On-call in-flight: Local doctor recalls answering requests to help air passengers with medical emergencies

When Dr. Jonathan Edwards boards his next international flight in September, he wouldn't be surprised to hear a flight attendant ask, "Is there a physician on board?"

The neurologist specializing in epilepsy at the Medical University of South Carolina has answered that call on the last three international trips he has taken.

"Each time, it was right over the middle of the Atlantic," said Edwards. "I hope I'm disaster-proofed for the next 50 flights I take."

Limited medical access

Since the earliest days of commercial aviation, airlines have coped with medical emergencies in-flight by calling on physicians who happen to be passengers. And as more people travel by air, the number of emergencies has risen accordingly.

"Passenger health is becoming more and more of an issue because of increased life expectancy and more people flying with pre-existing conditions," Dr. Paulo Alves, president of MedAire, said in an interview with The New York Times recently.

MedAire, which advises more than 60 airlines around the world, managed about 19,000 in-flight medical cases for commercial airlines in 2010. Although few were life-threatening, 442 were serious enough to require diverting the plane, and 94 people died onboard.

The Times noted those numbers reflect a fraction of the actual number of in-flight emergencies. The Federal Aviation Adminis-

tration does not track episodes, and airlines are not required to report them.

Figuring it out

Edwards notes that airborne calls for medical assistance are a challenge because cases may be unrelated to the responding physician's specialty and the patient is inevitably a total stranger, often with no readily available medical history.

"It's a different situation on a plane than here at MUSC, where any doctor is within earshot of an expert on anything," says Edwards.

While all three emergencies Edwards attended to turned out fine, he says some doctors are faced with more dire scenarios and that he has heard doctors tell of passengers who died.

In Edwards' first airline emergency, he was dozing off on a flight to Cairo via Germany when a flight attendant asked for assistance.

A German man was sweating profusely, groggy and acting confused. His friends, who spoke decent English, told Edwards that the man had gone to an all-you-can-eat dessert cafe the night before and then hadn't eaten that day.

"I figured his glucose had bottomed out and he was suffering from hypoglycemia," says Edwards, saying a little food made the man feel better.

On another trip, flying back with his family after a trip to Italy, he attended to an Indiana woman in her 60s who had crushing chest pain and shortness of breath -- symptoms of a possible heart attack. He used a "flimsy" stethoscope and asked what medications they had on board. The crew pulled some out and he described the one for nitroglycerin.

"At that point, the flight attendant said, 'Do you have your doctor's license on you?' and the woman (the patient) looked up and said, 'I believe him, I believe him,' " he recalls, noting that a doctor's license is not like a driver's license that physicians carry around for identification.

At one point, the flight attendants turned their backs and the woman popped the pill under her tongue. Her symptoms were relieved. In fact, she felt so good that she wanted to continue on the flight to her destination, but a waiting ambulance whisked her off upon her arrival.

On his last trip, Edwards was returning home from a Mediterranean cruise with his family when the call came again.

"At the same time, my wife, niece and parents turned and looked at me, saying, 'This can't be true.' "

In that case, a New Jersey man in his 40s was laid out flat in the aisle, unconscious and taking shallow breaths. Two other medical personnel, an anesthesiologist and a cardiac ICU nurse, joined him.

They found out that the man, who wanted to sleep during the flight, had taken 400 milligrams of his wife's medication for bipolar disorder and depression because it had a sedating effect. The starter dose for the medication is 50 milligrams. The mild overdose made him prone to orthostatic hypotension, a condition in which a person's blood pressure suddenly falls when the person stands up.

They gave him fluids intravenously and took turns staying with him until the flight arrived.

'Good Samaritan laws'

Edwards heard back from the latter two people he treated, who thanked him for taking care of them.

He notes that some physicians say they would not answer the call for help on a flight because of liability issues, even though "Good Samaritan laws" tend to protect them from lawsuits.

"The way I look at is that if my parents, or wife, or other family members needed help, I would hope a physician would step up and help."

Reach David Quick at 937-5516.