Is there anyone on the plane with medical training?

Flight Attendant: Excuse me, but is there anyone on-board with medical training?
Me: Yo.

Well, that’s not exactly how it went, though I have had that happen before on a flight. But this time it started with people in my section looking to the starboard aisle. At first, I thought someone had just fallen in the aisle but when I noticed no one moving, and everyone staring, something in me started yelling “Get up!” Before I knew it, I was up and across the plane and at the side of a guy who was in a bad way.

I honestly don’t even remember getting that far. It was all automatic, reflex from years of EMS. For a long time, I was an Advanced Life Support provider as both a volunteer and professional. I worked for a private ambulance company as well as two clinics and an Emergency Room. I took classes, I was certified and I lived it 24/7. Then I left it all behind to move to North Carolina and a more lucrative career in computers. But all that training, all that experience, it never really left me. Not in the least.

And there I found myself, kneeling next to an unconscious white male in the starboard aisle of a Boeing 777-200, half way between Tokyo and Washington, DC.

It was amazing to me how it all came back. How effortlessly I started an assessment and made sure all the basics were covered. Airway? Yep, it’s clear. Breathing? Yes, but shallow. Circulation? No distal pulses, but carotid is there. Sternum rub, shake the shoulder. Nothing. Diaphoretic. He had all the symptoms of hypovolemic shock. But he obviously wasn’t bleeding to death, unless he had something nasty like a ruptured aortic anyeurism, but if that was the case, there wasn’t much I could do.

So treat the shock to start with. Elevate the feet and start checking vitals again. And then, almost like magic, he opened his eyes, took a deep breath and sat upright. At this time, the flight attendants had arrived.

“Are you a doctor?”
“No, but I play one on TV.”
Well, that’s what I thought, but in reality, I just told them I had training and let it go at that.

After the guy had a moment to get his wits about him, I asked about a history of seizures, because despite the shock symptoms, he looked as though he had just had one (and with the mild twitching when he was out, seizure did cross my mind). But then, perhaps something related to meds? Ah hah!

It would seem, that on a long flight, at 38,000 feet in the air, taking a vasodilator while dehydrated is not such a good idea. What happened is that he took the pill an hour or so before. It kicked in, and he started feeling nauseous. Thinking he was getting airsick, he got up quickly and headed to the lavatory. So add in standing up quickly to all of the above, and the blood drained from his head and over he went. Luckily, this went well. He woke up after a few seconds. I escorted him back to his seat to make sure he was OK and the flight attendants brought some water.

I suggested he re-hydrate well and not get up too quickly for a while. I think it was probably a combination of dehydration, altitude and meds that bottomed his blood pressure and caused him to experience a nice syncopal episode.

What really surprised me, though, is how quickly it all came back to me. It’s been a LONG time since I was an active EMS provider, and yet all that training came flooding back to me as soon as the adrenaline started flowing. In hind-sight, I was lucky. I really didn’t want to work a code there somewhere over Alaska, half-way though a 13 hour flight. It all worked out for the best and everyone gets to go home to their families tonight. The flight crew were very thankful that I had jumped in to help out, and to be honest, so am I. I miss that part of my life sometimes. I’m glad that I still have it, and that I know, in an emergency, I can still do what needs to be done, at least to a basic degree.

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