In-air medical emergencies occur in an estimated 1 in every 604 airplane flights worldwide.

“Is there a medical professional on board?”
It’s an in-flight announcement no one wants to hear. Yet nurses and other healthcare professionals routinely raise their hands to help.
“To me it’s a moral obligation, part of our civic duty,” said Denise Smart, associate professor and master’s degree program director at the Washington State University College of Nursing.
Smart is one of many College of Nursing faculty who’ve volunteered to help in a travel-related medical emergency.
It’s estimated that 1 in every 604 airplane flights worldwide involves an in-air medical emergency. A study published in the Journal of the American Medical Association in December said that number is likely low, however, because it’s based only on emergencies that required a consultation with someone on the ground. With 4 billion commercial airline passengers traveling annually worldwide, it’s possible there are up to 1,420 in-air medical emergencies occurring every day, the study said.
The stories of WSU nursing faculty who’ve responded to travel emergencies share many of the same elements: Working in cramped spaces with little privacy. Limited medical supplies. Being part of an ad hoc team of volunteers with varying specialties and qualifications. And, as sometimes happens in health care, not knowing how the patient fared.

Few flights are diverted
Susan Fleming was an assistant professor at the College of Nursing a few years ago when she was on a flight from Munich, Germany to Seattle. When the pilot requested help, she and a doctor responded and were directed to a woman who was having trouble breathing.
In assessing the passenger, they discovered she had recently been hospitalized for blood clots.
“It was obvious this is nothing you play with,” said Fleming, who’s now on faculty at the Seattle University College of Nursing. “Blood clots, on a plane, the patient can’t breathe – this is something major.”
The pilot came out of the cockpit to confer with them, saying he had to make a decision immediately – land in Iceland or it would be another three hours before they would be able to land again. The patient didn’t want the pilot to divert the plane. But Fleming and the doctor agreed: “I looked at the pilot and said, ‘It would negligent if you do not land,’” she said.
Fewer than 5% of flights are diverted from their original course because of a medical emergency, with cardiac arrest, obstetric emergencies and possible stroke being the leading causes, according to a 2013 study published in the New England Journal of Medicine. Diverting a plane is costly and disruptive, and most in-air emergencies are relatively minor events, the JAMA study said.

The FAA requires U.S. airlines to carry emergency medical kits with basic devices and medications.

Environment on a plane presents unique challenges
Smart, the College of Nursing associate professor, has had three experiences rendering aid to fellow travelers and indeed, two were minor. In the third case, she was called out of the waiting area to evaluate an elderly veteran who was already on a plane. The man had been discharged from Seattle’s VA hospital, where he was treated for a respiratory condition, and was returning home.
His lips were slightly blue and he was sucking air, and “I could see he was panicking a little bit,” said Smart, a former chief nurse at Fairchild Air Force Base. “I knew the minute you put him up in the air, with a pressurized plane on a 5-hour flight, it would be a little risky. I made a recommendation they call an ambulance and have him transported back to the VA.”
Sarah Fincham, a clinical assistant professor, said it’s not easy to conduct a medical evaluation in-flight. “You can’t hear breath sounds well, or at all, with a stethoscope on a plane, adding to the challenge of an already tight space and loud, non-private environment,” she said. “It makes it tough to do any kind of exam or ask the patient about symptoms and pertinent health history.”
Shelly Fritz, an assistant professor at the College of Nursing in Vancouver, was on a flight this spring when a woman who’d had neurosurgery developed a severe headache. Fritz wanted to administer oxygen but the airline’s rules would only let someone who could produce a medical or nursing license open the oxygen bottle. That’s not a typical request, but it varies from airline to airline, the JAMA study notes.
Fritz told the flight attendant that the passenger needed oxygen and would potentially be harmed by not getting it. The impasse was resolved by Fritz producing her WSU business card.

Volunteers expected to work together
Often, multiple healthcare professionals respond to the call for assistance. In those cases “a collegial conversation about capabilities is optimal,” the JAMA study said.
Associate Professor Billie Severtsen had an experience that started off not so collegial, but ended up that way. In the late 1980s she was on a flight when the luggage compartment popped open just after takeoff and a suitcase fell out, hitting an older passenger on her head. “She was out cold,” Severtsen recalled.
When the call came over the intercom for medical professionals, Severtsen and a doctor stood up. The pilot asked to see their licenses; Severtsen had hers and the doctor didn’t. So the pilot decreed that the doctor could treat the passenger, but his decisions needed to be approved by Severtsen.
“It made the doctor angry,” she said. “He said things like, ‘We should lay her down on the ground if it’s all right with you.’ After awhile he realized it was not really my fault. And after he got over being mad at me we worked really well together.”
Benjamin Verbil, a College of Nursing teaching assistant who’s studying to become a family nurse practitioner, was on a flight from Hawaii to Seattle when a pregnant woman in her third trimester complained of abdominal and back pain. Though he’d been an ER nurse for five years, he wasn’t an obstetrics expert. There was a first-year OB medical resident also on the flight, however, so together the two of them worked out a plan of action.
The FAA requires U.S. airlines to carry an emergency medical kit with basic devices and medications. Verbil started an IV and administered oxygen, and the passenger was met by an emergency medical team when the plane landed, he said.

‘The gift of knowledge’ 
Christina Chacon, who’s adjunct faculty at the College of Nursing in the Tri-Cities, was on a whale-watching cruise off the coast of western Washington last year when a woman fell and broke her ankle.
Chacon spent the cruise caring for the woman, which was a frustrating experience. She missed seeing the whales, which she’d spent a lot of money to do, and received no thanks from the tour company or the boat captain. Asked if she’d raise her hand again, however, she didn’t hesitate. “I absolutely would,” Chacon said. As a health care professional, “you’ve been given the gift of knowledge, and it helps people to know someone with medical knowledge is with them.”
Both Verbil and Fritz said they have received generous vouchers from airlines in thanks for their assistance. On Verbil’s Hawaii flight, however, the thanks came in the form of chocolate-covered macadamia nuts and an offer of free drinks. Verbil couldn’t partake because he was monitoring the pregnant passenger, “but my girlfriend did,” he said, laughing.

–Story by Addy Hatch