Last night I went to a Tai Kwon Do black belt testing to watch a friend who was testing for a fourth-dan master belt. It was a pretty impressive affair, capped off by watching my friend break a tall stack of bricks, and break his hand in the process. He then proceeded to walk around the forum shaking hands with everyone using his bloody, broken hand.
I was invited to attend because of a friendship, but it was also made clear by several of the instructors that it would be nice if I could come, you know … “just in case.”
This sort of thing happens to all of us from time to time.
As cliché as it sounds, very few of us really take off the uniform when our work day is over. Being an EMT or a paramedic is a 24/7 job.
Our neighbors know that we work in emergency services. Our friends and family look to us for advice and medical guidance.
Happy to help off duty
I’m not complaining. I wouldn’t want it any other way.
In fact, I get a little perturbed when friends or family describe a significant injury or illness that they didn’t tell me about because, “Well, we just didn’t want to bother you.”
And don’t even get me started on the time when my father, visiting from out of state, drove himself to the hospital with chest pain because he didn’t want to wake me up.
I think most of us make peace with the fact that we are always on call to some extent. In fact, the majority of us prefer it. I don’t know if it’s like this in other professions. I’ve been in emergency service for my entire working career.
I’m not sure if construction workers or accountants get called to ply their trade outside of their work environment, or if tax preparers ever get the urgent knocks on their door from neighbors who are about to miss a filling deadline.
I don’t know if people who work in sales get calls from friends asking for advice on how to best word their Ebay furniture description or if dental hygienists get asked about the best toothbrush.
I do know that I’ve never heard any of them called for while flying on an airplane.
I have, on several occasions, heard urgent requests for medical assistance while flying. I’ve even responded to these requests when the call went unanswered.
The first time I stood up and offered my help to the flight crew, I had no idea what to expect. Now that I have half a dozen or so of these experiences under my belt, I thought I might pass on a few tips for responding to in-flight emergencies.
1. Don’t depend on the flight crew for medical assistance
They are trained in basic CPR and AED operations. They also receive some basic medical training as part of their annual required emergency training.
They will be more than happy to take direction and bring you things that you need, but they are not clinicians. They are typically very happy to receive your assistance but, for the most part, they will leave the emergency to you.
2. You won’t be the only one to respond
United Airlines reports that three out of four requests for assistance are answered by a qualified medical professional, so it’s likely you won’t be the only one who responds to the call for assistance.
Talk with the other medical providers and decide who would like to take the lead and who would like to assist. Don’t assume that you are the most qualified person to take care of the patient.
Having said that, don’t automatically differ to the highest level of training. A family practice physician or a pediatric nurse may be more comfortable assisting than leading the patient evaluation.
3. Have your ID handy
The plane will likely have a fairly extensive medical kit, but don’t expect to get your hands on it without proper identification. The crew will accept your help, but they can only turn the kit over to someone who has a valid medical identification.
If you don’t have the proper ID, they may not even tell you that the kit exists.
4. Know what you have to work with
Inside the kit you’ll find a blood pressure cuff and a stethoscope, as well as IV supplies, first round cardiac arrest medications and several commonly used emergency medications.
You may also find intubation supplies and basic trauma dressings. Don’t forget you have an AED available as well. Call for it sooner rather than later if you think you might need it.
They also should have supplemental oxygen for one person for the duration of the flight, but if you are using high flow rates you may want to assess the supply. Flight attendants can also apply oxygen but will probably prefer to let you do it.
5. Know your limits
Regardless of what medical equipment is made available to you, you are still obligated to stay within the limits of your scope of practice, your training and your local protocols. Make good clinical decisions and don’t get too far out in the weeds when you’re operating off-duty and outside of your response area.
6. Clear some space
You can ask to move passengers around if you and the patient need more room. Unless the flight is filled, the crew should be able to accommodate you.
You’ll have to decide if you’d prefer to assist the patient and return to your seat to check on them periodically, or if you’d like to remain with them for the duration of the flight.
7. Phone for help if necessary
It’s a good idea to keep your local ER phone numbers in your cell phone. Most planes have several options to make a phone call from inside the plane.
If you’re assisting with a medical emergency, your local doctors back home should be more than happy to help you out with some advice and direction.
8. Advise an emergency landing
If you deem the emergency significant enough to divert to an alternate location, you’ll need to speak with the captain about your options. Remember that you are only there to advise and recommend. It isn’t your aircraft and it isn’t your emergency.
Depending on your location and a myriad of other factors, landing the plane at an alternate location might not be possible even for the most critical of medical emergencies. Act in the patient’s best interest, but understand that diverting to an alternate airport isn’t as easy as steering an ambulance toward a different hospital.
Sometimes, answering the call for assistance on a day off, especially in the middle of a busy travel day at 30,000 feet above ground can be an inconvenience, but most of us wouldn’t want it any other way.
Hopefully, the next time you hear a request for assistance on an airplane, you’ll feel a bit more comfortable about offering your help.
