that air crew should not rely on there being a Dr on board and should really have more available medical equipment and first aid experience themselves. It is a huge responsibility to decide whether a plane needs redirecting when you are a doctor. we have not been trained to respond to emergencies without medical equipment. Of course our Hippocratic Oath says we should do all we can to help a patient in distress and our instinct is to do so. However we offer these services charitably and at our own risk never mind that the patient was trying to avoid medical costs.

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  • Those dreaded words,'Is there a doctor on board?' I was on a flight to Johannesburg with my wife and three children. We had stopped at Paris,first stop from Heathrow. The next stop was Las Palmas. The voice made the announcement and I slid down in my seat. As did the passenger in front of me! It came again, slightly more urgent? I pressed the button, as did the hand in front of me! I wasn't alone. There was a male passenger on board who needed our help. The passenger was a retired Guy's doctor going home to Jo'burg. He was clearly having a bout of angina, and he knew! My fellow passenger said he was a kidney transplant specialist! Didn't do hearts. I was a GP! The cabin staff said the captain would radio ahead and put the 'Patient' off in Las Palmas. I asked for the medical kit on board the plane, apart from oxygen…. Not good! My wife had more in her hand baggage.

    The patient begged me, do not let them put me off at Las Palmas just get me back to Johannesburg. I spoke to the cabin crew and they said it was up to the captain. The captain asked, would I agree to look after him? I agreed and we continued with our journey, putting down at Las Palmas and made it to our destination without further drama.

    It was the 1970's I didn't give my indemnity a thought! Didn't ever hear from the airline! The patient wrote to me, very grateful. Has happened since, in a London Theatre! Not as terrifying as thirty five thousand feet in the air.

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  • It was an Air India flight from London to Delhi. I raised my hand to the announcement for a doctor in the plane. There was this type 1 diabetic who had left his insulin in main luggage. He was getting dehydrated and feeling thirsty and nervously gulping a bottle of beer! There was another 5 long hours before we would reach Delhi. He was late for his insulin by few hours. We announced for any other diabetic patient in case he or she had insulin. Another passenger did turn out to be diabetic and he was carrying a rapid acting insulin. We used his insulin in the best interest of the patient. It saved all other passengers from hassle of an unintended destination.

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  • There's a great NEJM couple of reviews of airline emergencies - I seem to recall there's a higher risk of diversion and early landing when there is a healthcare professional, as there's more of an appreciation of the potential disastrous outcomes that come with a lack of certainty - so sometimes it's actually in the airline's (but not the patient's) best interest for there not to be a doctor, as it saves costly diversions!

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  • Pipin Singh

    Good work. Potential medico legal nightmare though aswell if goes wrong. Glad went well. Should be proud.

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